Update on the diagnosis and management of malignant pleural effusions

• Published in: Respiratory medicine Vol. 196; p. 106802
• Main Authors: Bashour, Sami I., Mankidy, Babith J., Lazarus, Donald R.
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.05.2022
• Subjects: Drainage - methods; Humans; Malignant pleural effusion; Medical thoracoscopy; Pleural Effusion, Malignant - diagnostic imaging; Pleural Effusion, Malignant - therapy; Pleurodesis; Pleurodesis - methods; Pleuroscopy; Thoracentesis - methods; Thoracoscopy - methods; Tunneled indwelling pleural catheters; Tunneled indwelling pleural catheters; Malignant pleural effusion; Medical thoracoscopy; Pleurodesis; Pleuroscopy
• ISSN: 0954-6111; 1532-3064
• DOI: 10.1016/j.rmed.2022.106802

Roughly 150,000 malignant pleural effusions (MPE) are diagnosed in the United States each year. The majority of cases are caused by lung and breast cancer, and since MPE represents advanced disease, the prognosis is generally poor. In this article we review the pathophysiology, epidemiology, and prognosis of MPE. We then discuss the approach to diagnosis of MPE including the role of imaging, pleural fluid analysis, and medical thoracoscopy. Current management strategies for symptomatic MPE include repeated thoracentesis for patients with very limited life expectancy as well as more definitive procedures such as chemical pleurodesis, tunneled indwelling pleural catheters, and novel combined approaches. The choice of intervention is guided by the efficacy, local expertise, and risk, as well as patient factors and preferences. •Malignant pleural effusions are common and cause significant morbidity•The diagnosis is confirmed with pleural fluid cytology or pleural tissue biopsy•Management is focused on control of dyspnea with pleural catheters or pleurodesis•Patient and health system factors determine the optimal clinical approach