Update on pleural diseases--2007

Our plain-English summary of Update on pleural diseases--2007, by A. Bishay, S. Raoof, A. Esan, et al (Annals of Thoracic Medicine, 2007).

The study

• Authors: A. Bishay, S. Raoof, A. Esan, A. Sung, S. Wali, L.Y. Lee, L. George, A. Saleh, M. Baumann
• Journal: Annals of Thoracic Medicine
• Published: 2007;2(3):128-42
• Cited by: 1 article, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: New information is available on pleural diseases. The authors selected articles to make recommendations on diagnostic and treatment aspects of pleural diseases.

Materials And Methods: Eleven articles published in the English language between 2004 and 2007 were chosen. The basis of selection of the articles was the impact on daily practice, change in prior thinking of a disease process or specific treatment modality, as well as proper design and execution of the study. 5-Amino-laevulinic acid with fluorescent light combined with white light may allow further diagnostic yield in undiagnosed pleural disease. FDG-PET may allow prognostication of patients with pleural tumors. Utilizing ultrasound by trained Emergency Department physicians is a rapid and effective technique to evaluate non-traumatic pleural effusions in symptomatic patients. Serum osteopontin levels may distinguish patients exposed to asbestos with benign disease from those with pleural mesothelioma. Administration of streptokinase in patients with empyema does not need for surgical drainage, length of hospital stay, or mortality as compared to conventional treatment with chest tube drainage and intravenous antibiotics. Silver nitrate may be an alternative agent to talc for producing pleurodesis. Routine use of graded talc (50% particles greater than 25 microns) is recommended to reduce the morbidity associated with talc pleurodesis. Study design does not permit us to conclude that aspiration of spontaneous pneumothorax is as effective as chest tube drainage. Pleural catheter may prove to be an important palliative modality in treating debilitated patients or patients with trapped lung who show symptomatic improvement with drainage; however, at the present time, these catheters cannot be considered a first line treatment option for patients with malignant pleural effusion. One of the studies reviewed showed no significant difference in tract metastasis in patients with malignant mesothelioma undergoing an invasive pleural procedure with or without irradiation to the procedure site. However, the design of the trial does not allow us to make this conclusion at the present time.

In plain English

This article was a review. The authors summarized and commented on eleven articles on pleural diseases published in English between 2004 and 2007. Several concerned asbestos or mesothelioma. In a reviewed study of the blood protein osteopontin, the asbestos-exposed group's mean level did not differ significantly from unexposed controls (P = 0.06). Levels were higher with lung fibrosis and with 10 or more years of exposure. The pleural mesothelioma group differed significantly from the exposed group (P less than 0.001). That study's authors concluded osteopontin could distinguish asbestos-exposed people with benign disease from those with pleural mesothelioma. A cited editorial said other asbestos-related conditions still needed assessment. A reviewed study of 137 malignant pleural mesothelioma patients linked higher PET tracer uptake with poorer survival. A reviewed trial of single-dose chest wall radiation versus no preventive radiation, covering 58 procedure sites (28 irradiated, 30 not), found no statistically significant difference in procedure tract metastasis (7% versus 10%). The review authors said that trial should not change current three-fraction irradiation practice. The review also covered pleural infection, pleurodesis, pneumothorax and pleural catheters.

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: Review of eleven selected published studies (narrative summaries with the review authors' commentary)
• Who was studied: Eleven clinical studies on diagnosis and treatment of pleural diseases, published in English between 2004 and 2007, found by searching Ovid and PubMed
• Exposure: Asbestos exposure appeared in one reviewed study (serum osteopontin), whose first group had a history of asbestos exposure, evidence of asbestosis, or both. The other reviewed studies concerned diagnostic and treatment methods for pleural diseases, not asbestos exposure.
• Main results:
  • Osteopontin study (reviewed): the mean serum osteopontin level in the asbestos-exposed group did not differ significantly from that in subjects without asbestos exposure (P = 0.06).
  • Osteopontin study (reviewed): within the asbestos-exposed group, levels did not differ significantly by presence or absence of pleural plaques (P = 0.88).
  • Osteopontin study (reviewed): levels were significantly higher in the subgroup with lung fibrosis than without (P = 0.004), and with 10 or more years of exposure than with fewer than 10 years (P = 0.02).
  • Osteopontin study (reviewed): the mean level in the 76 pleural mesothelioma patients differed significantly from that in the asbestos-exposed group (P less than 0.001).
  • PET study (reviewed), 137 patients with biopsy-proven, previously untreated malignant pleural mesothelioma: increasing standard uptake value (SUV) correlated with poorer survival. Patients with SUV greater than 10 had a 1.9 times greater risk of death than those with SUV less than 10.
  • Radiotherapy trial (reviewed): patients with malignant pleural mesothelioma were randomized to a single dose of electron beam chest wall irradiation or no prophylactic therapy. The trial had 58 procedure sites (28 irradiated, 30 control). Tract metastasis rates were 7% in the irradiation arm and 10% in the control arm, not a statistically significant difference.
  • Silver nitrate vs talc trial (reviewed), malignant pleural effusion: at 30 days, 23 of 24 silver nitrate patients and 21 of 25 talc patients had no recurrence (P = 0.349). The talc used was described as asbestos-free.
  • MIST 1 trial (reviewed), pleural infection: streptokinase showed no statistically or clinically significant difference from placebo in death or need for surgical drainage at 3 months.
• The authors' conclusion: The review authors concluded that, with further confirmatory studies, osteopontin could become an important step in early diagnosis and management of mesothelioma. They also concluded that prophylactic three-fraction irradiation to the biopsy or chest drain site is still routinely recommended for proven or suspected mesothelioma.
• Limitations the authors state:
  • The review authors criticized the reviewed single-dose radiotherapy trial: many procedures were fine-needle aspirations, which carry the lowest seeding risk, and the trial lacked a three-fraction irradiation comparison arm.
  • The review authors noted that the reviewed silver nitrate trial was not blinded and was underpowered.
  • The review authors did not state limitations of their own review method; the articles were selected on criteria including whether they were likely to change the authors' practice.

Topics

Medical terms in this study, explained in our Lexicon: Ultrasound, Pleural Effusion, Osteopontin, Pleural Mesothelioma, Empyema, Talc, Pleurodesis, Talc Pleurodesis.

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• Asbestos disease in sheet metal workers: proportional mortality update — D. Michaels, S. Zoloth (1988)
• Guidelines for Pathologic Diagnosis of Malignant Mesothelioma 2017 Update of the Consensus Statement From the International Mesothelioma Interest Group — A.N. Husain, T.V. Colby, et al. (2018)
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