Optimal diagnosis and treatment of malignant disease: Challenging the guidelines
The evidence base for the diagnosis and management of malignant pleural disease has strengthened significantly in the last decade. In this chapter, we summarise the new research that will be included in the next iteration of international guidelines. In diagnostics, magnetic resonance imaging, PET and pleural biomarkers remain “specialist techniques” compared with the tried and tested utility of CT and pleural fluid cytology, both of which have limitations in some disease subtypes. Recent large randomised trials in the management of MPEs allow us to offer more personalised fluid management plans to our patients. These studies have developed strategies for more rapid fluid control using IPCs, pleurodesis agents or a combination of both. Future research directions are focused on patient-centred outcomes in effusion management and the appropriate roles of surgery and palliative care.
