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Semin Respir Crit Care Med 2014; 35(06): 723-731
DOI: 10.1055/s-0034-1395795
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Current Controversies in the Management of Malignant Pleural Effusions

Maree Azzopardi
1   Thoracic Medicine Program, The Prince Charles Hospital, Brisbane, Australia
,
José M. Porcel
2   Pleural Diseases Unit, Department of Internal Medicine, Arnau de Vilanova University Hospital, Biomedical Re search Institute of Lleida, Lleida, Spain
,
Coenraad F. N. Koegelenberg
3   Division of Pulmonology, Department of Medicine, Stellenbosch University and Tygerberg Academic Hospital, Cape Town, South Africa
,
Y. C. Gary Lee
4   Centre for Asthma, Allergy & Respiratory Research, School of Medicine & Pharmacology, University of Western Australia, Perth, Australia
5   Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Perth, Australia
,
Edward T. H. Fysh
4   Centre for Asthma, Allergy & Respiratory Research, School of Medicine & Pharmacology, University of Western Australia, Perth, Australia
5   Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Perth, Australia
› Author Affiliations
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Publication History

Publication Date:
02 December 2014 (online)

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Abstract

Malignant pleural effusion (MPE) can complicate most malignancies and is a common clinical problem presenting to respiratory and cancer care physicians. Despite its frequent occurrence, current knowledge of MPE remains limited and controversy surrounds almost every aspect in its diagnosis and management. A lack of robust data has led to significant practice variations worldwide, inefficiencies in healthcare provision, and threats to patient safety. Recent studies have highlighted evolving concepts in MPE care that challenge traditional beliefs. Advancing laboratory techniques have improved the diagnostic yield from pleural fluid cytology, minimizing the need for invasive tissue biopsies, even in many cases of mesothelioma. Imaging-guided biopsy is comparable to thoracoscopy in suitable patients, if cytological examination was noncontributory. Cumulating evidence for the benefits of indwelling pleural catheters (IPCs) has led some centers to adopt this approach as first-line definitive management for MPE over conventional talc pleurodesis. The optimal technique of talc pleurodesis is still debated despite its use for many decades. Strategies combining pleurodesis and IPC are being studied. MPE consists of a heterogenous group of diseases and careful phenotyping of malignant effusion patients can provide important clinical information that will advance the field and allow better stratification of patients and planning of therapy accordingly. This review addresses the controversies in MPE diagnosis and management and exposes the deficits in knowledge of MPE that should be the focus of future research.

Keywords

malignant effusion - pleural - pleurodesis - indwelling pleural catheter - talc - cancer