What is the role of a medical thoracoscopy (pleuroscopy) in the treatment of malignant pleural effusion?

Updated: Jul 08, 2021
  • Author: Shannon E Burke, DO; Chief Editor: Zab Mosenifar, MD, FACP, FCCP  more...
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In cases with an established malignant diagnosis, medical thoracoscopy also has a therapeutic role in the form of pleurodesis. [6]  Complete evacuation of pleural fluid, with maximization of lung expandability by removing adhesions and pleurodesis by talc insufflations has short- and long-term success rates greater than 90%. [3]

Talc pleurodesis on lung and parietal pleura. Talc pleurodesis on lung and parietal pleura.

The benefits of pleurodesis include improvement of functional status as well as improving the quality of life, especially for patients with advanced malignant disease. In patients who are undergoing further treatment for malignancy, improving the functional status may allow for increased treatment options overall.

In addition, patients who do require further treatment can be excluded from certain chemotherapeutics because of chemotherapeutic tendency to distribute into the pleural effusion and affect serum levels. The classic examples of this are methotrexate, fludarabine, and possibly pemetrexed. [7, 8, 9]

Survival of patients with advanced pleural disease is often limited, from weeks to months. The benefits of medical thoracoscopy versus repeated thoracentesis should be carefully considered for the individual patient.

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