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Comment & Response
May 12, 2020

Delivery of Talc for Pleurodesis of Malignant Pleural Effusions

Author Affiliations
  • 1Department of Thoracic Surgery, University of Lorraine, Vandoeuvre-lès-Nancy, France
JAMA. 2020;323(18):1855. doi:10.1001/jama.2020.3265

To the Editor Dr Bhatnagar and colleagues1 examined the effect of thoracoscopic talc poudrage vs talc slurry on pleurodesis in individuals with malignant pleural effusions and found no significant differences between the procedures. We have a number of concerns about the study.

The term thoracoscopic talc poudrage usually refers to video-assisted thoracoscopic surgery and not to medical thoracoscopy, as described in the study, which may be confusing for readers. Furthermore, the type of procedure performed by the authors was not clearly described in the Methods section, suggesting that a range of techniques was used (including rigid, semi-rigid, and flexible medical thoracoscopy) with variation in efficiency.2 This hypothesis is reinforced by the multi-institutional design of the study and could lead to possible bias.