Diagnosis and Management of Malignant Pleural Effusion: A Decade in Review

Abstract

Malignant pleural effusion (MPE) is a common complication of thoracic and extrathoracic malignancies and is associated with high mortality. Treatment is mainly palliative, with symptomatic management achieved via effusion drainage and pleurodesis. Pleurodesis may be hastened by administering a sclerosing agent through a thoracostomy tube, thoracoscopy, or an indwelling pleural catheter (IPC). Over the last decade, several randomized controlled studies shaped the current management of MPE in favor of an outpatient-based approach with a notable increase in IPC usage. Patient preferences remain essential in choosing optimal therapy, especially when the lung is expandable. In this article, we reviewed the last 10 to 15 years of MPE literature with a particular focus on the diagnosis and evolving management.

Keywords: chest tube; indwelling pleural catheter; malignant pleural effusion; pleurodesis; talc; thoracoscopy.

Figure 1

Suggested MPE Management algorithm (adapted from Feller-Kopman et al. [7]). IPC (indwelling pleural catheter), VATS (video assisted thoracoscopic surgery), MT (medical thoracoscopy). * The role of prognostication scores in clinical practice is still unclear, and physicians’ prediction of survival is not very accurate; therefore, a “predicted” short survival should be interpreted with caution.

Figure 2

Key randomized controlled trials in MPE management over the last decade. NSAID (nonsteroidal anti-inflammatory drug), IPC (indwelling pleural catheter), MPE (malignant pleural effusion).