Current and future options for the diagnosis of malignant pleural effusion

Our plain-English summary of Current and future options for the diagnosis of malignant pleural effusion, by F. Rodriguez-Panadero, B. Romero-Romero (Expert Opinion on Medical Diagnostics, 2013).

The study

• Authors: F. Rodriguez-Panadero, B. Romero-Romero
• Journal: Expert Opinion on Medical Diagnostics
• Published: 2013;7(3):275-87
• Type of article: Review
• Cited by: 7 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Introduction: Malignant pleural effusion (MPE) is a frequent problem faced by clinicians, but tumor pleural involvement can be seen without effusion.

Areas Covered: Imaging, pleural fluid analysis, biomarkers for MPE, needle pleural biopsy and thoracoscopy. To prepare this review, we performed a search using keywords: 'diagnosis' + 'malignant' + 'pleural' + 'effusion' (all fields) in PubMed, and found 4106 articles overall (until 16 January 2013, 881 in the last 5 years).

Expert Opinion: Ultrasound techniques will stay as valuable tools for pleural effusions. Biomarkers in pleural fluid do not currently provide an acceptable yield for MPE. In subjects with past history of asbestos exposure, some serum or plasma markers (soluble mesothelin, fibulin) might help in selecting cases for close follow-up, to detect mesothelioma early. Needle pleural biopsy is justified only if used with image-techniques (ultrasound or CT) guidance, and thoracoscopy is better for both diagnosis and immediate palliative treatment (pleurodesis). Animal models of MPE and 'spheroids' are promising for research involving both pathophysiology and therapy. Considering the possibility of direct pleural delivery of nanotechnology-developed compounds-fit to both diagnosis and therapy purposes ('theranostics')-MPE and mesothelioma in particular are likely to benefit sooner than later from this exciting perspective.

In plain English

This article was a review, not a new study. The authors searched PubMed up to 16 January 2013 for articles on diagnosing malignant pleural effusion, meaning fluid around the lung caused by cancer. They found 4106 articles and discussed imaging, fluid testing, biomarkers, needle biopsy and thoracoscopy. In the authors' own thoracoscopy series of 556 patients with malignant effusion, fluid cytology detected cancer in 60% overall. This ranged from 20% in metastatic sarcomas to 80% in metastatic breast cancer, and was 56% in mesothelioma. The review also described other studies. In one series of 815 patients, cytology sensitivity in histology-proven mesothelioma was 68%. In one study of plasma fibulin-3, comparing early-stage mesothelioma patients with asbestos-exposed persons gave 100% sensitivity and 94.1% specificity at a cut-off of 46.0 ng per milliliter. The authors concluded that biomarkers do not currently give an acceptable yield for diagnosing malignant effusion. They added that in people with past asbestos exposure, soluble mesothelin or fibulin might help select cases for close follow-up to detect mesothelioma early.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Narrative review (expert opinion article) based on a PubMed literature search
• Who was studied: Published literature on the diagnosis of malignant pleural effusion found in PubMed up to 16 January 2013: 4106 articles, 881 of them from the last 5 years
• Exposure: The review is about diagnostic techniques, not an exposure. Asbestos appears only in the discussion of blood markers (soluble mesothelin, fibulin) for people with past asbestos exposure. No fiber types are named.
• Main results:
  • In the authors' own thoracoscopy series of 556 patients with malignant pleural effusion, the overall sensitivity of cytology was 60%. It was 20% in metastatic sarcomas, 80% in metastatic breast cancer, 70% in lung cancer, 56% in mesothelioma and 40% in lymphoma.
  • A cited series of 815 patients reported a cytology sensitivity of 68% in histology-proven mesothelioma.
  • A cited prospective study included 230 consecutive patients with undiagnosed pleural effusion, 28 of whom had malignant pleural mesothelioma. Its authors concluded that routinely testing mesothelin in all undiagnosed pleural effusions is unhelpful.
  • A cited study of plasma fibulin-3 compared patients with and without mesothelioma. It reported a sensitivity of 96.7% and a specificity of 95.5% at a cut-off of 52.8 ng per milliliter.
  • In the same cited fibulin-3 study, comparing patients with early-stage mesothelioma against asbestos-exposed persons gave a sensitivity of 100% and a specificity of 94.1% at a cut-off of 46.0 ng per milliliter.
  • A cited prospective study of 208 patients with malignant pleural effusion compared needle biopsy and thoracoscopy performed at the same time. It reported diagnostic yields of 44% for needle biopsy and 95% for thoracoscopy.
  • Of patients whose thoracoscopic biopsy showed non-specific pleuritis, about 8 to 12% later turned out to have a malignancy, especially mesothelioma (citing other work).
• The authors' conclusion: The authors concluded that, in people with past asbestos exposure, some serum markers (soluble mesothelin, fibulin) might help select cases for close follow-up to detect mesothelioma as early as possible. They also stated that biomarkers do not currently give an acceptable yield for diagnosing malignant pleural effusion.

Topics

Medical terms in this study, explained in our Lexicon: Pleural Effusion, Biomarker, Pleural Biopsy, Thoracoscopy, Ultrasound, Asbestos Exposure, Mesothelin, Mesothelioma.

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