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Simó M, Persiva O, Sánchez L, Montoro JB, Sansano I, Vázquez A, Ascanio F, Alemán C. Association of PET/CT and VATS findings with histology analysis in the study of pleural effusions. Rev Esp Med Nucl Imagen Mol 2024:500059. [PMID: 39260800 DOI: 10.1016/j.remnie.2024.500059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2024] [Revised: 08/27/2024] [Accepted: 08/27/2024] [Indexed: 09/13/2024]
Abstract
INTRODUCTION Histological analysis of the pleura obtained by video-assisted thoracoscopic surgery (VATS) is the best diagnostic technique in the study of neoplastic pleural effusions. This study evaluates the relationship between Positron Emission Tomography (PET)/Computed Tomography (CT) and VATS findings, the result of the first pleural biopsy, and the final diagnosis of malignancy or non-malignancy. METHODS Prospective study of consecutive patients with pleural effusions undergoing PET/CT and VATS from October 2013 to December 2023. The following variables were recorded: PET/CT score (nodular pleural thickening, pleural nodules with standardized uptake value (SUV) > 7.5, lung mass or extra pleural malignancy, mammary lymph node with SUV > 4.5 and cardiomegaly); VATS data (drained volume, visceral and parietal pleural thickening, nodules or masses, septa, plaques, fluid appearance, trapped lung, and suspected diagnosis of the procedure), as well as the histological study of the first pleural biopsy (benign or malignant) and the final diagnosis of benign or malignant pleural effusion. A logistic regression study of the variables was performed. RESULTS 95.8% of the patients with PET/CT and pleuroscopy not suggestive of malignancy had non-malignant histological findings, while 93.2% of the patients with PET/CT and pleuroscopy suggestive of malignancy had malignant histological findings. PET/CT, pleuroscopy, and the result of the first pleural biopsy showed a significant association with the final diagnosis of pleural effusion. CONCLUSIONS There is a strong association between PET/CT findings, VATS and pleural histology.
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Affiliation(s)
- M Simó
- Departments of Nuclear Imaging, Grupo de Patología Pleural, Universitat Autònoma de Barcelona, University Hospital Vall d'Hebron, Passeig Vall d'Hebron 119-129, Barcelona 08035, Spain
| | - O Persiva
- Departments of Radiology, Grupo de Patología Pleural, Universitat Autònoma de Barcelona, University Hospital Vall d'Hebron, Passeig Vall d'Hebron 119-129, Barcelona 08035, Spain
| | - L Sánchez
- Departments of Thoracic Surgery, Grupo de Patología Pleural, Universitat Autònoma de Barcelona, University Hospital Vall d'Hebron, Passeig Vall d'Hebron 119-129, Barcelona 08035, Spain
| | - J B Montoro
- Departments of Pharmacy, Grupo de Patología Pleural, Universitat Autònoma de Barcelona, University Hospital Vall d'Hebron, Passeig Vall d'Hebron 119-129, Barcelona 08035, Spain
| | - I Sansano
- Departments of Pathology, Grupo de Patología Pleural, Universitat Autònoma de Barcelona, University Hospital Vall d'Hebron, Passeig Vall d'Hebron 119-129, Barcelona 08035, Spain
| | - A Vázquez
- Departments of Internal Medicine, Grupo de Patología Pleural, Universitat Autònoma de Barcelona, University Hospital Vall d'Hebron, Passeig Vall d'Hebron 119-129, Barcelona 08035, Spain
| | - F Ascanio
- Departments of Thoracic Surgery, Grupo de Patología Pleural, Universitat Autònoma de Barcelona, University Hospital Vall d'Hebron, Passeig Vall d'Hebron 119-129, Barcelona 08035, Spain
| | - C Alemán
- Departments of Internal Medicine, Grupo de Patología Pleural, Universitat Autònoma de Barcelona, University Hospital Vall d'Hebron, Passeig Vall d'Hebron 119-129, Barcelona 08035, Spain.
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Ferreiro L, Landín Rey E, Carreiras Cuiña M, Gude F, Antúnez JR, Suárez-Antelo J, Toubes ME, Rodríguez Núñez N, Golpe A, Riveiro V, Valdés L. Non-specific pleuritis: long-term follow-up outcomes. Expert Rev Respir Med 2024; 18:333-339. [PMID: 38877875 DOI: 10.1080/17476348.2024.2368610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 06/12/2024] [Indexed: 06/21/2024]
Abstract
BACKGROUND The definitive etiology of nonspecific pleuritis (NSP), the influence of the type of pleural biopsy on clinical results and the minimum duration of follow-up is controversial. RESEARCH DESIGN AND METHODS A retrospective, observational study of patients ≥ 18 years with NSP confirmed by closed pleural biopsy (CPB), local anesthesia pleuroscopy (LAP), or video-assisted thoracic surgery (VATS). RESULTS A total of 167 patients were included (mean follow-up, 14.4 months), of which 25 (15%) were diagnosed within one month; [15 (60%) malignant]. Of the remaining 142 pleural effusions (PEf), 69 (48.6%) were idiopathic; 49 (34.5%) not-malignant and 24 (16.9%) malignant (4 mesotheliomas and 20 metastasic). The diagnosis of NSP was established by CPB (7; median time to diagnosis, 9.4 months), LAT (5; 15.8 months), and VATS (8; 13.5 months) (p = 0.606). Sixty-eight patients (40.7%) died during follow-up (mean time, 12 months). CONCLUSIONS In a substantial percentage of patients diagnosed with NSP, a definitive diagnosis will not be obtained, a relevant number of patients will develop a malignant PEf. The diagnostic procedure used for the diagnosis of NSP does not seem to influence delay in the diagnosis of malignant PEf. The data obtained suggest that follow-up should be maintained for at least 24 months.
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Affiliation(s)
- Lucía Ferreiro
- Servicio de Neumología, Hospital Clínico-Universitario de Santiago, Santiago de Compostela, Spain
- Grupo Interdisciplinar de Investigación en Neumología, Instituto de Investigaciones Sanitarias de Santiago (IDIS), Santiago de Compostela, Spain
| | - Elisa Landín Rey
- Servicio de Neumología, Hospital Clínico-Universitario de Santiago, Santiago de Compostela, Spain
| | - María Carreiras Cuiña
- Servicio de Neumología, Hospital Clínico-Universitario de Santiago, Santiago de Compostela, Spain
| | - Francisco Gude
- Unidad de Epidemiología Clínica, Hospital Clínico-Universitario de Santiago, Santiago de Compostela, Spain
| | - José R Antúnez
- Servicio de Anatomía Patológica, Hospital Clínico-Universitario de Santiago, Santiago de Compostela, Spain
| | - Juan Suárez-Antelo
- Servicio de Neumología, Hospital Clínico-Universitario de Santiago, Santiago de Compostela, Spain
| | - María Elena Toubes
- Servicio de Neumología, Hospital Clínico-Universitario de Santiago, Santiago de Compostela, Spain
| | - Nuria Rodríguez Núñez
- Servicio de Neumología, Hospital Clínico-Universitario de Santiago, Santiago de Compostela, Spain
| | - Antonio Golpe
- Servicio de Neumología, Hospital Clínico-Universitario de Santiago, Santiago de Compostela, Spain
| | - Vanessa Riveiro
- Servicio de Neumología, Hospital Clínico-Universitario de Santiago, Santiago de Compostela, Spain
| | - Luis Valdés
- Servicio de Neumología, Hospital Clínico-Universitario de Santiago, Santiago de Compostela, Spain
- Grupo Interdisciplinar de Investigación en Neumología, Instituto de Investigaciones Sanitarias de Santiago (IDIS), Santiago de Compostela, Spain
- Departamento de Medicina, Facultad de Medicina, Universidad de Santiago de Compostela, Santiago de Compostela, Spain
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Simó M, Persiva O, Sánchez L, Montoro B, Vázquez A, Sansano I, Alemán C. A PET-CT score for discriminating malignant from benign pleural effusions. Med Clin (Barc) 2023; 161:422-428. [PMID: 37487808 DOI: 10.1016/j.medcli.2023.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 06/19/2023] [Accepted: 06/20/2023] [Indexed: 07/26/2023]
Abstract
BACKGROUND AND OBJECTIVES The results of previous PET-CT studies are contradictory for discriminating malignant from benign pleural effusions. We purpose to develop a PET-CT score for differentiating between benign and malignant effusions. PATIENTS AND METHODS We conducted a prospective study of consecutive patients with pleural effusions undergoing PET-CT from October 2013 to October 2019 (referral cohort). PET-CT scan features evaluated using the SUV were: linear thickening; nodular thickening; nodules; masses; circumferential thickening; mediastinal and fissural pleural involvement; intrathoracic lymph nodes; pleural loculation; inflammatory consolidation; pleural calcification; cardiomegaly; pericardial effusion; bilateral effusion; lung mass; liver metastasis and other extra-pleural malignancy. The results were validated in an independent prospective cohort from November 2019 to June 2021. RESULTS One hundred and ninety-nine patients were enrolled in the referral cohort (91 with malignant effusions and 108 benign). The most useful parameters for the development of a PET-CT score were: nodular pleural thickening, pleural nodules with SUV>7.5, lung mass or extra pleural malignancy (10 points each), mammary lymph node with SUV>4.5 (5 points) and cardiomegaly (-1 point). With a cut-off value of >9 points in the referral cohort, the score established the diagnosis of malignant pleural effusion with sensitivity 87.9%, specificity 90.7%, positive predictive value 88.9%, negative predictive value 89.9%, positive likelihood ratio 7.81 and negative likelihood ratio 0.106. These results were validated in an independent prospective cohort of 75 patients. CONCLUSIONS PET-CT score was shown to provide relevant information for the identification of malignant pleural effusion.
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Affiliation(s)
- Marc Simó
- Department of Nuclear Imaging, Universitat Autònoma de Barcelona, Hospital Universitari Vall d'Hebron, Barcelona, Spain.
| | - Oscar Persiva
- Department of Radiology, Universitat Autònoma de Barcelona, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Leire Sánchez
- Department of Thoracic Surgery, Universitat Autònoma de Barcelona, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Bruno Montoro
- Department of Pharmacy, Universitat Autònoma de Barcelona, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Ana Vázquez
- Department of Internal Medicine, Universitat Autònoma de Barcelona, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Irene Sansano
- Department of Pathology, Universitat Autònoma de Barcelona, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Carmen Alemán
- Department of Internal Medicine, Universitat Autònoma de Barcelona, Hospital Universitari Vall d'Hebron, Barcelona, Spain
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Vázquez A, Simó M, Persiva O, Sánchez L, Sansano I, Alemán C. Diagnosis and outcome of patients with idiopathic pleural effusions. Rev Clin Esp 2023; 223:320-324. [PMID: 36990383 DOI: 10.1016/j.rceng.2023.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2023]
Abstract
INTRODUCTION Long-term follow-up course for patients with idiopathic pleural effusions has not been established. METHODS From October 2013 to June 2021 all patients with idiopathic effusion were prospectively followed up with clinical examination and imaging at 1, 3, 6 and every 6 months for a minimum of 1 year. RESULTS Twenty-nine patients were diagnosed with idiopathic effusion and followed up. Mesothelioma was detected during the follow-up in two patients at 7 and 18 months, one of whom had blood-tinged pleural fluid and the other reported a 10% weight loss. Mesothelioma was not diagnosed in any of the patients with effusion covering less than two thirds of the hemithorax, and without constitutional symptoms or a blood-tinged fluid appearance. Most of the effusions resolved or showed a clear improvement in the first six months. CONCLUSION Patients without weight loss and with small, non-hematic effusions, may benefit from conservative treatment and clinical-radiological follow-up.
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Affiliation(s)
- A Vázquez
- Departments of Internal Medicine, University Autonomous of Barcelona, Universitat Autònoma de Barcelona, University Hospital Vall d'Hebron, Passeig Vall d'Hebron 119-129, Barcelona, Spain
| | - M Simó
- Departments of Nuclear Imaging, University Autonomous of Barcelona, Universitat Autònoma de Barcelona, University Hospital Vall d'Hebron, Passeig Vall d'Hebron 119-129, Barcelona, Spain
| | - O Persiva
- Departments of Radiology, University Autonomous of Barcelona, Universitat Autònoma de Barcelona, University Hospital Vall d'Hebron, Passeig Vall d'Hebron 119-129, Barcelona, Spain
| | - L Sánchez
- Departments of Thoracic Surgery, University Autonomous of Barcelona, Universitat Autònoma de Barcelona. University Hospital Vall d'Hebron, Passeig Vall d'Hebron 119-129, Barcelona, Spain
| | - I Sansano
- Departments of Pathology, University Autonomous of Barcelona, Universitat Autònoma de Barcelona, University Hospital Vall d'Hebron, Passeig Vall d'Hebron 119-129, Barcelona, Spain
| | - C Alemán
- Departments of Internal Medicine, University Autonomous of Barcelona, Universitat Autònoma de Barcelona, University Hospital Vall d'Hebron, Passeig Vall d'Hebron 119-129, Barcelona, Spain.
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Karpathiou G, Péoc’h M, Sundaralingam A, Rahman N, Froudarakis ME. Inflammation of the Pleural Cavity: A Review on Pathogenesis, Diagnosis and Implications in Tumor Pathophysiology. Cancers (Basel) 2022; 14:1415. [PMID: 35326567 PMCID: PMC8946533 DOI: 10.3390/cancers14061415] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 03/08/2022] [Accepted: 03/08/2022] [Indexed: 12/12/2022] Open
Abstract
Pleural effusions are a common respiratory condition with many etiologies. Nonmalignant etiologies explain most pleural effusions and despite being nonmalignant, they can be associated with poor survival; thus, it is important to understand their pathophysiology. Furthermore, diagnosing a benign pleural pathology always harbors the uncertainty of a false-negative diagnosis for physicians and pathologists, especially for the group of non-specific pleuritis. This review aims to present the role of the inflammation in the development of benign pleural effusions, with a special interest in their pathophysiology and their association with malignancy.
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Affiliation(s)
- Georgia Karpathiou
- Pathology Department, University Hospital of Saint-Etienne, 42055 Saint-Etienne, France;
| | - Michel Péoc’h
- Pathology Department, University Hospital of Saint-Etienne, 42055 Saint-Etienne, France;
| | - Anand Sundaralingam
- Oxford Centre for Respiratory Medicine, Nuffield Department of Medicine, University of Oxford, Oxford OX3 7LE, UK; (A.S.); (N.R.)
| | - Najib Rahman
- Oxford Centre for Respiratory Medicine, Nuffield Department of Medicine, University of Oxford, Oxford OX3 7LE, UK; (A.S.); (N.R.)
| | - Marios E. Froudarakis
- Pneumonology and Thoracic Oncology Department, University Hospital of Saint-Etienne, 42055 Saint-Etienne, France;
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Ma J, Huang M, Wang SH, Tan QM, Zhang LS. Undiagnosed pleural effusion treated with traditional Chinese medicine: A case report. Explore (NY) 2021; 18:362-365. [PMID: 33712360 DOI: 10.1016/j.explore.2021.02.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 02/12/2021] [Indexed: 11/29/2022]
Abstract
The main clinical manifestations of pleural effusion are exertional dyspnea, predominantly dry cough, and pleuritic chest pain. To treat pleural effusion appropriately, it is important to determine its etiology; which however, remains unclear in nearly 20% of cases.A 73-year-old man with a history of invasive pulmonary tuberculosis (TB), had been experiencing chest congestion and dyspnea with undiagnosed pleural effusion for six years. After a series of clinical examination and laboratory tests, there was still no clear diagnosis. Despite administering diuretics and intermittent draining, the patient's condition aggravated progressively. He sought further treatment at Dongzhimen Hospital Respiratory Outpatient Clinic. The patient was treated with Zanthoxylum and Trichosanthes Decoction (Jiao Mu Gua Lou Tang). After one and a half years, his symptoms greatly improved and ultrasound revealed that the pleural effusion had apparently absorbed.It is suggested that TCM herbal formulas can play a critical role in preventing the progression of complicated, undiagnosed pleural effusion, especially in cases of poor response to conventional therapy and thoracentesis. Additional studies on the functions and mechanisms of the medicinals are warranted.
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Affiliation(s)
- Jie Ma
- Department of Respiratory Medicine, Beijing Hospital of Integrated Traditional Chinese and Western Medicine, No. 3, East Street, Yongding Road, Haidian District, Beijing 100039, China.
| | - Mao Huang
- Department of Respiratory Medicine, Dongzhimen Hospital affiliated to Beijing University of Chinese Medicine (BUCM), No. 5 Haiyuncang, Dongcheng District, Beijing 100700, China.
| | - Shao-Hua Wang
- Department of Respiratory Medicine, Beijing Hospital of Integrated Traditional Chinese and Western Medicine, No. 3, East Street, Yongding Road, Haidian District, Beijing 100039, China.
| | - Quan-Ming Tan
- Singapore Thong Chai Medical Institution,No. 50 Chin Swee Road, #01-01 Thong Chai Building, 169874, Singapore.
| | - Li-Shan Zhang
- Department of Respiratory Medicine, Dongzhimen Hospital affiliated to Beijing University of Chinese Medicine (BUCM), No. 5 Haiyuncang, Dongcheng District, Beijing 100700, China.
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Karpathiou G, Anevlavis S, Tiffet O, Casteillo F, Mobarki M, Mismetti V, Ntolios P, Koulelidis A, Trouillon T, Zadel N, Hathroubi S, Peoc'h M, Froudarakis ME. Clinical long-term outcome of non-specific pleuritis (NSP) after surgical or medical thoracoscopy. J Thorac Dis 2020; 12:2096-2104. [PMID: 32642113 PMCID: PMC7330408 DOI: 10.21037/jtd-19-3496] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Background Thoracoscopy, either “medical” or “surgical”, is the gold standard to reveal the cause of pleural effusion by taking large biopsies. However, in some cases, the histology of pleural biopsies is inconclusive for a specific cause, describing a variable process of inflammation, encompassing for non-specific pleuritis (NSP). Questions are raised whether the surgical (or video-assisted thoracoscopic surgery, VATS) is doing better than the medical thoracoscopy (MT or pleuroscopy), but no direct comparison between the two techniques exist in the current bibliography. The aim of our retrospective study was to compare these two techniques to find whether there is any difference in the false negative cases of NSP. Methods We included in our study 295 patients with NSP, 179 patients who underwent VATS comparing to 116 patients who underwent MT for pleural effusion of initially undetermined cause, having a follow-up of at least one year. Analysis of patients’ files, history, clinical examinations, further tests, and follow-up were recorded. Results The mean age of our patients was 58.5±19.1 and M/F gender was 216/79; no difference was observed between the two groups. The mean follow-up period was 47.3±20.7 months. After VATS, only one patient (0.55%) was finally diagnosed with pleural malignancy (false negative) while after MT 2 patients (1.7%). Negative predictive value for pleura-related malignancy for VATS was 0.994 and for MT 0.982. Conclusions In patients with histological diagnosis of NSP both VATS and MT showed similar and excellent results of false negative cases and negative predictive value in excluding malignant pleural disease.
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Affiliation(s)
- Georgia Karpathiou
- Department of Pathology, North Hospital, University Hospital of St-Etienne, Saint-Priest-en-Jarez, France
| | - Stavros Anevlavis
- Department of Pneumonology, University Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - Olivier Tiffet
- Department of Thoracic Surgery, North Hospital, University Hospital of St-Etienne, Saint-Priest-en-Jarez, France
| | - Francois Casteillo
- Department of Pathology, North Hospital, University Hospital of St-Etienne, Saint-Priest-en-Jarez, France
| | - Mousa Mobarki
- Department of Pathology, North Hospital, University Hospital of St-Etienne, Saint-Priest-en-Jarez, France
| | - Valentine Mismetti
- Department of Pneumonology and Thoracic Oncology, North Hospital, University Hospital of St-Etienne, Saint-Priest-en-Jarez, France
| | - Paschalis Ntolios
- Department of Pneumonology, University Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - Andreas Koulelidis
- Department of Pneumonology, University Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - Tiffany Trouillon
- Department of Pneumonology and Thoracic Oncology, North Hospital, University Hospital of St-Etienne, Saint-Priest-en-Jarez, France
| | - Nicolas Zadel
- Department of Thoracic Surgery, North Hospital, University Hospital of St-Etienne, Saint-Priest-en-Jarez, France
| | - Sirine Hathroubi
- Department of Pathology, North Hospital, University Hospital of St-Etienne, Saint-Priest-en-Jarez, France
| | - Michel Peoc'h
- Department of Pathology, North Hospital, University Hospital of St-Etienne, Saint-Priest-en-Jarez, France
| | - Marios E Froudarakis
- Department of Pneumonology, University Hospital of Alexandroupolis, Alexandroupolis, Greece.,Department of Pneumonology and Thoracic Oncology, North Hospital, University Hospital of St-Etienne, Saint-Priest-en-Jarez, France
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Park JE, Do YW, Lee DH, Lee SY, Lim JK, Choi SH, Seo HW, Yoo SS, Lee SY, Cha SI, Park JY, Lee J, Kim CH. Idiopathic Pleural Effusions: Characteristics and Discrimination From Cytology-Negative Malignant Pleural Effusions. Am J Med Sci 2020; 360:236-242. [PMID: 32423747 DOI: 10.1016/j.amjms.2020.04.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 03/10/2020] [Accepted: 04/18/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND The etiology of pleural effusions often remained unknown notwithstanding surgical pleural biopsy and further clinical observation. A better understanding of clinical characteristics of patients with idiopathic pleural effusion (IPE) may improve the ability to differentiate between IPEs and cytology-negative malignant pleural effusions (MPEs) and facilitate the identification of patients requiring invasive investigation. However, little is known about the clinical factors that can help distinguish patients with IPE from those with cytology-negative MPE. MATERIALS AND METHODS Patients who were diagnosed with IPE or cytology-negative MPE between 2010 and 2017 were enrolled in this retrospective study. Clinical, laboratory and radiologic characteristics were compared between patients with IPE and cytology-negative MPE. Diagnostic performances of predictors for IPE were assessed using receiver operating characteristic curves. RESULTS Of 146 patients undergoing pleural biopsy owing to cytology-negative pleural effusion of uncertain cause, MPE was confirmed in 54 patients. IPE was ultimately diagnosed in 22 patients. Multivariate analysis demonstrated that a minimal amount of pleural effusion (odds ratio [OR] = 12.41, P = 0.039), presence of pleural nodularity (OR = 0.01, P < 0.001) and pleural fluid carcinoembryonic antigen levels less than 14 ng/mL (OR = 87.59, P = 0.002) were independent factors for distinguishing IPEs from cytology-negative MPEs. A combination of the absence of pleural nodularity with pleural fluid carcinoembryonic antigen levels less than 14 ng/mL yielded an area under the curve of 0.94 (sensitivity = 91% and specificity = 96%). CONCLUSIONS Using these readily available parameters to identify IPE in patients with cytology-negative exudative effusion of unknown cause can help guide decision-making when choosing to perform an invasive pleural biopsy or to take a conservative approach.
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Affiliation(s)
- Ji Eun Park
- Department of Internal Medicine, Kyungpook National University, School of Medicine, Daegu, Republic of Korea
| | - Young Woo Do
- Department of Thoracic and Cardiovascular Surgery, Kyungpook National University, School of Medicine, Daegu, Republic of Korea
| | - Deok Heon Lee
- Department of Thoracic and Cardiovascular Surgery, Kyungpook National University, School of Medicine, Daegu, Republic of Korea
| | - Sang Yub Lee
- Department of Radiology, Kyungpook National University, School of Medicine, Daegu, Republic of Korea
| | - Jae Kwang Lim
- Department of Radiology, Kyungpook National University, School of Medicine, Daegu, Republic of Korea
| | - Sun Ha Choi
- Department of Internal Medicine, Kyungpook National University, School of Medicine, Daegu, Republic of Korea
| | - Hye Won Seo
- Department of Internal Medicine, Kyungpook National University, School of Medicine, Daegu, Republic of Korea
| | - Seung Soo Yoo
- Department of Internal Medicine, Kyungpook National University, School of Medicine, Daegu, Republic of Korea
| | - Shin Yup Lee
- Department of Internal Medicine, Kyungpook National University, School of Medicine, Daegu, Republic of Korea
| | - Seung Ick Cha
- Department of Internal Medicine, Kyungpook National University, School of Medicine, Daegu, Republic of Korea
| | - Jae Yong Park
- Department of Internal Medicine, Kyungpook National University, School of Medicine, Daegu, Republic of Korea
| | - Jaehee Lee
- Department of Internal Medicine, Kyungpook National University, School of Medicine, Daegu, Republic of Korea.
| | - Chang Ho Kim
- Department of Internal Medicine, Kyungpook National University, School of Medicine, Daegu, Republic of Korea.
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9
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Bibby AC, Dorn P, Psallidas I, Porcel JM, Janssen J, Froudarakis M, Subotic D, Astoul P, Licht P, Schmid R, Scherpereel A, Rahman NM, Maskell NA, Cardillo G. ERS/EACTS statement on the management of malignant pleural effusions. Eur J Cardiothorac Surg 2019; 55:116-132. [PMID: 30060030 DOI: 10.1093/ejcts/ezy258] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Accepted: 03/28/2018] [Indexed: 12/26/2022] Open
Abstract
Malignant pleural effusions (MPE) are a common pathology, treated by respiratory physicians and thoracic surgeons alike. In recent years, several well-designed randomized clinical trials have been published that have changed the landscape of MPE management. The European Respiratory Society (ERS) and the European Association for Cardio-Thoracic Surgery (EACTS) established a multidisciplinary collaboration of clinicians with expertise in the management of MPE with the aim of producing a comprehensive review of the scientific literature. Six areas of interest were identified, including the optimum management of symptomatic MPE, management of trapped lung in MPE, management of loculated MPE, prognostic factors in MPE, whether there is a role for oncological therapies prior to intervention for MPE and whether a histological diagnosis is always required in MPE. The literature revealed that talc pleurodesis and indwelling pleural catheters effectively manage the symptoms of MPE. There was limited evidence regarding the management of trapped lung or loculated MPE. The LENT score was identified as a validated tool for predicting survival in MPE, with Brims' prognostic score demonstrating utility in mesothelioma prognostication. There was no evidence to support the use of oncological therapies as an alternative to MPE drainage, and the literature supported the use of tissue biopsy as the gold standard for diagnosis and treatment planning.Management options for malignant pleural effusions have advanced over the past decade, with high-quality randomized trial evidence informing practice in many areas. However, uncertainties remain and further research is required http://ow.ly/rNt730jOxOS.
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Affiliation(s)
- Anna C Bibby
- Academic Respiratory Unit, University of Bristol Medical School Translational Health Sciences, Bristol, UK
- North Bristol Lung Centre, North Bristol NHS Trust, Bristol, UK
| | - Patrick Dorn
- Division of Thoracic Surgery, University Hospital Bern, Bern, Switzerland
| | | | - Jose M Porcel
- Pleural Medicine Unit, Arnau de Vilanova University Hospital, IRB Lleida, Lleida, Spain
| | - Julius Janssen
- Department of Pulmonary Diseases, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Marios Froudarakis
- Department of Respiratory Medicine, Medical School of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece
| | - Dragan Subotic
- Clinic for Thoracic Surgery, Clinical Center of Serbia, Belgrade, Serbia
| | - Phillippe Astoul
- Department of Thoracic Oncology, Pleural Diseases and Interventional Pulmonology, Hospital North Aix-Marseille University, Marseille, France
| | - Peter Licht
- Department of Cardiothoracic Surgery, Odense University Hospital, Odense, Denmark
| | - Ralph Schmid
- Division of Thoracic Surgery, University Hospital Bern, Bern, Switzerland
| | - Arnaud Scherpereel
- Pulmonary and Thoracic Oncology Department, Hospital of the University (CHU) of Lille, Lille, France
| | - Najib M Rahman
- Oxford Respiratory Trials Unit, University of Oxford, Oxford, UK
- Oxford Centre for Respiratory Medicine, University Hospitals, NHS Foundation Trust, Oxford, UK
| | - Nick A Maskell
- Academic Respiratory Unit, University of Bristol Medical School Translational Health Sciences, Bristol, UK
- North Bristol Lung Centre, North Bristol NHS Trust, Bristol, UK
- Task force chairperson
| | - Giuseppe Cardillo
- Task force chairperson
- Department of Thoracic Surgery, Carlo Forlanini Hospital, Azienda Ospedaliera San Camillo Forlanini, Rome, Italy
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10
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Reuter SB, Clementsen PF, Bodtger U. Incidence of malignancy and survival in patients with idiopathic pleuritis. J Thorac Dis 2019; 11:386-392. [PMID: 30962981 DOI: 10.21037/jtd.2018.12.136] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background The long-term outcome after non-diagnostic thoracoscopy (idiopathic pleuritis) has not been investigated in nationwide studies, and the survival has never been estimated. Therefore, we decided to investigate the three-year incidence of malignancy and survival of patients with idiopathic pleuritis. Methods Retrospective, register-based, nationwide study of patients undergoing diagnostic video-assisted thoracoscopic surgery (VATS) thoracoscopy ≤30 days after thoracentesis, using The National Patient Registry and The Danish Cancer Registry. Idiopathic pleuritis was defined as; no diagnosis of malignancy within 31 days after VATS. Patients were followed for 36 months after VATS. Results In total, idiopathic pleuritis were identified in 547 out of 658 patients undergoing VATS (83%), and 29 (5%) were diagnosed with malignancy during the 3 years follow-up period after VATS. Of these, 93% were diagnosed with malignancy within the first year. Numbers-needed-to-follow-up for detecting one case of malignancy was 18 during the first year after VATS and 250 in the two subsequent years. Survival was independent on type of malignancy (MPM vs. other malignancies; P=0.13) and of time from VATS to diagnosis (≤31 days vs. 1-36 months; P=0.15). Median survival in the non-malignant group was 1,095 days. Conclusions Our study confirms a low incidence of malignancy in idiopathic pleuritis after VATS. Nearly all incident cases of malignancy were diagnosed within 12 months from VATS. No survival disadvantage was observed in patients with incident malignancy. Our data suggest that follow-up of idiopathic pleuritis could safely be limited to 1 year. The optimal follow-up strategy remains to be investigated.
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Affiliation(s)
- Simon Bertram Reuter
- Department of Respiratory Medicine, Naestved Hospital, Naestved, Denmark.,Institute of Regional Health Research, University of Southern Denmark, Odense C, Denmark
| | - Paul Frost Clementsen
- Department of Internal Medicine, Zealand University Hospital, Roskilde, Roskilde, Denmark.,Copenhagen Academy for Medical Education and Simulation (CAMES), Rigshospitalet, Copenhagen, Denmark.,University of Copenhagen, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Uffe Bodtger
- Department of Respiratory Medicine, Naestved Hospital, Naestved, Denmark.,Institute of Regional Health Research, University of Southern Denmark, Odense C, Denmark.,Department of Internal Medicine, Zealand University Hospital, Roskilde, Roskilde, Denmark
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11
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Karpathiou G, Peoc’h M. Pleura revisited: From histology and pathophysiology to pathology and molecular biology. CLINICAL RESPIRATORY JOURNAL 2019; 13:3-13. [DOI: 10.1111/crj.12982] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Revised: 05/27/2018] [Accepted: 11/14/2018] [Indexed: 12/17/2022]
Affiliation(s)
- Georgia Karpathiou
- Department of Pathology; North Hospital, University Hospital of St-Etienne; St-Etienne France
| | - Michel Peoc’h
- Department of Pathology; North Hospital, University Hospital of St-Etienne; St-Etienne France
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12
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Castaniere I, Tonelli R, Fantini R, Marchioni A, Garofalo M, Clini EM, Cerri S. The encaged lung: rapidly progressive idiopathic pleurisy. Oxf Med Case Reports 2018; 2018:omy041. [PMID: 30109031 PMCID: PMC6084563 DOI: 10.1093/omcr/omy041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2018] [Revised: 05/02/2018] [Accepted: 05/18/2018] [Indexed: 11/17/2022] Open
Abstract
A 56-year-old, non-smoker male with no exposure, presented with right chest pain and a huge loss in forced vital capacity due to right lung volume reduction with consensual pleural thickening on high-resolution computed tomography. All serological and microbiological tests were negative. The surgical lung biopsy showed fibrinous pleurisy while the search for neoplastic cells resulted negative. Because of symptoms worsening he started low dose steroids without benefits until he died 3 months later for cardiac ischemic attack. We reviewed the literature to identify possible etiologies and a rapidly progressive idiopathic pleurisy revealed to be the most probable diagnosis.
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Affiliation(s)
- Ivana Castaniere
- Department of Medical and Surgical Sciences, University of Modena Reggio Emilia, Modena, Italy
| | - Roberto Tonelli
- Department of Medical and Surgical Sciences, University of Modena Reggio Emilia, Modena, Italy
| | - Riccardo Fantini
- Department of Medical and Surgical Sciences, University of Modena Reggio Emilia, Modena, Italy
| | - Alessandro Marchioni
- Department of Medical and Surgical Sciences, University of Modena Reggio Emilia, Modena, Italy
| | - Martina Garofalo
- Department of Medical and Surgical Sciences, University of Modena Reggio Emilia, Modena, Italy
| | - Enrico M Clini
- Department of Medical and Surgical Sciences, University of Modena Reggio Emilia, Modena, Italy.,Respiratory Diseases Unit and Centre for Rare Lung Diseases, University Hospital of Modena, Modena, Italy
| | - Stefania Cerri
- Respiratory Diseases Unit and Centre for Rare Lung Diseases, University Hospital of Modena, Modena, Italy
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13
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Bibby AC, Dorn P, Psallidas I, Porcel JM, Janssen J, Froudarakis M, Subotic D, Astoul P, Licht P, Schmid R, Scherpereel A, Rahman NM, Cardillo G, Maskell NA. ERS/EACTS statement on the management of malignant pleural effusions. Eur Respir J 2018; 52:13993003.00349-2018. [DOI: 10.1183/13993003.00349-2018] [Citation(s) in RCA: 116] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Accepted: 03/28/2018] [Indexed: 02/07/2023]
Abstract
Malignant pleural effusions (MPE) are a common pathology, treated by respiratory physicians and thoracic surgeons alike. In recent years, several well-designed randomised clinical trials have been published that have changed the landscape of MPE management. The European Respiratory Society (ERS) and the European Association for Cardio-Thoracic Surgery (EACTS) established a multidisciplinary collaboration of clinicians with expertise in the management of MPE with the aim of producing a comprehensive review of the scientific literature.Six areas of interest were identified, including the optimum management of symptomatic MPE, management of trapped lung in MPE, management of loculated MPE, prognostic factors in MPE, whether there is a role for oncological therapies prior to intervention for MPE and whether a histological diagnosis is always required in MPE.The literature revealed that talc pleurodesis and indwelling pleural catheters effectively manage the symptoms of MPE. There was limited evidence regarding the management of trapped lung or loculated MPE. The LENT score was identified as a validated tool for predicting survival in MPE, with Brims' prognostic score demonstrating utility in mesothelioma prognostication. There was no evidence to support the use of oncological therapies as an alternative to MPE drainage, and the literature supported the use of tissue biopsy as the gold standard for diagnosis and treatment planning.
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14
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Bielsa S, García-Zamalloa A, Monteagudo P, González-Sans D, Ascanio D, Esquerda A, Taboada-Gómez J, Porcel JM. Detection of Pleural Fluid Biochemistry Changes in Two Consecutive Thoracenteses for Differentiating Malignant from Benign Effusions. Arch Bronconeumol 2018; 54:320-326. [PMID: 29496288 DOI: 10.1016/j.arbres.2018.01.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Revised: 01/03/2018] [Accepted: 01/19/2018] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To assess whether changes in pleural fluid (PF) biochemistries between two consecutive thoracenteses enable clinicians to predict malignant or benign pleural effusions (PE). METHODS Retrospective study of patients with lymphocytic exudates and negative PF cytology, who underwent a second thoracentesis in our center in the last 15 years in whom a final diagnosis was reached (derivation sample). Absolute (Δa) and percentage differences (Δp) in PF biochemistries which predicted a malignant or benign PE in the derivation sample were evaluated in an independent population (validation sample). RESULTS The derivation sample included 214 PE patients (70 malignant and 144 benign PE). Δp lactate dehydrogenase (LDH) >0%, Δp neutrophils >-10% (any increase or less than 10% decrease) and Δa protein <0.1g/dL (any increase or less than 0.1g/dL decrease) between the second and the first thoracentesis had an odds ratio of 6.4, 3.9 and 2.1, respectively, to discriminate malignant from benign PE. The presence of the three conditions together had a positive likelihood ratio of 5.6, whereas the absence of any of the 3 parameters had a likelihood ratio of 0.04 for predicting malignancy. These results were reproduced in the validation sample. CONCLUSION An increase in LDH and neutrophils along with a decrease in protein in a second thoracentesis increase the probability of malignant PE, while the opposite reduces it significantly.
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Affiliation(s)
- Silvia Bielsa
- Unidad de Medicina Pleural, Hospital Universitario Arnau de Vilanova, IRBLLEIDA, Lleida, España
| | | | - Paula Monteagudo
- Unidad de Medicina Pleural, Hospital Universitario Arnau de Vilanova, IRBLLEIDA, Lleida, España
| | - Didac González-Sans
- Servicio de Medicina Interna, Hospital Universitario Vall d'Hebrón, Barcelona, España
| | - David Ascanio
- Facultad de Medicina, Universitat de Lleida, Lleida, España
| | - Aureli Esquerda
- Servicio de Análisis Clínicos, Hospital Universitario Arnau de Vilanova, IRBLLEIDA, Lleida, España
| | - Jorge Taboada-Gómez
- Servicio de Medicina Preventiva y Salud Pública, Hospital de Urdúliz-Alfredo Espinosa, Urduliz, Vizcaya, España
| | - José M Porcel
- Unidad de Medicina Pleural, Hospital Universitario Arnau de Vilanova, IRBLLEIDA, Lleida, España.
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15
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Yang Y, Wu YB, Wang Z, Wang XJ, Xu LL, Tong ZH, Shi HZ. Long-term outcome of patients with nonspecific pleurisy at medical thoracoscopy. Respir Med 2017; 124:1-5. [PMID: 28284315 DOI: 10.1016/j.rmed.2017.01.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2016] [Revised: 01/16/2017] [Accepted: 01/20/2017] [Indexed: 10/20/2022]
Abstract
BACKGROUND Medical thoracoscopy is an effective and safe procedure for diagnosing pleural effusions of undetermined causes. But there are still a part of patients with pleural effusions were diagnosed as nonspecific pleurisy when no specific biopsy results were found after undergoing thoracoscopic biopsy. The long-term outcome of these patients is unclear, and anxieties about undiagnosed malignancy persist. METHODS Between July 2005 and June 2014, medical thoracoscopy using the semi-rigid instrument was performed and pleural biopsy was taken in 833 patients with pleural effusions. Fifty-two patients diagnosed with nonspecific pleurisy with available follow-up data were included in the present study and their medical records were reviewed. RESULTS Fifty-two patients (31 men and 21 women) were included. Mean follow up was 35.5 ± 40.9 months (range, 1-143 months). No specific diagnosis was established in 21 (40.4%) of the patients. Eight of 52 patients with nonspecific pleurisy (15.4%) were subsequently diagnosed with pleural malignancies. 23 of 52 patients (44.2%) were diagnosed as benign diseases. The recurrence of pleural effusion during followed-up and pleural nodules or plaques found in medical thoracoscopy was associated with malignant disease. CONCLUSION Patients with nonspecific pleurisy after medical thoracoscopy should be closely monitored, especially in those patients with the recurrence of pleural effusion during followed-up, pleural nodules or plaques found in medical thoracoscopy. One year of clinical follow-up for patients found to have nonspecific pleurisy is likely sufficient.
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Affiliation(s)
- Yuan Yang
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Yan-Bing Wu
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Zhen Wang
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Xiao-Juan Wang
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Li-Li Xu
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Zhao-Hui Tong
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Huan-Zhong Shi
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chaoyang Hospital, Capital Medical University, Beijing, China.
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