title: Current and future options for the diagnosis of malignant pleural effusion.
abstract: BACKGROUND
  Malignant pleural effusion (MPE) is a frequent problem faced by clinicians, but tumor pleural involvement can be seen without effusion.
  
  
  METHODS
  Imaging, pleural fluid analysis, biomarkers for MPE, needle pleural biopsy and thoracoscopy. To prepare this review, we performed a search using keywords: 'diagnosis' + 'malignant' + 'pleural' + 'effusion' (all fields) in PubMed, and found 4106 articles overall (until 16 January 2013, 881 in the last 5 years).
  
  
  CONCLUSIONS
  Ultrasound techniques will stay as valuable tools for pleural effusions. Biomarkers in pleural fluid do not currently provide an acceptable yield for MPE. In subjects with past history of asbestos exposure, some serum or plasma markers (soluble mesothelin, fibulin) might help in selecting cases for close follow-up, to detect mesothelioma early. Needle pleural biopsy is justified only if used with image-techniques (ultrasound or CT) guidance, and thoracoscopy is better for both diagnosis and immediate palliative treatment (pleurodesis). Animal models of MPE and 'spheroids' are promising for research involving both pathophysiology and therapy. Considering the possibility of direct pleural delivery of nanotechnology-developed compounds-fit to both diagnosis and therapy purposes ('theranostics')-MPE and mesothelioma in particular are likely to benefit sooner than later from this exciting perspective.
authors.affiliation: Unidad Médico-Quirúrgica de Enfermedades Respiratorias (UMQUER), Hospital Universitario Virgen del Rocío, Seville, Spain. frodriguezpan@gmail.com
authors.forename: Francisco
authors.initials: F
authors.lastname: Rodriguez-Panadero
authors.forename: Beatriz
authors.initials: B
authors.lastname: Romero-Romero
mesh_terms: D015415:Biomarkers / Q000032:analysis; D003952:Diagnostic Imaging / Q000379:methods; D006801:Humans; D025202:Molecular Diagnostic Techniques / Q000379:methods; D050997:Nanomedicine / Q000379:methods; D016066:Pleural Effusion, Malignant / Q000175:diagnosis*
chemical_list: D015415:Biomarkers