What is the role of a medical thoracoscopy (pleuroscopy) in the treatment of malignant pleural effusion?

Answer

In cases with an established malignant diagnosis, medical thoracoscopy also has a therapeutic role in the form of pleurodesis.^[6] Complete evacuation of pleural fluid, with maximization of lung expandability by removing adhesions and pleurodesis by talc insufflations has short- and long-term success rates greater than 90%.^[3]

Talc pleurodesis on lung and parietal pleura.

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The benefits of pleurodesis include improvement of functional status as well as improving the quality of life, especially for patients with advanced malignant disease. In patients who are undergoing further treatment for malignancy, improving the functional status may allow for increased treatment options overall.

In addition, patients who do require further treatment can be excluded from certain chemotherapeutics because of chemotherapeutic tendency to distribute into the pleural effusion and affect serum levels. The classic examples of this are methotrexate, fludarabine, and possibly pemetrexed.^{[7, 8, 9]}

Survival of patients with advanced pleural disease is often limited, from weeks to months. The benefits of medical thoracoscopy versus repeated thoracentesis should be carefully considered for the individual patient.

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Media Gallery

Biopsy forceps sampling parietal pleura.
Talc pleurodesis on lung and parietal pleura.
Bulky metastasis on parietal pleura.
Examination for evidence of metastasis.
Pleural adhesions on medical thoracoscopy.
Patient positioning for medical thoracoscopy.
Trocar insertion for medical thoracoscopy.
Insertion of semirigid scope through trocar.
Olympus semirigid pleuroscope.
Olympus semirigid pleuroscope.
Olympus semirigid pleuroscope.
Semirigid pleuroscope in extension.
Semirigid pleuroscope in flexion.
Semirigid pleuroscope in neutral position.

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Author

Shannon E Burke, DO Fellow in Pulmonary and Critical Care Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, St Louis University School of Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Edward Charbek, MD, FCCP Assistant Professor of Internal Medicine, Associate Director of Pulmonary and Critical Care Fellowship Program, Division of Pulmonary, Critical Care and Sleep Medicine, St Louis University School of Medicine; Medical Director, Kindred Hospital-St Louis

Edward Charbek, MD, FCCP is a member of the following medical societies: American College of Chest Physicians, American Thoracic Society, Association of Pulmonary and Critical Care Medicine Program Directors

Disclosure: Nothing to disclose.

Chief Editor

Zab Mosenifar, MD, FACP, FCCP Geri and Richard Brawerman Chair in Pulmonary and Critical Care Medicine, Professor and Executive Vice Chairman, Department of Medicine, Medical Director, Women's Guild Lung Institute, Cedars Sinai Medical Center, University of California, Los Angeles, David Geffen School of Medicine

Zab Mosenifar, MD, FACP, FCCP is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, American Federation for Medical Research, American Thoracic Society

Disclosure: Nothing to disclose.

Additional Contributors

Rajiv Malhotra, DO, MS, FCCP Assistant Professor of Internal Medicine, Division of Pulmonary and Critical Care, Department of Internal Medicine, Virginia Commonwealth University; Medical Director of Cardiac Surgery ICU, Associate Fellowship Director of Interventional Pulmonology, Virginia Commonwealth University Health System

Rajiv Malhotra, DO, MS, FCCP is a member of the following medical societies: American Association for Bronchology and Interventional Pulmonology, American College of Chest Physicians, International Society for Heart and Lung Transplantation, Society of Critical Care Medicine

Disclosure: Nothing to disclose.

Hans J Lee, MD Assistant Professor of Medicine, Director of Pleural Disease Services, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine

Hans J Lee, MD is a member of the following medical societies: American Association for Bronchology and Interventional Pulmonology, American College of Chest Physicians, American Thoracic Society, Association of Interventional Pulmonary Fellowship Directors

Disclosure: Nothing to disclose.

Ray W Shepherd, MD Associate Professor of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Virginia Commonwealth University School of Medicine; Staff Physician, Division of Pulmonary and Critical Care Medicine, Virginia Commonwealth University Medical Center

Ray W Shepherd, MD is a member of the following medical societies: American College of Chest Physicians, American Thoracic Society, Christian Medical and Dental Associations, American Association for Bronchology and Interventional Pulmonology

Disclosure: Nothing to disclose.

Cecilia C Bergh, MD Fellow in Pulmonary and Critical Care Medicine, Virginia Commonwealth University Medical Center

Disclosure: Nothing to disclose.

What is the role of a medical thoracoscopy (pleuroscopy) in the treatment of malignant pleural effusion?

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