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Review
. 2024 Jun 19;6(4):100349.
doi: 10.1016/j.opresp.2024.100349. eCollection 2024 Oct-Dec.

Malignant Pleural Effusion: A Multidisciplinary Approach

Ana Pardessus Otero  1 , Albert Rafecas-Codern  1   2 , José M Porcel  3 , Pere Serra-Mitjà  1 , Lucía Ferreiro  4 , Maribel Botana-Rial  5   6 , Cristina Ramos-Hernández  7 , José Manuel Brenes  8 , Lydia Canales  8 , Valle Camacho  9 , Beatriz Romero-Romero  10 , Juan Carlos Trujillo  11 , Elisabeth Martinez  11 , Enrique Cases  12 , Andrés Barba  13 , Margarita Majem  13 , Ernest Güell  14 , Virginia Pajares  1   2
Affiliations
Review

Malignant Pleural Effusion: A Multidisciplinary Approach

Ana Pardessus Otero et al. Open Respir Arch. .

Abstract
in English, Spanish

Malignant pleural effusion (MPE) has become an increasingly prevalent complication in oncological patients, negatively impacting their quality of life and casting a shadow over their prognosis. Owing to the pathophysiological mechanisms involved and the heterogeneous nature of the underlying disease, this entity is both a diagnostic and therapeutic challenge. Advances in the understanding of MPE have led to a shift in the treatment paradigm towards a more personalized approach. This article provides a comprehensive review and update on the pathophysiology of MPE and describes the diagnostic tools and the latest advances in the treatment of this complex clinical entity.

El derrame pleural maligno (DPM) se ha convertido en una complicación cada vez más prevalente en los pacientes oncológicos, empeorando la calidad de vida y ensombreciendo el pronóstico de los mismos. Debido a los mecanismos fisiopatológicos involucrados y a la naturaleza heterogénea de la enfermedad subyacente, esta entidad representa un desafío diagnóstico y terapéutico. Los avances en la comprensión del DPM han originado un cambio en el paradigma del tratamiento hacia un enfoque más personalizado. Este artículo proporciona una revisión exhaustiva y una actualización sobre la fisiopatología del DPM, y describe las herramientas diagnósticas y los últimos avances en el tratamiento de esta compleja entidad clínica.

Keywords: Chest drain; Indwelling pleural catheter (IPC); Malignant pleural effusion (MPE); Pleural; Pleurodesis; Thoracoscopy; oncology.

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Figures

Fig. 1
Fig. 1
Septate pleural effusion.
Fig. 2
Fig. 2
Pleural and diaphragmatic nodules.
Fig. 3
Fig. 3
Pleural mesothelioma. (A) Chest radiograph showing massive left pleural effusion, thickening of the parietal pleura (white arrow) and left mediastinal widening (black arrow). (B) Chest CT shows diffuse pleural thickening involving the mediastinal pleura (black asterisk), and loculated pleural effusion (white asterisks).
Fig. 4
Fig. 4
[18F]FDG PET/CT with left pleural effusion in the CT study (A and B). The [18F]FDG images (C and D) and the [18F]FDG PET/CT fusion images (E and F) present increased glycolytic metabolism with an encapsulation pattern. Pathological diagnosis: mesothelioma.
Fig. 5
Fig. 5
Two type of needle closed pleural biopsy. (A) Abram's needle shown in both retracted and extended positions. (B) Cutting-needle (16G).
Fig. 6
Fig. 6
Indwelling pleural catheter insertion technique.
Fig. 7
Fig. 7
Management approach in MPE. IPC, indwelling pleural catheter; MPE, malignant pleural effusion; PE, pleural effusion. *Pleural manometry can be useful in the diagnosis of trapped lung. **It is enough that one of the two answers is negative.
See this image and copyright information in PMC

References

    1. Gompelmann D., Eberhardt R., Herth F.J. Advanced malignant lung disease: what the specialist can offer. Respiration. 2011;82:111–123. doi: 10.1159/000329703. - DOI - PubMed
    1. Detterbeck F.C., Lewis S.Z., Diekemper R., Addrizzo-Harris D., Alberts W.M. Executive summary: diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2013;143(Suppl.):7S–37S. doi: 10.1378/chest.12-2377. - DOI - PubMed
    1. Roberts M.E., Rahman N.M., Maskell N.A., Bibby A.C., Blyth K.G., Corcoran J.P., et al. British Thoracic Society Guideline for pleural disease. Thorax. 2023;78(Suppl. 3):s1–s42. doi: 10.1136/thorax-2022-219784. - DOI - PubMed
    1. Clive A.O., Kahan B.C., Hooper C.E., Bhatnagar R., Morley A.J., Zahan-Evans N., et al. Predicting survival in malignant pleural effusion: development and validation of the LENT prognostic score. Thorax. 2014;69:1098–1104. doi: 10.1136/thoraxjnl-2014-205285. - DOI - PMC - PubMed
    1. Psallidas I., Kanellakis N.I., Gerry S., Thézénas M.L., Charles P.D., Samsonova A., et al. Development and validation of response markers to predict survival and pleurodesis success in patients with malignant pleural effusion (PROMISE): a multicohort analysis. Lancet Oncol. 2018;19:930–939. doi: 10.1016/S1470-2045(18)30294-8. - DOI - PubMed

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