Study objective: To evaluate the efficacy of small-bore
(12 French vanSonnenberg) catheters compared with standard large-bore
chest tubes in the drainage and sclerotherapy of malignant pleural
Design: Retrospective review.
Setting: An academic tertiary care hospital.
Patients: Adult patients with documented neoplasms and
malignant pleural effusions, treated between 1986 and 1995.
Intervention: All patients included in the study underwent
drainage of malignant pleural effusions either by large-bore chest tube
or by ultrasound-guided small-bore catheter. After drainage,
pleurodesis was performed.
Results: Outcome as defined
by recurrence of effusion was determined by blinded examination of all
postpleurodesis chest radiographs. We identified 58 cases of malignant
pleural effusion in which small-bore catheters were used and 44 in
which large-bore chest tubes were used. The majority of patients had
breast (n = 56, 55%) or lung cancer (n = 29, 28%). The median age
was 65 years. Fifty-nine patients were actively being treated with
chemotherapy at the time of pleurodesis. The following sclerosing
agents were used: talc, 27 (26%); tetracycline, 72 (70%); bleomycin,
2 (2%); and interferon, 1 (1%). Actuarial probabilities of recurrence
at 6 weeks and 4 months were 45% and 53% for the small tubes vs 45%
and 51% for the large tubes. Univariate and multivariate analyses
failed to demonstrate that tube size had any influence on the rate of
Conclusions: We were unable to detect any
major differences in outcomes with the use of either size of chest
tube. Our study suggests that small-bore catheters may be effective in
the treatment of malignant pleural effusions and deserve further
evaluation in prospectively designed trials.