{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,26]],"date-time":"2026-10-26T20:55:09Z","timestamp":1793048109522,"version":"4.5.0"},"reference-count":57,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2022,12,31]],"date-time":"2022-12-31T00:00:00Z","timestamp":1672444800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Life"],"abstract":"<jats:p>Malignant pleural effusions remain a significant clinical problem resulting in greater than 125,000 hospitalizations per year and leading to over 5 billion dollars in healthcare utilization costs. Not only are health care expenditures related to malignant pleural effusion significant, but malignant pleural effusions also often result in significant patient discomfort and distress, largely at the end of life. Advances in management over the past several years have provided patients with greater autonomy as they are able to provide self-aid at home either alone or with family assistance. Additionally, practice changes have allowed for fewer interventions allowing patients to spend more time out of the clinic or inpatient wards.<\/jats:p>","DOI":"10.3390\/life13010115","type":"journal-article","created":{"date-parts":[[2023,1,2]],"date-time":"2023-01-02T02:12:48Z","timestamp":1672625568000},"page":"115","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Malignant Pleural Effusions: Updates in Diagnosis and Management"],"prefix":"10.3390","volume":"13","author":[{"given":"Stephen M.","family":"Hughes","sequence":"first","affiliation":[{"name":"Department of Pulmonary, Critical Care, and Sleep Medicine, Naval Medical Center San Diego, San Diego, CA 92134, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacob Jonas","family":"Carmichael","sequence":"additional","affiliation":[{"name":"Department of Pulmonary, Critical Care, and Sleep Medicine, Naval Medical Center San Diego, San Diego, CA 92134, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,12,31]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"839","DOI":"10.1164\/rccm.201807-1415ST","article-title":"Management of Malignant Pleural Effusions. An Official ATS\/STS\/STR Clinical Practice Guideline","volume":"198","author":"Reddy","year":"2018","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"740","DOI":"10.1056\/NEJMra1403503","article-title":"Pleural Disease","volume":"378","author":"Light","year":"2018","journal-title":"N. Engl. J. Med."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1313","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":"ref_4","doi-asserted-by":"crossref","first-page":"210025","DOI":"10.1183\/16000617.0025-2021","article-title":"Interventions for the management of malignant pleural effusions: An updated network meta-analysis","volume":"30","author":"Dipper","year":"2021","journal-title":"Eur. Respir. 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J."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"ii4","DOI":"10.1136\/thx.2010.136978","article-title":"Investigation of a unilateral pleural effusion in adults: British Thoracic Society pleural disease guideline 2010","volume":"65","author":"Hooper","year":"2010","journal-title":"Thorax"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"513","DOI":"10.1378\/chest.14-0013","article-title":"Derivation and Validation of a CT Scan Scoring System for Discriminating Malignant From Benign Pleural Effusions","volume":"147","author":"Porcel","year":"2015","journal-title":"Chest"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1565803","DOI":"10.1080\/20018525.2019.1565803","article-title":"The value of computed tomography in discriminating malignant from non-malignant causes of unresolved unilateral pleural effusions: A systematic review","volume":"6","author":"Reuter","year":"2019","journal-title":"Eur. Clin. Respir. 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Med."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"681","DOI":"10.1007\/s00408-016-9891-2","article-title":"Pleural Fluid Adenosine Deaminase (ADA) Predicts Survival in Patients with Malignant Pleural Effusion","volume":"194","author":"Terra","year":"2016","journal-title":"Lung"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1136\/thoraxjnl-2021-217959","article-title":"Diagnostic sensitivity of pleural fluid cytology in malignant pleural effusions: Systematic review and meta-analysis","volume":"78","author":"Kassirian","year":"2023","journal-title":"Thorax"},{"key":"ref_21","first-page":"665","article-title":"The value of multiple fluid specimens in the cytological diagnosis of malignancy","volume":"7","author":"Garcia","year":"1994","journal-title":"Mod. Pathol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"657","DOI":"10.1002\/cncy.21452","article-title":"A minimum fluid volume of 75 mL is needed to ensure adequacy in a pleural effusion: A retrospective analysis of 2540 cases","volume":"122","author":"Rooper","year":"2014","journal-title":"Cancer Cytopathol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"144","DOI":"10.1016\/j.rce.2016.11.004","article-title":"Examination of cytological smears and cell blocks of pleural fluid: Complementary diagnostic value for malignant effusions","volume":"217","author":"Porcel","year":"2017","journal-title":"Rev. Clin. Esp."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"354","DOI":"10.1159\/000448325","article-title":"Flow Cytometry and Effusions in Lymphoproliferative Processes and Other Hematologic Neoplasias","volume":"60","year":"2016","journal-title":"Acta Cytol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"28","DOI":"10.21037\/amj-2019-mpe-05","article-title":"Etiopathogenesis of malignant pleural effusion","volume":"6","author":"Jovanovic","year":"2021","journal-title":"AME Med. J."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"504","DOI":"10.1002\/cyto.b.21886","article-title":"The utility of flow cytometry in the diagnostic work up of malignant effusions due to nonhematopoietic neoplasms","volume":"98","author":"Rey","year":"2020","journal-title":"Cytom. Part B Clin. Cytom."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"3207","DOI":"10.21037\/jtd.2019.03.86","article-title":"Pleuroscopy or video-assisted thoracoscopic surgery for exudative pleural effusion: A comparative overview","volume":"11","author":"Ali","year":"2019","journal-title":"J. Thorac. Dis."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"784","DOI":"10.1016\/j.arbr.2020.10.003","article-title":"Diagnostic Yield and Safety of Pleural Cryobiopsy during Medical Thoracoscopy to Diagnose Pleural Effusion. A Systematic Review and Meta-Analysis","volume":"56","author":"Rial","year":"2020","journal-title":"Arch. Bronconeumol."},{"key":"ref_29","first-page":"S339","article-title":"Thoracoscopy: Medical versus surgical\u2014In the management of pleural diseases","volume":"7","author":"Shojaee","year":"2015","journal-title":"J. Thorac. Dis."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"756","DOI":"10.4187\/respcare.02738","article-title":"A Randomized Trial Comparing the Diagnostic Yield of Rigid and Semirigid Thoracoscopy in Undiagnosed Pleural Effusions","volume":"59","author":"Dhooria","year":"2013","journal-title":"Respir. Care"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"ii32","DOI":"10.1136\/thx.2010.136994","article-title":"Management of a malignant pleural effusion: British Thoracic Society pleural disease guideline 2010","volume":"65","author":"Roberts","year":"2010","journal-title":"Thorax"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1098","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":"ref_33","doi-asserted-by":"crossref","first-page":"930","DOI":"10.1016\/S1470-2045(18)30294-8","article-title":"Development and validation of response markers to predict survival and pleurodesis success in patients with malignant pleural effusion (PROMISE): A multicohort analysis","volume":"19","author":"Psallidas","year":"2018","journal-title":"Lancet Oncol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1283","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":"ref_35","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1378\/chest.117.1.79","article-title":"Pleural Fluid pH as a Predictor of Survival for Patients With Malignant Pleural Effusions","volume":"117","author":"Heffner","year":"2000","journal-title":"Chest"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1186\/s12935-022-02518-w","article-title":"Prognostic biomarkers of malignant patients with pleural effusion: A systematic review and meta-analysis","volume":"22","author":"Peng","year":"2022","journal-title":"Cancer Cell Int."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"634","DOI":"10.1378\/chest.12-1285","article-title":"Course and Variation of the Intercostal Artery by CT Scan","volume":"143","author":"Helm","year":"2013","journal-title":"Chest"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"378","DOI":"10.1097\/MCP.0000000000000285","article-title":"Complications of thoracentesis: Incidence, risk factors, and strategies for prevention HHS Public Access","volume":"22","author":"Cantey","year":"2016","journal-title":"Curr. Opin. Pulm. Med."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"2383","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":"ref_40","first-page":"CD010529","article-title":"Interventions for the management of malignant pleural effusions: A network meta-analysis","volume":"2016","author":"Clive","year":"2016","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"60","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\u2014J. Am. Med. Assoc."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1186\/s13019-021-01475-1","article-title":"Complications of thoracoscopic talc insufflation for the treatment of malignant pleural effusions: A meta-analysis","volume":"16","author":"Zhang","year":"2021","journal-title":"J. Cardiothorac. Surg."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"832","DOI":"10.1007\/s11748-020-01549-2","article-title":"Talc pleurodesis in malignant pleural effusion: A systematic review and meta-analysis","volume":"69","author":"Beltsios","year":"2020","journal-title":"Gen. Thorac. Cardiovasc. Surg."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"581","DOI":"10.1378\/chest.122.2.581","article-title":"Iodopovidone Pleurodesis for Recurrent Pleural Effusions","volume":"122","author":"Light","year":"2002","journal-title":"Chest"},{"key":"ref_45","first-page":"282","article-title":"Local iodine pleurodesis versus thoracoscopic talc insufflation in recurrent malignant pleural effusion: A prospective randomized control trial","volume":"40","author":"Mohsen","year":"2010","journal-title":"Eur. J. Cardio-Thoracic Surg."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"4733","DOI":"10.1007\/s00520-021-06004-3","article-title":"Iodopovidone pleurodesis for malignant pleural effusions: An updated systematic review and meta-analysis","volume":"29","author":"Muthu","year":"2021","journal-title":"Support. 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Bronc.-Interv. Pulmonol."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"1050","DOI":"10.1164\/rccm.201607-1404OC","article-title":"Randomized Trial of Pleural Fluid Drainage Frequency in Patients with Malignant Pleural Effusions. The ASAP Trial","volume":"195","author":"Wahidi","year":"2017","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"671","DOI":"10.1016\/S2213-2600(18)30288-1","article-title":"Aggressive versus symptom-guided drainage of malignant pleural effusion via indwelling pleural catheters (AMPLE-2): An open-label randomised trial","volume":"6","author":"Muruganandan","year":"2018","journal-title":"Lancet Respir. Med."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"1722","DOI":"10.1513\/AnnalsATS.202111-1301OC","article-title":"Silver Nitrate\u2013coated 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":"ref_53","doi-asserted-by":"crossref","first-page":"1407","DOI":"10.1016\/j.chest.2021.11.031","article-title":"The Frequency, Risk Factors, and Management of Complications From Pleural Procedures","volume":"161","author":"Sundaralingam","year":"2021","journal-title":"Chest"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"21121","DOI":"10.1038\/s41598-021-00653-4","article-title":"Nicotinamide phosphoribosyltransferase as a biomarker for the diagnosis of infectious pleural effusions","volume":"11","author":"Huang","year":"2021","journal-title":"Sci. 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