{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T03:13:01Z","timestamp":1790219581892,"version":"4.1.0"},"reference-count":56,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2022,11,17]],"date-time":"2022-11-17T00:00:00Z","timestamp":1668643200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Oncol."],"abstract":"<jats:p>Malignant pleural effusion (MPE) is a common condition which often causes significant symptoms to patients and costs to healthcare systems. Over the past decade, the management of MPE has progressed enormously with large scale, randomised trials answering key questions regarding optimal diagnostic strategies and effective management strategies. Despite a number of management options, including talc pleurodesis, indwelling pleural catheters and combinations of the two, treatment for MPE remains symptom directed and centered around drainage strategy. The future goals for providing improved care for patients lies in changing the treatment paradigm from a generic pathway to personalised care, based on probability of malignancy type and survival. This article reviews the current evidence base, new discoveries and future directions in the diagnosis and management of MPE.<\/jats:p>","DOI":"10.3389\/fonc.2022.1053574","type":"journal-article","created":{"date-parts":[[2022,11,17]],"date-time":"2022-11-17T05:50:06Z","timestamp":1668664206000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":27,"title":["Malignant pleural effusion: Updates in diagnosis, management and current challenges"],"prefix":"10.3389","volume":"12","author":[{"given":"Dinesh Narayan","family":"Addala","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nikolaos I.","family":"Kanellakis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eihab O.","family":"Bedawi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tao","family":"Dong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Najib M.","family":"Rahman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2022,11,17]]},"reference":[{"key":"B1","article-title":"Management of malignant pleural effusions","volume-title":"Principles and Practice of Interventional Pulmonology","author":"Villanueva","year":"2012"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1183\/09031936.00063109","article-title":"Guidelines of the European respiratory society and the European society of thoracic surgeons for the management of malignant pleural mesothelioma","volume":"35","author":"Scherpereel","year":"2010","journal-title":"Eur Respir J"},{"key":"B3","doi-asserted-by":"publisher","first-page":"18000349","DOI":"10.1183\/13993003.00349-2018","article-title":"ERS\/EACTS statement on the management of malignant pleural effusions","volume":"52","author":"Bibby","year":"2018","journal-title":"Eur Respir J"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1111\/resp.12496","article-title":"Clinical features and survival of lung cancer patients with pleural effusions","volume":"20","author":"Porcel","year":"2015","journal-title":"Respirology"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1016\/j.chest.2021.05.026","article-title":"Epidemiology of adult pleural disease in the united states","volume":"160","author":"Mummadi","year":"2021","journal-title":"Chest"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2012.5535","article-title":"Effect of an indwelling pleural catheter vs chest tube and talc pleurodesis for relieving dyspnea in patients with malignant pleural effusion: the TIME2 randomized controlled trial","volume":"307","author":"Davies","year":"2012","journal-title":"JAMA"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2017.17426","article-title":"Effect of an indwelling pleural catheter vs talc pleurodesis on hospitalization days in patients with malignant pleural effusion: The AMPLE randomized clinical trial","volume":"318","author":"Thomas","year":"2017","journal-title":"JAMA"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1716883","article-title":"Outpatient talc administration by indwelling pleural catheter for malignant effusion","volume":"378","author":"Bhatnagar","year":"2018","journal-title":"N Engl J Med"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.201607-1404OC","article-title":"Randomized trial of pleural fluid drainage frequency in patients with malignant pleural effusions","volume":"195","author":"Wahidi","year":"2017","journal-title":"ASAP Trial Am J Respir Crit Care Med"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.1136\/bmjresp-2020-000701","article-title":"Critical analysis of the utility of initial pleural aspiration in the diagnosis and management of suspected malignant pleural effusion","volume":"7","author":"Mercer","year":"2020","journal-title":"BMJ Open Respir Res"},{"key":"B11","doi-asserted-by":"publisher","first-page":"1801254","DOI":"10.1183\/13993003.congress-2018.PA2868","article-title":"Investigating unilateral pleural effusions: the role of cytology","volume":"52","author":"Arnold","year":"2018","journal-title":"Eur Respir J"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.1136\/thx.2010.137000","article-title":"Management of pleural infection in adults: British thoracic society pleural disease guideline 2010","author":"Davies","year":"2010","journal-title":"Thorax"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.1016\/S1076-6332(05)80373-3","article-title":"Pleural fluid volume estimation: a chest radiograph prediction rule","volume":"3","author":"Blackmore","year":"1996","journal-title":"Acad Radiol"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.1136\/thoraxjnl-2016-209340","article-title":"State of the art thoracic ultrasound: intervention and therapeutics","volume":"72","author":"Corcoran","year":"2017","journal-title":"Thorax"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.1136\/thx.2008.100545","article-title":"Thoracic ultrasound in the diagnosis of malignant pleural effusion","volume":"64","author":"Qureshi","year":"2009","journal-title":"Thorax"},{"key":"B16","doi-asserted-by":"publisher","first-page":"589","DOI":"10.1016\/S0873-2159(15)30054-4","article-title":"[Ultrasound in chest disease]","volume":"16","author":"Bugalho","year":"2010","journal-title":"Rev Port Pneumol"},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.1378\/chest.123.2.436","article-title":"Accuracy of pleural puncture sites*: A prospective comparison of clinical examination with ultrasound","volume":"123","author":"Diacon","year":"2003","journal-title":"Chest"},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.1378\/chest.13-2876","article-title":"Novel use of pleural ultrasound can identify malignant entrapped lung prior to effusion drainage","volume":"146","author":"Salamonsen","year":"2014","journal-title":"Chest"},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.1016\/S2213-2600(21)00353-2","article-title":"Role of thoracic ultrasonography in pleurodesis pathways for malignant pleural effusions (SIMPLE): an open-label, randomised controlled trial","volume":"10","author":"Psallidas","year":"2022","journal-title":"Lancet Respir Med"},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.2214\/ajr.154.3.2106209","article-title":"CT in differential diagnosis of diffuse pleural disease","volume":"154","author":"Leung","year":"1990","journal-title":"AJR Am J Roentgenol"},{"key":"B21","doi-asserted-by":"publisher","DOI":"10.1136\/thoraxjnl-2014-206054","article-title":"Role of CT in assessing pleural malignancy prior to thoracoscopy","volume":"70","author":"Hallifax","year":"2015","journal-title":"Thorax"},{"key":"B22","doi-asserted-by":"publisher","DOI":"10.1378\/chest.14-0820","article-title":"Accuracy of fluorodeoxyglucose-PET imaging for differentiating benign from malignant pleural effusions: A meta-analysis","volume":"147","author":"Porcel","year":"2015","journal-title":"Chest"},{"key":"B23","doi-asserted-by":"publisher","DOI":"10.1136\/bmjresp-2017-000270","article-title":"Randomised controlled trial to compare the diagnostic yield of positron emission tomography CT (PET-CT) TARGETed pleural biopsy versus CT-guided pleural biopsy in suspected pleural malignancy (TARGET trial)","volume":"5","author":"de Fonseka","year":"2018","journal-title":"BMJ Open Resp Res"},{"key":"B24","doi-asserted-by":"publisher","DOI":"10.1016\/j.lungcan.2019.05.017","article-title":"Baseline predictors of negative and incomplete pleural cytology in patients with suspected pleural malignancy \u2013 data supporting \u2018Direct to LAT\u2019 in selected groups","volume":"133","author":"Tsim","year":"2019","journal-title":"Lung Cancer"},{"key":"B25","year":"2022","journal-title":"Overview | Lung cancer: diagnosis and management | Guidance | NICE"},{"key":"B26","doi-asserted-by":"publisher","first-page":"153","DOI":"10.3390\/jcm7060153","article-title":"An update on predictive biomarkers for treatment selection in non-small cell lung cancer","volume":"7","author":"Ahmadzada","year":"2018","journal-title":"J Clin Med"},{"key":"B27","doi-asserted-by":"publisher","first-page":"1900980","DOI":"10.1183\/13993003.00980-2019","article-title":"The pleural effusion and symptom evaluation (PLEASE) study of breathlessness in patients with a symptomatic pleural effusion","volume":"55","author":"Muruganandan","year":"2020","journal-title":"Eur Respir J"},{"key":"B28","doi-asserted-by":"publisher","DOI":"10.1016\/S2213-2600(18)30421-1","article-title":"Routine monitoring with pleural manometry during therapeutic large-volume thoracentesis to prevent pleural-pressure-related complications: A multicentre, single-blind randomised controlled trial","volume":"7","author":"Lentz","year":"2019","journal-title":"Lancet Respir Med"},{"key":"B29","doi-asserted-by":"publisher","DOI":"10.1097\/MCP.0b013e3282fe9a04","article-title":"Image-guided pleural biopsy","volume":"14","author":"Rahman","year":"2008","journal-title":"Curr Opin Pulmonary Med"},{"key":"B30","doi-asserted-by":"publisher","first-page":"77","DOI":"10.1159\/000511626","article-title":"Diagnostic yield and safety of image-guided pleural biopsy: A systematic review and meta-analysis","volume":"100","author":"Mei","year":"2021","journal-title":"Respiration"},{"key":"B31","doi-asserted-by":"publisher","first-page":"S28","DOI":"10.1016\/S0169-5002(21)00267-1","article-title":"Physician performed US guided pleural biopsies in thoracic malignancy","volume":"156","author":"Sundaralingam","year":"2021","journal-title":"Lung Cancer"},{"key":"B32","doi-asserted-by":"publisher","DOI":"10.1093\/annonc\/mdv199","article-title":"Malignant pleural mesothelioma: ESMO clinical practice guidelines for diagnosis, treatment and follow-up","author":"Baas","year":"2015","journal-title":"Ann Oncol"},{"key":"B33","doi-asserted-by":"publisher","DOI":"10.1378\/chest.107.3.845","article-title":"The impact of thoracoscopy on the management of pleural disease","volume":"107","author":"Harris","year":"1995","journal-title":"Chest"},{"key":"B34","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(16)00173-X","article-title":"Postoperative pain and quality of life after lobectomy via video-assisted thoracoscopic surgery or anterolateral thoracotomy for early stage lung cancer: a randomised controlled trial","volume":"17","author":"Bendixen","year":"2016","journal-title":"Lancet Oncol"},{"key":"B35","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2019.19997","article-title":"Effect of thoracoscopic talc poudrage vs talc slurry via chest tube on pleurodesis failure rate among patients with malignant pleural effusions: A randomized clinical trial","volume":"323","author":"Bhatnagar","year":"2020","journal-title":"JAMA"},{"key":"B36","doi-asserted-by":"publisher","DOI":"10.1136\/bmjspcare-2020-002584","article-title":"Therapeutic thoracentesis symptoms and activity: a qualitative study","volume":"8","author":"Twose","year":"2021","journal-title":"BMJ Support Palliat Care"},{"key":"B37","doi-asserted-by":"publisher","first-page":"CD010529","DOI":"10.1002\/14651858.CD010529.pub2","article-title":"Interventions for the management of malignant pleural effusions: a network meta-analysis","author":"Clive","year":"2016","journal-title":"Cochrane Database Syst Rev"},{"key":"B38","doi-asserted-by":"publisher","DOI":"10.1016\/j.lungcan.2019.09.003","article-title":"Survival in patients with malignant pleural effusion undergoing talc pleurodesis","volume":"137","author":"Hassan","year":"2019","journal-title":"Lung Cancer"},{"key":"B39","doi-asserted-by":"publisher","DOI":"10.1378\/chest.12-3103","article-title":"Clinical outcomes of indwelling pleural catheter-related pleural infections: an international multicenter study","volume":"144","author":"Fysh","year":"2013","journal-title":"Chest"},{"key":"B40","doi-asserted-by":"publisher","DOI":"10.1378\/chest.129.2.362","article-title":"Single-center experience with 250 tunnelled pleural catheter insertions for malignant pleural effusion","volume":"129","author":"Tremblay","year":"2006","journal-title":"Chest"},{"key":"B41","doi-asserted-by":"publisher","DOI":"10.1111\/resp.12962","article-title":"Cost-effectiveness of indwelling pleural catheter compared with talc in malignant pleural effusion","volume":"22","author":"Olfert","year":"2017","journal-title":"Respirology"},{"key":"B42","doi-asserted-by":"publisher","DOI":"10.1136\/thorax-2021-BTSabstracts.281","article-title":"P172 indwelling pleural catheter removal and auto-pleurodesis: predictors and outcome","volume":"76","author":"Addala","year":"2021","journal-title":"Thorax"},{"key":"B43","doi-asserted-by":"publisher","DOI":"10.1080\/01902148.2017.1384865","article-title":"Local and systemic effects of a silver nitrate coated indwelling pleural catheter in an animal model of pleurodesis","volume":"43","author":"Tremblay","year":"2017","journal-title":"Exp Lung Res"},{"key":"B44","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.201701-0097LE","article-title":"A novel drug-eluting indwelling pleural catheter for the management of malignant effusions","volume":"197","author":"Bhatnagar","year":"2018","journal-title":"Am J Respir Crit Care Med"},{"key":"B45","doi-asserted-by":"publisher","DOI":"10.1513\/AnnalsATS.202111-1301OC","article-title":"Silver nitrate-coated versus standard indwelling pleural catheter for malignant effusions: The SWIFT randomized trial","volume":"19","author":"Shrager","year":"2022","journal-title":"Ann Am Thorac Soc"},{"key":"B46","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2016-012795","article-title":"OPTIMUM: a protocol for a multicentre randomised controlled trial comparing out patient talc slurry via indwelling pleural catheter for malignant pleural effusion vs usual inpatient management","volume":"6","author":"Sivakumar","year":"2016","journal-title":"BMJ Open"},{"key":"B47","doi-asserted-by":"publisher","DOI":"10.1136\/thoraxjnl-2014-205285","article-title":"Predicting survival in malignant pleural effusion: development and validation of the LENT prognostic score","volume":"69","author":"Clive","year":"2014","journal-title":"Thorax"},{"key":"B48","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(18)30294-8","article-title":"Survival and pleurodesis response markers in malignant pleural effusion - the PROMISE study: A multicohort analysis","volume":"19","author":"Psallidas","year":"2018","journal-title":"Lancet Oncol"},{"key":"B49","doi-asserted-by":"publisher","DOI":"10.1111\/resp.13837","article-title":"Malignant pleural effusion survival prognostication in an Asian population","volume":"25","author":"Quek","year":"2020","journal-title":"Respirology"},{"key":"B50","doi-asserted-by":"publisher","DOI":"10.1016\/j.chest.2021.03.059","article-title":"Breast and lung effusion survival score models: Improving survival prediction in patients with malignant pleural effusion and metastasis","volume":"160","author":"Molina","year":"2021","journal-title":"Chest"},{"key":"B51","doi-asserted-by":"publisher","first-page":"36","DOI":"10.4081\/mrm.2020.36","article-title":"Fractional exhaled nitric oxide (FENO) in the management of asthma: a position paper of the Italian respiratory society (SIP\/IRS) and Italian society of allergy, asthma and clinical immunology (SIAAIC)","volume":"15","author":"Heffler","year":"2020","journal-title":"Multidiscip Respir Med"},{"key":"B52","doi-asserted-by":"publisher","first-page":"4","DOI":"10.1097\/LBR.0000000000000602","article-title":"Pleural fluid cytokine levels at baseline and over time are associated with time to IPC removal: An exploratory study","volume":"27","author":"Grosu","year":"2020","journal-title":"J Bronchology Interv Pulmonol"},{"key":"B53","doi-asserted-by":"publisher","DOI":"10.3389\/fonc.2021.658395","article-title":"Pleural fluid has pro-growth biological properties which enable cancer cell proliferation","volume":"11","author":"Asciak","year":"2021","journal-title":"Front Oncol"},{"key":"B54","doi-asserted-by":"publisher","DOI":"10.1016\/j.cllc.2011.02.006","article-title":"EGFR mutation status in primary lung adenocarcinomas and corresponding metastatic lesions: discordance in pleural metastases","volume":"12","author":"Han","year":"2011","journal-title":"Clin Lung Cancer"},{"key":"B55","doi-asserted-by":"publisher","DOI":"10.3892\/or.2013.2349","article-title":"Intrapleural combination therapy with bevacizumab and cisplatin for non-small cell lung cancer\u2212mediated malignant pleural effusion","volume":"29","author":"Du","year":"2013","journal-title":"Oncol Rep"},{"key":"B56","doi-asserted-by":"publisher","first-page":"75","DOI":"10.1097\/JTO.0b013e3181c07ddc","article-title":"Phase I trial of intrapleural docetaxel administered through an implantable catheter in subjects with a malignant pleural effusion","volume":"5","author":"Jones","year":"2010","journal-title":"J Thorac Oncol"}],"container-title":["Frontiers in Oncology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fonc.2022.1053574\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,11,17]],"date-time":"2022-11-17T05:50:08Z","timestamp":1668664208000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fonc.2022.1053574\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,11,17]]},"references-count":56,"alternative-id":["10.3389\/fonc.2022.1053574"],"URL":"https:\/\/doi.org\/10.3389\/fonc.2022.1053574","relation":{},"ISSN":["2234-943X"],"issn-type":[{"value":"2234-943X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,11,17]]},"article-number":"1053574"}}