M24 Non-expandable lung in malignant pleural effusions at medical thoracoscopy. (December 2018)

• Record Type: Journal Article
• Authors: Ip, H; Ahmed, S; Noorzad, F; West, A; Ahmed, L
• Is Part Of: Thorax. Volume 73(2018)Supplement 4
• Page Start: A259
• Page End: A259
• Publication Date: 2018-12
• Subjects: Chest -- Diseases -- Periodicals; Thorax; Chest -- Diseases; Periodicals; Periodicals; 617.54
• DOI: 10.1136/thorax-2018-212555.444
• Languages: English
• ISSNs: 0040-6376

Abstract

Abstract : Introduction and objectives: During thoracoscopy for suspected malignant pleural effusions, non-expandable lung (NEL) is managed with indwelling pleural catheters (IPCs) at our centre. To choose the appropriate drain, medical thoracoscopists need to predict NEL. In a 2016 UK survey, 1 NEL was correctly predicted in only 12.5% of cases (on reviewing thoracoscopy video clips). Are thoracoscopists better at choosing the appropriate management in clinical practice? Methods: All medical thoracoscopies at St Thomas' Hospital, London were reviewed. Patients with a diagnosis of malignant pleural effusion were included. Retrospective data were collected from May 2013 to May 2018. NEL was defined by a post thoracoscopy chest radiograph showing under 50% apposition between the visceral and parietal pleura. Results: 106 medical thoracoscopies were performed in patients with malignant pleural effusions. 3 were excluded from analysis; 2 failed intubation, and 1 had no post procedure chest radiograph. 42 were day case procedures, and 61 were admitted. The median age was 69 (31–92). NEL was present in 50 cases (49%). The most common cancers (table 1) were mesothelioma (30%), lung adenocarcinoma (26%) and breast (17%). During thoracoscopy 40/50 (80%) patients with NEL received an IPC, and 10 (20%) received an Argyll/Seldinger chest drain. 34/53 (64%) patients with expandable lung received a temporary drain, and 19 (36%) received an IPC. The median volume of pleural fluid drained during thoracoscopy was 2000 ml in cases with NEL, and 1500 ml in cases with expandable lung. Conclusions: At our centre, an IPC is inserted at the end of thoracoscopy if NEL is suspected, and an Argyll drain for expandable lung. 80% of patients with NEL received an IPC. The better prediction of NEL was likely achieved by reviewing: the duration of the malignant effusion, radiological appearances, flow of pleural fluid on entering the pleural cavity, along with the thoracoscopic appearance. 48% of patients with malignant pleural effusions undergoing thoracoscopy had NEL. Reference: Hallifax RJ, Corcoran JP, Psallidas I, Rahman NM. Medical thoracoscopy: Survey of current practice-how successful are medical thoracoscopists at predicting malignancy?RespirologyJuly 2016;21(5):958–60.