The Korean Journal of Medicine

  • 제81권2호
  • /
  • Pages.167-173
  • /
  • 2011
  • /
  • 1738-9364(pISSN)
  • /
  • 2289-0769(eISSN)
대한내과학회 (The Korean Association of Internal Medicine)
권호 표지

악성흉수의 진단과 치료

Diagnosis and Management of Malignant Pleural Effusion

  • 남해성 (인하대학교 의학전문대학원 내과학교실) ;
  • 류정선 (인하대학교 의학전문대학원 내과학교실)
  • Nam, Hae-Seong (Department of Internal Medicine, School of Medicine, Inha University) ;
  • Ryu, Jeong-Seon (Department of Internal Medicine, School of Medicine, Inha University)
  • 발행 : 2011.08.01
⟨ 이전 논문 다음 논문 ⟩

초록

Malignant pleural effusions (MPEs) are an important clinical problem in patients with neoplastic disease. They can occur as the initial presentation of cancer, a delayed complication in patients with previously diagnosed malignancies, or the first manifestation of cancer recurrence after therapy. Common cancer types causing MPEs include lymphomas, mesotheliomas, and carcinomas of the breast, lung, and ovaries. However, almost all tumor types have been reported to cause MPEs. Regardless of the etiology, the median survival from clinical recognition is 4 months. New imaging modalities assist the evaluation of patients with a suspected MPE. However cytologic or tissue confirmation of malignant cells is necessary to establish a diagnosis. Management of an MPE remains palliative. Managements are directed toward removing pleural fluids and when appropriate, performing pleurodesis or initiating long-term drainage to prevent fluid reaccumulation. Talc pleurodesis is still the choice of treatment although concerns about its safety remain. Several factors such as performance status, expected survival, lung re-expansion following pleural fluid drainage and co-morbidities should be considered before the treatment.

키워드

참고문헌

  1. Rodriguez-Panadero F, Borderas Naranjo F, Lopez Mejias J. Pleural metastatic tumours and effusions: frequency and pathogenic mechanisms in a post-mortem series. Eur Respir J 1989;2:366-369.
  2. Light RW. Pleural Diseases. 5th ed. Philadelphia: Lippincott Williams & Wilkins, 2007.
  3. Kraft A, Weindel K, Ochs A, et al. Vascular endothelial growth factor in the sera and effusions of patients with malignant and nonmalignant disease. Cancer 1999;85:178-187. https://doi.org/10.1002/(SICI)1097-0142(19990101)85:1<178::AID-CNCR25>3.0.CO;2-7
  4. Roberts ME, Neville E, Berrisford RG, Antunes G, Ali NJ. Management of a malignant pleural effusion: British Thoracic Society Pleural Disease Guideline 2010. Thorax 2010;65(Suppl 2):ii32-ii40. https://doi.org/10.1136/thx.2010.136994
  5. Heffner JE, Nietert PJ, Barbieri C. Pleural fluid pH as a predictor of survival for patients with malignant pleural effusions. Chest 2000;117:79-86. https://doi.org/10.1378/chest.117.1.79
  6. Goldstraw P, Crowley J, Chansky K, et al. The IASLC lung cancer staging project: proposals for the revision of the TNM stage groupings in the forthcoming (seventh) edition of the TNM classification of malignant tumours. J Thorac Oncol 2007;2:706-714. https://doi.org/10.1097/JTO.0b013e31812f3c1a
  7. Abbruzzese JL, Abbruzzese MC, Hess KR, Raber MN, Lenzi R, Frost P. Unknown primary carcinoma: natural history and prognostic factors in 657 consecutive patients. J Clin Oncol 1994;12:1272-1280.
  8. van de Molengraft FJ, Vooijs GP. Survival of patients with malignancy-associated effusions. Acta Cytol 1989;33:911-916.
  9. Heffner JE, Klein JS. Recent advances in the diagnosis and management of malignant pleural effusions. Mayo Clin Proc 2008;83:235-250.
  10. Maher GG, Berger HW. Massive pleural effusion: malignant and nonmalignant causes in 46 patients. Am Rev Respir Dis 1972;105:458-460.
  11. Qureshi NR, Gleeson FV. Imaging of pleural disease. Clin Chest Med 2006;27:193-213. https://doi.org/10.1016/j.ccm.2006.02.001
  12. Kocijancic I, Vidmar K, Ivanovi-Herceg Z. Chest sonography versus lateral decubitus radiography in the diagnosis of small pleural effusions. J Clin Ultrasound 2003;31:69-74. https://doi.org/10.1002/jcu.10141
  13. Yilmaz U, Polat G, Sahin N, Soy O, Gulay U. CT in differential diagnosis of benign and malignant pleural disease. Monaldi Arch Chest Dis 2005;63:17-22.
  14. Schaffler GJ, Wolf G, Schoellnast H, et al. Non-small cell lung cancer: evaluation of pleural abnormalities on CT scans with 18F FDG PET. Radiology 2004;231:858-865. https://doi.org/10.1148/radiol.2313030785
  15. Porcel JM, Alvarez M, Salud A, Vives M. Should a cytologic study be ordered in transudative pleural effusions? Chest 1999;116:1836-1837. https://doi.org/10.1378/chest.116.6.1836
  16. Ryu JS, Ryu ST, Kim YS, Cho JH, Lee HL. What is the clinical significance of transudative malignant pleural effusion? Korean J Intern Med 2003;18:230-233.
  17. Gaspar MJ, De Miguel J, Garcia Díaz JD, Díez M. Clinical utility of a combination of tumour markers in the diagnosis of malignant pleural effusions. Anticancer Res 2008;28:2947-2952.
  18. Porcel JM, Vives M, Esquerda A, Salud A, Perez B, Rodriguez- Panadero F. Use of a panel of tumor markers (carcinoembryonic antigen, cancer antigen 125, carbohydrate antigen 15-3, and cytokeratin 19 fragments) in pleural fluid for the differential diagnosis of benign and malignant effusions. Chest 2004;126:1757-1763. https://doi.org/10.1378/chest.126.6.1757
  19. Lombardi G, Zustovich F, Nicoletto MO, Donach M, Artioli G, Pastorelli D. Diagnosis and treatment of malignant pleural effusion: a systematic literature review and new approaches. Am J Clin Oncol 2010;33:420-423. https://doi.org/10.1097/COC.0b013e3181aacbbf
  20. Antony VB, Loddenkemper R, Astoul P, et al. Management of malignant pleural effusions. Eur Respir J 2001;18:402-419. https://doi.org/10.1183/09031936.01.00225601
  21. Rahman NM, Gleeson FV. Image-guided pleural biopsy. Curr Opin Pulm Med 2008;14:331-336. https://doi.org/10.1097/MCP.0b013e3282fe9a04
  22. Maskell NA, Butland RJ. BTS guidelines for the investigation of a unilateral pleural effusion in adults. Thorax 2003;58(Suppl 2): ii8-ii17.
  23. Ferrer J, Roldan J, Teixidor J, Pallisa E, Gich I, Morell F. Predictors of pleural malignancy in patients with pleural effusion undergoing thoracoscopy. Chest 2005;127:1017-1022. https://doi.org/10.1378/chest.127.3.1017
  24. Antunes G, Neville E, Duffy J, Ali N. BTS guidelines for the management of malignant pleural effusions. Thorax 2003;58(Suppl 2):ii29-ii38.
  25. Shaw P, Agarwal R. Pleurodesis for malignant pleural effusions. Cochrane Database Syst Rev 2004:CD002916.
  26. Tan C, Sedrakyan A, Browne J, Swift S, Treasure T. The evidence on the effectiveness of management for malignant pleural effusion: a systematic review. Eur J Cardiothorac Surg 2006;29:829-838. https://doi.org/10.1016/j.ejcts.2005.12.025
  27. Janssen JP, Collier G, Astoul P, et al. Safety of pleurodesis with talc poudrage in malignant pleural effusion: a prospective cohort study. Lancet 2007;369:1535-1539. https://doi.org/10.1016/S0140-6736(07)60708-9
  28. Pollak JS, Burdge CM, Rosenblatt M, Houston JP, Hwu WJ, Murren J. Treatment of malignant pleural effusions with tunneled long-term drainage catheters. J Vasc Interv Radiol 2001;12:201-208. https://doi.org/10.1016/S1051-0443(07)61826-0
  29. Tremblay A, Michaud G. Single-center experience with 250 tunnelled pleural catheter insertions for malignant pleural effusion. Chest 2006;129:362-368. https://doi.org/10.1378/chest.129.2.362
  30. Musani AI. Treatment options for malignant pleural effusion. Curr Opin Pulm Med 2009;15:380-387. https://doi.org/10.1097/MCP.0b013e32832c6a8a