Is thoracoscopic talc pleurodesis really safe?

Talc is a mineral defined as hydrated magnesium silicate in its pure form. It is mined in open pits throughout the world. For induction of chemical pleurodesis, talc has been shown to be superior to all other products. The safety of the use of talc for pleurodesis is subject to discussion in the literature. In early days, there was concern about asbestos contamination of talc, which could cause mesothelioma in patients who had undergone talc pleurodesis. The long-term safety of talc was proven in several studies, and today talc for pharmaceutical use is asbestos-free. Today the discussion is concentrated on the early complications of talc; Acute respiratory failure, sometimes with fatal outcome, has been attributed to the intrapleural use of talc particles. In recent animal studies, a relation was demonstrated between the size of talc particles and pulmonary injury as well as dissemination to other organs. Pulmonary injury and dissemination to other organs are related to a talc particle size of less than 10 micro. With certain precautions, talc can be used safely for pleurodesis; Simultaneous bilateral procedures, concomitant pulmonary biopsies and use of more than 5 grams of talc should be avoided. As long as the hypothesis about the influence of particle size on complications has not been confirmed by studies in humans, the use of talc with a large mean particle diameter is to be preferred.