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Mesothelioma Pleurocentesis

Mesothelioma pleurocentesis, or thoracentesis, is a non-invasive outpatient procedure performed to remove pleural fluid buildup. The removal of the excess fluid can alleviate pleural mesothelioma symptoms such as shortness of breath.

Pleural mesothelioma patients frequently experience fluid buildup in the lungs as a result of malignant pleural effusions, which can cause difficulty breathing. A pleurocentesis is a common surgical procedure used by mesothelioma specialists to remove the excess buildup of fluid and alleviate symptoms. While the procedure can improve quality of life, it is not curative and will not necessarily improve life expectancy. Patients may undergo pleurocentesis many times for symptom management and to improve overall quality of life.

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How Pleurocentesis Treats Mesothelioma

Pleurocentesis may be used as a diagnostic procedure or as a palliative treatment option for those confirmed to have malignant pleural mesothelioma. For pleural mesothelioma patients, a pleurocentesis may be used to alleviate shortness of breath, coughing and chest pain, which occur due to a pleural effusion. While there’s typically a small amount of fluid within the chest cavity to lubricate the lungs during expansion, an abundance of fluid may create uncomfortable symptoms.

When undergoing pleurocentesis, patients are seated upright in a hospital bed or outpatient exam table and lean forward onto an over-the-bed table. This positioning helps spread out the space between the ribs, enabling the doctor to more easily access the excess fluid. Once positioned appropriately, the doctor will insert a hollow needle between the ribs and into the pleural cavity. The fluid can then be removed via the needle or, depending on the volume of fluid to be removed, through hollow tubing. While undergoing the procedure, there should be minimal accompanying pain. Numbing agents are used throughout the procedure, so at most a patient may feel light pressure at the needle insertion site.

A pleurocentesis or thoracentesis procedure is commonly administered on an outpatient basis. However, depending on a patient’s specific case, their medical care team may request they have a short hospital stay for observation. If required to stay, patients are often released the following day.

In some cases, a thoracentesis may be used as part of the diagnostic process. When used in this way, it is considered a type of fluid biopsy. Biopsies are the only definitive method to diagnose mesothelioma, and a pleurocentesis may also be used to diagnose patients with congestive heart failure, bacterial infections, liver failure and other cancers. The diagnostic application of a pleurocentesis is about the same as the palliative treatment, though the removed fluid will be sent to a lab for analysis and confirmation of disease.

Eligibility for Mesothelioma Pleurocentesis

A pleurocentesis is a non-invasive outpatient procedure that is suitable for most malignant pleural mesothelioma patients. However, patients that have blood disorders or are taking anticoagulants are not optimal candidates for the procedure because they are at an increased risk for bleeding side effects. Imaging tests, such as a CT scan or chest X-ray, are used to determine if a pleurocentesis would be a beneficial addition to a patient's treatment plan.

For those that are eligible for the treatment, benefits include:

Side Effects and Risks of Pleurocentesis

Due to the non-invasive nature of the procedure, recovery is minimal. After completing the pleurocentesis, the doctor will place a bandage on the needle insertion site. The insertion site will heal on its own with no stitches necessary. A chest X-ray may be given after the pleurocentesis to ensure that there was no damage incurred during the procedure, such as a puncture of the chest wall. If completed on an outpatient basis, the patient will need to be driven home by a caregiver following the procedure. Patients should be able to return to their normal activities and diet once home, unless directed otherwise by their doctor. However, patients are advised to avoid strenuous physical activity for a few days after the pleurocentesis. While the procedure is generally safe, there is the possibility for side effects following treatment. Most potential side effects are very mild, and for many malignant mesothelioma patients, palliative benefits from the procedure outweigh the rare chance of risk.

Possible Side Effects of Pleurocentesis
  • Air in the pleural space
  • Bleeding
  • Collapsed lung (pneumothorax)
  • Coughing
  • Fainting
  • Infection
  • Rarely, injury to the liver or spleen
  • Rarely, cancer seeding (cancer cells spreading elsewhere along the incision site)

When the pleurocentesis is performed by knowledgeable mesothelioma specialists in experienced cancer centers, these few risks can be properly controlled. According to a 2010 study, it is possible to mitigate the risk of a collapsed lung, one of the most serious potential side effects, through use of an ultrasound during the procedure. The study found less than 2% (3 out of 225) of patients whose pleurocentesis was administered using ultrasound guidance experienced complications. Comparatively, almost 6% (13 out of 221) of patients whose pleurocentesis was administered with a clinical exam alone experienced complications like coughing.

In addition to the above potential side effects, patients should contact their medical care team if they experience these more serious issues:

These issues are uncommon, but are indicative of a problem following the procedure.

Author: Linda Molinari

Editor in Chief, Mesothelioma Cancer Alliance

Linda Molinari

Reviewer: Dr. James Stevenson

Medical Reviewer and Thoracic Medical Oncologist

Dr. James Stevenson
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Sources

American Thoracic Society. Thoracentesis. ATS Patient Education Series. 2016.

Chandrasekhar A, Garrity E. Thoracentesis and Fluid analysis. Loyola University Medical Education Network. Updated January 2006.

Johns Hopkins Medicine. Thoracentesis. Health Library.

Lechtzin N. How to Do Thoracentesis. Merck Manual. Updated October 2016.

Mohammed I, Maddirala S, et al. Evaluating Clinical Predictors of Complications of Thoracentesis. CHEST Journal. October 2010; 138(4)suppl:348A. doi: 10.1378/chest.10230

Shyamala K, Girish H, et al. Risk of tumor cell seeding through biopsy and aspiration cytology. Journal of International Society of Preventive and Community Dentistry. January-April 2014; 4(1): 5–11. doi: 10.4103/2231-0762.129446

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