A practical approach to the diagnosis and management of malignant pleural effusions in resource-constrained settings.

IF 2.3 Q2 RESPIRATORY SYSTEM Breathe Pub Date : 2023-12-01 Epub Date: 2023-12-19 DOI:10.1183/20734735.0140-2023
Jane A Shaw, Elizabeth H Louw, Coenraad F N Koegelenberg
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Abstract

No pleural intervention in a patient with confirmed malignant pleural effusion (MPE) prolongs life, but even the recommended interventions for diagnosis and palliation can be costly and therefore unavailable in large parts of the world. However, there is good evidence to guide clinicians working in low- and middle-income countries on the most cost-effective and clinically effective strategies for the diagnosis and management of MPE. Transthoracic ultrasound-guided closed pleural biopsy is a safe method of pleural biopsy with a diagnostic yield approaching that of thoracoscopy. With the use of pleural fluid cytology and ultrasound-guided biopsy, ≥90% of cases can be diagnosed. Cases with an associated mass lesion are best suited to an ultrasound-guided fine needle aspiration with/without core needle biopsy. Those with diffuse pleural thickening and/or nodularity should have an Abrams needle (<1 cm thickening) or core needle (≥1 cm thickening) biopsy of the area of interest. Those with insignificant pleural thickening should have an ultrasound-guided Abrams needle biopsy close to the diaphragm. The goals of management are to alleviate dyspnoea, prevent re-accumulation of the pleural effusion and minimise re-admissions to hospital. As the most cost-effective strategy, we suggest early use of indwelling pleural catheters with daily drainage for 14 days, followed by talc pleurodesis if the lung expands. The insertion of an intercostal drain with talc slurry is an alternative strategy which is noninferior to thoracoscopy with talc poudrage.

Educational aims: To provide clinicians practising in resource-constrained settings with a practical evidence-based approach to the diagnosis and management of malignant pleural effusions.To explain how to perform an ultrasound-guided closed pleural biopsy.To explain the cost-effective use of indwelling pleural catheters.

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在资源有限的情况下诊断和管理恶性胸腔积液的实用方法。
对确诊为恶性胸腔积液(MPE)的患者进行任何胸腔干预都不会延长患者的生命,但即使是推荐的诊断和缓解干预措施也可能成本高昂,因此在世界上大部分地区都无法获得。不过,有充分的证据可以指导中低收入国家的临床医生采用最具成本效益和临床效果的策略来诊断和治疗 MPE。经胸超声引导封闭式胸膜活检是一种安全的胸膜活检方法,其诊断率接近胸腔镜检查。通过胸腔积液细胞学检查和超声引导下活检,≥90%的病例可以确诊。伴有肿块病变的病例最适合在超声引导下进行细针穿刺活检。有弥漫性胸膜增厚和/或结节的病例应进行艾氏针穿刺(教育目的:为资源有限的临床医生提供一个良好的学习机会:为在资源有限的环境中执业的临床医生提供实用的循证方法,用于诊断和管理恶性胸腔积液。解释如何在超声引导下进行闭合胸膜活检。
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来源期刊
Breathe
Breathe RESPIRATORY SYSTEM-
CiteScore
2.90
自引率
5.00%
发文量
51
审稿时长
12 weeks
期刊最新文献
An elderly woman with acute respiratory failure and diffuse pulmonary changes. Con: indwelling pleural catheters cause harm to patients. Erratum: "Steroids in severe community-acquired pneumonia". S. Ananth, A.G. Mathioudakis, J. Hansel. Breathe 2024; 20: 240081. Highlights from the Respiratory Failure and Mechanical Ventilation Conference 2024. Integration of lung function data: turning snapshots into stories.
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