Malignant pleural effusions because of lung cancer

Purpose of review The discovery of a pleural effusion in the setting of lung cancer has diagnostic, prognostic, and therapeutic challenges, some of which are addressed in this review. Recent findings Around 20% of patients with lung cancer have minimal pleural effusions, which are not amenable to a diagnostic thoracentesis. These patients have a poorer overall survival (∼7.5 months) than those without effusions (∼12–18 months), although slightly better than those with proven malignant fluids (∼5.5 months). Tumor genotype techniques are feasible on pleural fluid specimens and clinically helpful in identifying patients who may benefit from targeted therapies. If limited pleural involvement is detected during lung cancer surgery despite the presurgical imaging studies, macroscopic complete resection of the lung tumor is still a treatment option. Cytological examination for cancer cells in pleural cavity washings at the time of thoracotomy (pleural lavage cytology) is recommended to uncover pleural dissemination. Patients with non-small cell lung cancer with visceral pleural invasion might be considered candidates for postsurgical adjuvant therapy. Summary Some predictors of adverse survival in patients with lung cancer include the presence of a minimal pleural effusion, positive pleural lavage cytology, visceral pleural invasion on pathologic examination, and unexpected pleural involvement during surgery.

[1]  Se Hoon Choi,et al.  Surgical Outcomes after Pulmonary Resection for Non–Small Cell Lung Cancer with Localized Pleural Seeding First Detected during Surgery , 2015, The Thoracic and Cardiovascular Surgeon.

[2]  Y. She,et al.  Primary tumour resection showed survival benefits for non-small-cell lung cancers with unexpected malignant pleural dissemination. , 2016, Interactive cardiovascular and thoracic surgery.

[3]  J. Lee,et al.  Minimal Pleural Effusion in Small Cell Lung Cancer: Proportion, Mechanisms, and Prognostic Effect. , 2016, Radiology.

[4]  Edward S. Kim,et al.  Lung cancer biomarkers, targeted therapies and clinical assays. , 2015, Translational lung cancer research.

[5]  J. Crowley,et al.  The IASLC Lung Cancer Staging Project: Proposals for the Revision of the M Descriptors in the Forthcoming Eighth Edition of the TNM Classification of Lung Cancer , 2015, Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer.

[6]  J. M. Porcel,et al.  The diagnosis of pleural effusions , 2015, Expert review of respiratory medicine.

[7]  U. Pastorino,et al.  Survival patterns in lung and pleural cancer in Europe 1999-2007: Results from the EUROCARE-5 study. , 2015, European journal of cancer.

[8]  W. Liang,et al.  The impact of visceral pleural invasion in node-negative non-small cell lung cancer: a systematic review and meta-analysis. , 2015, Chest.

[9]  J. M. Porcel,et al.  TTF‐1 and napsin A on cell blocks and supernatants of pleural fluids for labeling malignant effusions , 2015, Respirology.

[10]  E. Miyaoka,et al.  Surgical Intervention for Non–Small-Cell Lung Cancer Patients with Pleural Carcinomatosis: Results From the Japanese Lung Cancer Registry in 2004 , 2015, Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer.

[11]  W. Nishio,et al.  Efficacy of adjuvant chemotherapy for lung adenocarcinoma patients with positive pleural lavage cytology findings. , 2015, Interactive cardiovascular and thoracic surgery.

[12]  Y. Ishikawa,et al.  Prognosis of non-small-cell lung cancer patients with positive pleural lavage cytology. , 2015, Interactive cardiovascular and thoracic surgery.

[13]  J. Zhao,et al.  Cell block samples from malignant pleural effusion might be valid alternative samples for anaplastic lymphoma kinase detection in patients with advanced non‐small‐cell lung cancer , 2015, Histopathology.

[14]  J. M. Porcel,et al.  Clinical features and survival of lung cancer patients with pleural effusions , 2015, Respirology.

[15]  He Huang,et al.  Visceral pleural invasion remains a size-independent prognostic factor in stage I non-small cell lung cancer. , 2015, The Annals of thoracic surgery.

[16]  Yong Song,et al.  Detection of EML4-ALK in Lung Adenocarcinoma Using Pleural Effusion with FISH, IHC, and RT-PCR Methods , 2015, PloS one.

[17]  G. Dy,et al.  Adequacy of Malignant Pleural Effusion for Epidermal Growth Factor Receptor Mutation Analysis Using the Pyrosequencing Method , 2015 .

[18]  W. Nishio,et al.  Pleural lavage cytology as an independent prognostic factor in non-small-cell lung cancer patients with stage I disease and adenocarcinoma. , 2015, Molecular and clinical oncology.

[19]  Jinguo Liu,et al.  ARMS for EGFR mutation analysis of cytologic and corresponding lung adenocarcinoma histologic specimens , 2015, Journal of Cancer Research and Clinical Oncology.

[20]  E. Miyaoka,et al.  Prognostic value of intraoperative pleural lavage cytology for non-small cell lung cancer: the influence of positive pleural lavage cytology results on T classification. , 2014, The Journal of thoracic and cardiovascular surgery.

[21]  Jie Lin,et al.  Detection of EGFR mutation in supernatant, cell pellets of pleural effusion and tumor tissues from non-small cell lung cancer patients by high resolution melting analysis and sequencing. , 2014, International journal of clinical and experimental pathology.

[22]  R. Flores,et al.  Prognostic significance of visceral pleural involvement in early-stage lung cancer. , 2014, Chest.

[23]  Yiyan Lei,et al.  Frequency of EGFR mutations in lung adenocarcinoma with malignant pleural effusion: Implication of cancer biological behaviour regulated by EGFR mutation , 2014, The Journal of international medical research.

[24]  J. M. Porcel,et al.  Etiology of pleural effusions: analysis of more than 3,000 consecutive thoracenteses. , 2014, Archivos de bronconeumologia.

[25]  J. M. Porcel,et al.  Etiología del derrame pleural: análisis de más de 3.000 toracocentesis consecutivas , 2014 .

[26]  S. Shiono,et al.  Positive intraoperative pleural lavage cytology is a predictive marker of disease recurrence in stage I lung adenocarcinoma. , 2014, Interactive cardiovascular and thoracic surgery.

[27]  Kyung-Hee Lee,et al.  Prognostic impact of minimal pleural effusion in non-small-cell lung cancer. , 2014, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[28]  Dan Liu,et al.  Malignant Pleural Effusion Supernatants Are Substitutes for Metastatic Pleural Tumor Tissues in EGFR Mutation Test in Patients with Advanced Lung Adenocarcinoma , 2014, PloS one.

[29]  Chan Kwon Park,et al.  Detection and comparison of EGFR mutations in matched tumor tissues, cell blocks, pleural effusions, and sera from patients with NSCLC with malignant pleural effusion, by PNA clamping and direct sequencing. , 2013, Lung cancer.

[30]  A. Fiorelli,et al.  In lung cancer patients where a malignant pleural effusion is found at operation could resection ever still be justified? , 2013, Interactive cardiovascular and thoracic surgery.

[31]  N. Tanner,et al.  EGFR mutations in malignant pleural effusions from lung cancer , 2013, Current Respiratory Care Reports.

[32]  F. Tanaka,et al.  Intrapleural chemotherapy improves the survival of non-small cell lung cancer patients with positive pleural lavage cytology , 2013, Surgery Today.

[33]  K. Yokoi,et al.  The value of pleural lavage cytology examined during surgery for primary lung cancer. , 2012, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

[34]  A. Darzi,et al.  Positive pre-resection pleural lavage cytology is associated with increased risk of lung cancer recurrence in patients undergoing surgical resection: a meta-analysis of 4450 patients , 2012, Thorax.

[35]  J. Koo,et al.  EGFR mutation status in primary lung adenocarcinomas and corresponding metastatic lesions: discordance in pleural metastases. , 2011, Clinical lung cancer.

[36]  M. Okada,et al.  Impact of positive pleural lavage cytology on survival in patients having lung resection for non-small-cell lung cancer: An international individual patient data meta-analysis. , 2010, The Journal of thoracic and cardiovascular surgery.

[37]  Y. Nishiwaki,et al.  The impact on survival of positive intraoperative pleural lavage cytology in patients with non-small-cell lung cancer. , 2010, The Journal of thoracic and cardiovascular surgery.