MyMedR

The diagnostic usefulness of tumour markers CEA and CA-125 in pleural effusion

Sthaneshwar P, Yap SF, Jayaram G

Malays J Pathol, 2002 Jun;24(1):53-8.

Pleural effusion is a common diagnostic problem. The analysis of serum and pleural fluid for tumour markers is widely used as a diagnostic aid in clinical practice. The aim of the present study was to determine the usefulness of simultaneous quantification of carcinoembryonic antigen (CEA) and carbohydrate antigen (CA-125) in distinction of malignant from benign effusion. Data from a total of 78 patients including 53 patients with benign and 25 patients with malignant effusion was evaluated. The cut-off values for differentiating benign from malignant effusions were determined using results obtained from patients with known benign effusions (mean + 2 SD, 95% confidence interval). The cut-off for CEA and CA-125 were 5.1 ng/ml and 1707 IU/ml respectively. CEA assay in pleural fluid had an acceptable sensitivity and good specificity of 64% and 98% respectively. CA-125 had a sensitivity of 36% and specificity of 94%. The combination of the two tumour markers gave a sensitivity of 72% and specificity of 92.4%. We suggest a good clinical strategy may be to begin with CEA measurement (assay specificity 98%); if CEA is below the cut-off value (negative), CA-125 could then be measured to improve the sensitivity of detection of malignant effusions. However, measurement of these tumour markers is not cost effective from the point of view that it does not give information on the type of malignancy present. The latter has to be determined either by histological or cytological study.

Matched MeSH terms: Pleural Effusion, Malignant/classification; Pleural Effusion, Malignant/diagnosis*; Pleural Effusion, Malignant/chemistry

Fulltext Bleomycin and oxytetracycline sclerotherapy for malignant pleural effusions

Liam CK, Lim KH, Wong CMM

Med J Malaysia, 2000 Jun;55(2):283-4.

PMID: 19839164

Matched MeSH terms: Pleural Effusion, Malignant/therapy*

Ways to overcome non-draining indwelling pleural catheter in malignant pleural effusion

Faisal AH, Ng BH

Med J Malaysia, 2019 12;74(6):555-557.

PMID: 31929490

The indwelling pleural catheter (IPC) is a 16-Fr-multifenestrated catheter. It has become an accepted practice in the management of malignant pleural effusion, especially in patients with non-expandable lung. However, IPC blockage or not draining is common. A 53-year-old female with malignant pleural effusion presented to us with blocked IPC and symptomatic pleural loculation one month after IPC insertion. After failing saline flushing and low-pressure wall suction, intrapleural alteplase was instituted through the IPC with a favourable outcome, and she continued to drain daily thereafter. The present case highlights the safety of intrapleural alteplase via IPC in the non-expandable lung.

Matched MeSH terms: Pleural Effusion, Malignant/therapy*

Fulltext Successful drainage of complex haemoserous malignant pleural effusion with a single modified low-dose intrapleural alteplase and dornase alfa

Ng BH, Mohd Aminudin NH, Nasaruddin MZ, Abdul Rahaman JA

BMJ Case Rep, 2021 Feb 05;14(2).

PMID: 33547099 DOI: 10.1136/bcr-2020-239702

Patients with symptomatic complex malignant pleural effusion (MPE) are frequently unfit for decortication and have a poorer prognosis. Septations can develop in MPE, which may lead to failure of complete drainage and pleural infection. Intrapleural fibrinolytic therapy (IPFT) is an alternative treatment. The use of IPFT in patients with anaemia and high risk for intrapleural bleeding is not well established. We report a successful drainage of complex haemoserous MPE with a single modified low-dose of intrapleural 5 mg of alteplase and 5 mg of dornase alfa in a patient with pre-existing anaemia with no significant risk of intrapleural bleeding.

Matched MeSH terms: Pleural Effusion, Malignant/microbiology; Pleural Effusion, Malignant/therapy*

Fulltext Protocol of the Australasian Malignant Pleural Effusion-2 (AMPLE-2) trial: a multicentre randomised study of aggressive versus symptom-guided drainage via indwelling pleural catheters

Azzopardi M, Thomas R, Muruganandan S, Lam DC, Garske LA, Kwan BC, et al.

BMJ Open, 2016 07 05;6(7):e011480.

PMID: 27381209 DOI: 10.1136/bmjopen-2016-011480

INTRODUCTION: Malignant pleural effusions (MPEs) can complicate most cancers, causing dyspnoea and impairing quality of life (QoL). Indwelling pleural catheters (IPCs) are a novel management approach allowing ambulatory fluid drainage and are increasingly used as an alternative to pleurodesis. IPC drainage approaches vary greatly between centres. Some advocate aggressive (usually daily) removal of fluid to provide best symptom control and chance of spontaneous pleurodesis. Daily drainages however demand considerably more resources and may increase risks of complications. Others believe that MPE care is palliative and drainage should be performed only when patients become symptomatic (often weekly to monthly). Identifying the best drainage approach will optimise patient care and healthcare resource utilisation.

METHODS AND ANALYSIS: A multicentre, open-label randomised trial. Patients with MPE will be randomised 1:1 to daily or symptom-guided drainage regimes after IPC insertion. Patient allocation to groups will be stratified for the cancer type (mesothelioma vs others), performance status (Eastern Cooperative Oncology Group status 0-1 vs ≥2), presence of trapped lung (vs not) and prior pleurodesis (vs not). The primary outcome is the mean daily dyspnoea score, measured by a 100 mm visual analogue scale (VAS) over the first 60 days. Secondary outcomes include benefits on physical activity levels, rate of spontaneous pleurodesis, complications, hospital admission days, healthcare costs and QoL measures. Enrolment of 86 participants will detect a mean difference of VAS score of 14 mm between the treatment arms (5% significance, 90% power) assuming a common between-group SD of 18.9 mm and a 10% lost to follow-up rate.

ETHICS AND DISSEMINATION: The Sir Charles Gairdner Group Human Research Ethics Committee has approved the study (number 2015-043). Results will be published in peer-reviewed journals and presented at scientific meetings.

TRIAL REGISTRATION NUMBER: ACTRN12615000963527; Pre-results.

Matched MeSH terms: Pleural Effusion, Malignant/epidemiology; Pleural Effusion, Malignant/physiopathology; Pleural Effusion, Malignant/therapy*

Fulltext Medical thoracoscopy: Pahang experience

Ng TH, How SH, Kuan YC, Hasmah H, Norra H, Fauzi AR

Med J Malaysia, 2008 Oct;63(4):298-301.

PMID: 19385488 MyJurnal

Medical thoracoscopy has gain its popularity in Malaysia recently. This paper presents our early experience in thoracoscopy using semi-rigid fiberoptic thoracoscope. All thoracoscopy records since October 2006 were retrieved. The patients' records, thoracocentesis investigations results, thoracoscopic findings and all pleural biopsy results were reviewed. Twenty-four thoracoscopic procedures on 22 patients in whom two patients had repeated thoracoscopy. Ten patients were confirmed carcinoma. Eight patients had inconclusive thoracoscopic pleural biopsy results. Three patients underwent pleurodesis for malignant effusion. One patient had adhesiolysis for empyema. There was no procedure-related deaths or intraoperative accidents. Thoracoscopy is a relatively safe procedure.

Matched MeSH terms: Pleural Effusion, Malignant/diagnosis

Causes of pleural exudates in a region with a high incidence of tuberculosis

Liam CK, Lim KH, Wong CM

Respirology, 2000 Mar;5(1):33-8.

PMID: 10728729

To define the causes of exudative pleural effusions in our region.

Matched MeSH terms: Pleural Effusion, Malignant/etiology

Tunneled catheter (PleurX) for long-term chest and abdominal drainages from 2012-2017 in a tertiary institution

H'ng MWC, Leow KS

Med J Malaysia, 2019 08;74(4):352-354.

PMID: 31424051

The PleurX catheter was developed to facilitate long-term intermittent drainage of malignant pleural effusion or ascites. For palliation, it is important that the process of insertion is safe and that this catheter remains complicationfree so as to improve end-of-life quality. We show that this catheter can be safely inserted and discuss methods to reduce infection, which was the most common complication. Our article hopes to enlighten clinicians, patients and their caregivers of this device as a treatment option in palliative patients. Proper case selection and caregiver training are essential in ensuring a successful outcome.

Matched MeSH terms: Pleural Effusion, Malignant/therapy*

Fulltext Successful treatment of a complex malignant pleural effusion with 1 mg alteplase instilled through a non-draining indwelling pleural catheter

Nik Abeed NN, Faisal M, Ng BH, Ban Yu-Lin A

BMJ Case Rep, 2021 Feb 19;14(2).

PMID: 33608330 DOI: 10.1136/bcr-2020-236116

Indwelling pleural catheter (IPC) is the treatment of choice in managing symptomatic recurrent malignant pleural effusion (MPE). Loculated effusions following insertion may occur due to infection, catheter malfunction or the inflammatory nature of MPE. Loculations may lead to ineffective drainage and make the IPC non-functional. We report a 56-year-old man with symptomatic loculated malignant pleural effusion with an IPC, successfully drained with a single dose of 1 mg recombinant tissue plasminogen activator alteplase. This is the lowest dose currently applied in our centre for efficient drainage and improvement of dyspnoea.

Matched MeSH terms: Pleural Effusion, Malignant/drug therapy*

Diagnostic Value of the EZH2 Immunomarker in Malignant Effusion Cytology

Ang PP, Tan GC, Karim N, Wong YP

Acta Cytol., 2020;64(3):248-255.

PMID: 31352449 DOI: 10.1159/000501406

BACKGROUND: Differentiating reactive mesothelial cells from metastatic carcinoma in effusion cytology is a challenging task. The application of at least 4 monoclonal antibodies including 2 epithelial markers (Ber-EP4, MOC-31, CEA, or B72.3) and 2 mesothelial markers (calretinin, WT-1, CK5/6, or HBME-1) are often useful in this distinction; however, it is not readily available in many resource-limited developing countries. Aberrant immunoexpression of enhancer of zeste homolog 2 (EZH2), a transcriptional repressor involved in cancer progression, is observed widely in various malignancy. In this study, we evaluate the diagnostic value of EZH2 as a single reliable immunomarker for malignancy in effusion samples.

METHODS: A total of 108 pleural, peritoneal, and pericardial effusions/washings diagnosed as unequivocally reactive (n = 41) and metastatic carcinoma (n = 67) by cytomorphology over 18 months were reviewed. Among the metastatic carcinoma cases, 54 were adenocarcinoma and others were squamous cell carcinoma (n = 1), carcinosarcoma (n = 1), and carcinoma of undefined histological subtypes (n = 11). Cell block sections were immunostained by EZH2 (Cell Marque, USA). The percentages of EZH2-immunolabeled cells over the total cells of interest were calculated. Receiver operating characteristic (ROC) curve analysis was performed to determine the optimal cut-off score to define EZH2 immunopositivity.

RESULTS: A threshold of 8% EZH2-immunolabeled cells allows distinction between malignant and reactive mesothelial cells, with 95.5% sensitivity, 100% specificity, 100% positive predictive value, and 93.2% negative predictive value (p < 0.0001). The area under the curve was 0.988.

CONCLUSION: EZH2 is a promising diagnostic biomarker for malignancy in effusion cytology which is inexpensive yet trustworthy and could potentially be used routinely in countries under considerable economic constraints.

Matched MeSH terms: Pleural Effusion, Malignant/diagnosis*; Pleural Effusion, Malignant/etiology

Fulltext Advanced right lung adenocarcinoma with ipsilateral breast metastasis

Liam CK, Pang YK, Poh ME, Kow KS, Wong CK, Varughese R

Respirol Case Rep, 2013 Sep;1(1):20-2.

PMID: 25473531 DOI: 10.1002/rcr2.14

Breast metastases from non-small cell lung carcinoma are rarely reported. We report a case of a female patient with primary adenocarcinoma of the lower lobe of her right lung presenting with a massive right-sided malignant pleural effusion. The tumor harbored an epidermal growth factor receptor insertion mutation in exon 20 but was anaplastic lymphoma kinase translocation negative. She did not respond to treatment with erlotinib. First- and second-line cytotoxic chemotherapy resulted in stable disease as the best responses. She developed right breast metastasis 20 months after her initial presentation. The rarity of the condition and the likely mechanism of the breast metastasis are discussed.

Matched MeSH terms: Pleural Effusion, Malignant

Fulltext Indwelling pleural catheter and successful autopleurodesis of refractory inflammatory lupus effusion

Ng BH, Nik Abeed NN, Abdul Hamid MF, Soo CI, Low HJ, Ban AY

Respirol Case Rep, 2020 Oct;8(7):e00621.

PMID: 32685166 DOI: 10.1002/rcr2.621

Indwelling pleural catheter (IPC) is a useful tool for refractory malignant pleural effusions (MPEs). It allows palliation by intermittent symptomatic relief of the effusion and improves quality of life. Its use in benign pleural effusions comes mainly from retrospective studies, case series, and case reports. Lupus effusion is common, causes minimal symptoms, and usually responds to either steroid therapy or immunosuppressants. Refractory lupus effusion is less common and treatment may require invasive surgical pleurectomy. We describe a 52-year-old woman whose first presentation of systemic lupus erythematosus (SLE) was a pleural effusion refractory to steroids and immunosuppressants. She successfully achieved spontaneous pleurodesis with intermittent IPC drainage at three months.

Matched MeSH terms: Pleural Effusion, Malignant

Successful pregnancy with epidermal growth factor receptor tyrosine kinase inhibitor treatment of metastatic lung adenocarcinoma presenting with respiratory failure

Lee CH, Liam CK, Pang YK, Chua KT, Lim BK, Lai NL

Lung Cancer, 2011 Nov;74(2):349-51.

PMID: 21920622 DOI: 10.1016/j.lungcan.2011.08.008

We report a woman presenting with respiratory failure due to a right-sided pleural effusion, lung metastases and lymphangitis carcinomatosis from advanced lung adenocarcinoma in the third trimester of pregnancy, who showed good response to EGFR tyrosine kinase inhibitor.

Matched MeSH terms: Pleural Effusion, Malignant

Displaying all 13 publications