Malignant pleural effusion

Question 1

What is the preference for drainage of IPC for MPE?

(ref: BTS pleural disease 2022)

Answer 1

Daily drainage increases rate of pleurodesis (thus removal of IPC).

Drainage symptom-based/ conservative drainage (alt day)/ daily drainage have similar Sx/ length of hosp stay & complications

Question 2

Recommendations from BTS pleural disease 2022 for MPE

Answer 2

1) IPC with talc pleurodesis:
- to be inserted in expanded lung (>75% hemithorax) –> improved pleurodesis rate, Sx & QoL

Question 3

Rate of yield for pleural biopsy in MPE

Answer 3

1) Pleural fluid cytology: 62-90% depending on primary cancer from case series
2) Blind biopsy (Abram’s needle): 30-40%
3) CT or US-guided: 70-80%
4) Pleuroscopy or VATs thoracoscopy: gold std 90% yield