Pleuroscopy First Versus Thoracentesis First in Patients With Suspected Malignant Pleural Effusions
Icahn School of Medicine at Mount Sinai
98 participants
Mar 24, 2025
INTERVENTIONAL
Conditions
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.
Eligibility
Inclusion Criteria3
- 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 Criteria8
- 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 appropriate for VATS biopsy.
- Terminally ill patients in whom a diagnosis will not change management, or who is unlikely to be a candidate for oncological treatment due to significant comorbidities.
- Pregnancy
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Interventions
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.
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)
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NCT06892691