title: Video-assisted management of malignant pleural effusion in breast carcinoma.
abstract: BACKGROUND
  Advanced breast carcinoma almost always leads to a malignant pleural effusion, conditioning the performance status of patients and consequently quality of life. The treatment of malignant pleural effusion should be a priority in the management of such patients. The results of video-thoracoscopic approach (VATS) chemical pleurodesis was analyzed in patients with recurrent pleural effusion from breast carcinoma.
  
  
  METHODS
  From October 1998 to June 2004, 71 consecutive patients with breast carcinoma-related pleural effusion were treated by the same thoracic-surgeon team with intracavitary nebulization of 8 g of asbestos-free sterilized talc via VATS. Multiple pleural biopsies were performed to determine biologic characteristics of recurrent disease.
  
  
  RESULTS
  Talc pleurodesis was performed in all cases, with no intraoperative or postoperative complications. Median length of hospital stay was 5 days (range, 5-8). The overall success rate of the surgical procedure was 89% (confidence interval [CI], 79-95%) with a mean follow-up of 22 months (range, 2-81 mos). The overall survival time was 17 months (range, 2-80). Biopsies showed a switch on receptor status and c-erB-2 status from negative (primary tumor) to positive (pleural metastasis) in 11 (15%) patients. In another 7 (9.8%) patients, we obtained completely new information that was hitherto unknown.
  
  
  CONCLUSIONS
  Talc pleurodesis via VATS is an effective and safe procedure that yields a high rate of success at the first attempt and achieves long-term control of malignant pleural effusion due to breast carcinoma. Concomitant biopsies performed during the VATS procedure were a determining factor in the subsequent decision-making process.
authors.affiliation: Division of Thoracic Surgery, European Institute of Oncology, Milan, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Gasparri
authors.forename: Francesco
authors.initials: F
authors.lastname: Leo
authors.forename: Giulia
authors.initials: G
authors.lastname: Veronesi
authors.forename: Tommaso
authors.initials: T
authors.lastname: De Pas
authors.forename: Tommaso
authors.initials: T
authors.lastname: DePas
authors.forename: Marco
authors.initials: M
authors.lastname: Colleoni
authors.forename: Patrick
authors.initials: P
authors.lastname: Maisonneuve
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Pelosi
authors.forename: Viviana
authors.initials: V
authors.lastname: Galimberti
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Spaggiari
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000150:complications*; D002277:Carcinoma / Q000150:complications*; D005260:Female; D006801:Humans; D008875:Middle Aged; D016066:Pleural Effusion, Malignant / Q000209:etiology / Q000601:surgery / Q000628:therapy*; D018700:Pleurodesis; D013627:Talc / Q000008:administration & dosage*; D020775:Thoracic Surgery, Video-Assisted; D016896:Treatment Outcome
chemical_list: D013627:Talc