Pleuroscopy First Versus Thoracentesis First in Patients With Suspected Malignant Pleural Effusions
Icahn School of Medicine at Mount Sinai
Summary
This is a randomized control trial of patients with suspected malignant pleural effusions to compare whether patients who have a thoracentesis or pleuroscopy (pleural biopsy) obtain an adequate biopsy, achieve a diagnosis, and begin cancer-directed therapy faster.
Description
This is a randomized control trial of patients with suspected malignant pleural effusions comparing patients who undergo either pleuroscopy or thoracentesis as the first diagnostic test. Both procedures are considered standard of care for this diagnosis but it is unknown which one provides more adequate biopsy samples and achieves faster diagnosis and shorter time to oncologic treatment. Currently, most patients undergo thoracentesis first and, if this is inadequate for diagnosis, they then undergo pleuroscopy for further biopsy samples. This study seeks to assess whether patients who undergo…
Eligibility
- Age range
- 18+ years
- Sex
- All
- Healthy volunteers
- No
Inclusion Criteria: * Referral for diagnostic pleural procedure. * Age ≥ 18 years. * Suspected malignant pleural effusion (Suggestive radiologic appearance (based on computed tomography or positron emission tomography) OR suspected cancer with associated effusion.) Exclusion Criteria: * Inability to provide informed consent. * Needs emergent drainage. * Pleural effusion is known to be malignant. * Suspected transudative, infectious or inflammatory effusion etiology. * Having prior inconclusive/non-diagnostic thoracentesis or pleuroscopy. * Patient is deemed by the clinical team to be more a…
Interventions
- ProcedurePleuroscopy first
Pleuroscopies are performed under moderate sedation with local anesthesia. Through a 1-cm incision a camera is introduced into the pleural space and the space is inspected after draining all fluid. Targeted biopsies under direct visualization are obtained using forceps. The aspirated fluid and biopsies obtained are sent to the cytology and pathology laboratories for analysis.
- ProcedureThoracentesis first
Thoracenteses are performed under local anesthesia with the insertion of a 5-8Fr catheter into the pleural space. The aspirated fluid obtained is sent to the cytology laboratory for analysis.
Locations (2)
- Mount Sinai WestNew York, New York
- Mount Sinai HospitalNew York, New York