Combined Ultrasound-Guided Thoracentesis, Percutaneous Pleural Biopsy, and Indwelling Pleural Catheter Insertion as the First Intervention in Patients With High Likelihood of Malignant Pleural Effusion

Our plain-English summary of Combined Ultrasound-Guided Thoracentesis, Percutaneous Pleural Biopsy, and Indwelling Pleural Catheter Insertion as the First Intervention in Patients With High Likelihood of Malignant Pleural Effusion, by M.V. Brown, J. Solujic, S. Yeo, et al (CHEST Pulmonary, 2025).

The study

• Authors: M.V. Brown, J. Solujic, S. Yeo, J. Kim, P. Nguyen, A. Badiei
• Journal: CHEST Pulmonary
• Published: 2025;3(4):100201
• Cited by: 1 article, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: Malignant pleural effusion (MPE) indicates advanced disease and imposes a significant symptomatic burden to patients. Current guidelines recommend stepwise investigation and management.

Research Question: Is it feasible and safe to combine ultrasound (US)-guided pleural biopsy and indwelling pleural catheter (IPC) insertion as the initial diagnostic and therapeutic procedure for patients with high preprocedural probability of MPE?

Study Design And Methods: We retrospectively analyzed patients who underwent pleural procedures between March 1, 2021, and September 30, 2022. Sixteen patients with symptomatic unilateral pleural effusion and clinical or radiologic features suggestive of malignancy underwent combined US-guided pleural biopsy and IPC insertion as their first management step. Feasibility was determined by the number of patients requiring repeat diagnostic and therapeutic procedures, and time to diagnosis. Safety was determined by complication rates.

Results: Of 258 patients who received 384 pleural procedures, 16 patients (11 male; mean age ± SD, 77 ± 9.5 years) underwent the combined procedure. All patients had high preprocedural probability of MPE as evidenced by appropriate history, a unilateral pleural effusion (93.7%), and pleural nodularity or thickening on CT chest scan or US (87.5%). Mean time to diagnostic procedure was 9.3 days. Malignancy was confirmed in 100% of cases, with mesothelioma being the most common (50%). Pleural fluid cytology was diagnostic in 3 cases (18.8%), whereas 13 US-guided pleural biopsies (81.3%) were diagnostic. Nine patients (56.25%) had their IPC removed because of autopleurodesis or treatment response, with a mean removal time of 55.8 days. At 12 months, 5 patients (31.25%) had a documented complication, with pain and catheter blockage being the most common. One patient (6.25%) developed pleural infection. Over one-half (56.2%) received antineoplastic treatment with their IPC in situ. No patient required a repeat pleural procedure on follow-up.

Interpretation: A combined approach of closed, percutaneous US-guided pleural biopsy and IPC insertion as initial pleural intervention was shown to be feasible in patients with high preprocedural probability for MPE with no unexpected safety signals.

Crown Copyright © 2025 Published by Elsevier Inc. under license from the American College of Chest Physicians.

In plain English

This retrospective review at the Royal Adelaide Hospital, Australia, covered patients who had pleural procedures from March 1, 2021, to September 30, 2022. Of 258 patients, 16 had a fluid build-up on one side of the chest that doctors judged highly likely to be cancer. As their first step, they had one combined procedure: pleural fluid sampling (thoracentesis), an ultrasound-guided needle biopsy of the pleura, and insertion of a long-term drainage tube (indwelling pleural catheter). Half of the 16 (8) had prior asbestos exposure. All 16 were diagnosed with cancer, and 8 (50%) had mesothelioma. Fluid testing was diagnostic in 3 patients (18.8%) and the biopsy in 13 (81.3%). The rest needed another procedure, which confirmed cancer. The mean time to the diagnostic procedure was 9.3 days. Over 12 months, 5 patients (31.25%) had at least one catheter complication: drainage-related pain in 3, a blocked catheter in 1 and pleural infection in 1. No patient needed a repeat pleural procedure. The authors concluded the approach was feasible with no unexpected safety signals. They noted it was small, retrospective and limited to selected patients.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Retrospective single-center review of patient records (descriptive statistics only)
• Who was studied: Of 258 patients who had 384 pleural procedures at the Royal Adelaide Hospital, Australia, between March 1, 2021, and September 30, 2022, 16 patients (11 male, 5 female; mean age 77) had the combined procedure. They had symptomatic one-sided pleural effusion judged highly likely to be malignant.
• Exposure: The study examined a medical procedure: combined pleural fluid sampling (thoracentesis), ultrasound-guided pleural biopsy and indwelling pleural catheter insertion. Prior asbestos exposure was recorded in 8 of the 16 patients. No fiber types, jobs or doses were reported.
• Main results:
  • All 16 patients received a cancer diagnosis. 8 (50%) had mesothelioma: biphasic 4, sarcomatoid 1, epithelioid 1, not further classified 2.
  • Other diagnoses were 4 (25%) primary lung adenocarcinoma, 1 primary squamous cell carcinoma, 1 Waldenstrom macroglobulinaemia, 1 metastatic gastrointestinal carcinoma and 1 melanoma.
  • Pleural fluid cytology was diagnostic for malignancy in 3 of 16 patients (18.8%).
  • Ultrasound-guided pleural biopsy was diagnostic for malignancy in 13 of 16 patients (81.3%).
  • Where fluid and biopsy results were inconclusive, an additional diagnostic procedure was done and confirmed malignancy.
  • Time to diagnostic procedure for all 16 patients: mean 9.3 days, median 6 days, range 1 to 32 days. For patients whose combined procedure was nondiagnostic, it was 18.7 days (range 8 to 32 days).
  • 9 of 16 patients (56.25%) had their catheter removed, at a mean of 55.8 days (SD 44.3).
  • Over 12 months, 5 patients (31.25%) had at least one catheter complication: drainage-related pain in 3 (18.75%), a blocked catheter in 1 (6.25%) and pleural infection in 1 (6.25%). No procedural complications were recorded.
  • No patient required a repeat pleural procedure after the initial intervention.
• The authors' conclusion: The authors concluded that combined ultrasound-guided pleural biopsy and catheter insertion as the first intervention was feasible in patients with high likelihood of malignant pleural effusion, with no unexpected safety signals in this cohort.
• Limitations the authors state:
  • The study was retrospective, and patient enrollment and management did not follow a set protocol, which limits generalizability.
  • Selecting patients with high likelihood of malignancy may have raised the diagnostic yield (selection bias).
  • The sample size was small.
  • All-cause readmission was not captured.

Topics

Medical terms in this study, explained in our Lexicon: Ultrasound, Thoracentesis, Pleural Biopsy, Indwelling Pleural Catheter, Pleural Effusion, Mesothelioma, Fluid Cytology.

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