Novel use of pleural ultrasound can identify malignant entrapped lung prior to effusion drainage.

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Novel use of pleural ultrasound can identify malignant entrapped lung prior to effusion drainage.

Chest. 2014 Jul 10;

Authors: Salamonsen MR, Lo AK, Ng AC, Bashirzadeh F, Wang WY, Fielding DI

Abstract
ABSTRACT: RationaleThe presence of entrapped lung changes the appropriate management of malignant pleural effusion from pleurodesis to insertion of an indwelling pleural catheter. No methods currently exist to identify entrapped lung prior to effusion drainage. ObjectivesTo develop a method to identify entrapped lung using tissue movement and deformation (strain) analysis with ultrasound, and compare it to the existing technique of pleural elastance. MethodsPrior to drainage, 81 patients with suspected malignant pleural effusion underwent thoracic ultrasound using an echocardiogram machine. Images of the atelectatic lower lobe were acquired during breath-hold, allowing motion and strain related to the cardiac impulse to be analysed using motion-mode and speckle-tracking imaging respectively. Pleural elastance was measured during effusion drainage. The gold standard diagnosis of entrapped lung was the consensus opinion of two interventional pulmonologists according to post-drainage imaging. Participants were randomly divided into development and validation sets. Measurements and Main ResultsBoth total movement and strain were significantly reduced in entrapped lung. Using data from the development set, the area under the receiver-operating curves for the diagnosis of entrapped lung was 0.86 (speckle-tracking), 0.79 (motion-mode) and 0.69 (pleural elastance). Using respective cut-offs of 6%, 1mm and 19cmH2O on the validation set, the sensitivity/specificity was 71%/85% (speckle-tracking), 50%/85% (motion mode) and 40%/100% (pleural elastance). ConclusionsThis novel ultrasound technique can identify entrapped lung prior to effusion drainage, which could allow appropriate choice of definitive management (pleurodesis versus indwelling catheter), reducing the number of interventions required to treat malignant pleural effusion.
Rationale: The presence of entrapped lung changes the appropriate management of malignant pleural effusion from pleurodesis to insertion of an indwelling pleural catheter. No methods currently exist to identify entrapped lung prior to effusion drainage.
Objectives: To develop a method to identify entrapped lung using tissue movement and deformation (strain) analysis with ultrasound, and compare it to the existing technique of pleural elastance.
Methods: Prior to drainage, 81 patients with suspected malignant pleural effusion underwent thoracic ultrasound using an echocardiogram machine. Images of the atelectatic lower lobe were acquired during breath-hold, allowing motion and strain related to the cardiac impulse to be analysed using motion-mode and speckle-tracking imaging respectively. Pleural elastance was measured during effusion drainage. The gold standard diagnosis of entrapped lung was the consensus opinion of two interventional pulmonologists according to post-drainage imaging. Participants were randomly divided into development and validation sets.
Measurements and Main Results: Both total movement and strain were significantly reduced in entrapped lung. Using data from the development set, the area under the receiver-operating curves for the diagnosis of entrapped lung was 0.86 (speckle-tracking), 0.79 (motion-mode) and 0.69 (pleural elastance). Using respective cut-offs of 6%, 1mm and 19cmH2O on the validation set, the sensitivity/specificity was 71%/85% (speckle-tracking), 50%/85% (motion mode) and 40%/100% (pleural elastance).
Conclusions: This novel ultrasound technique can identify entrapped lung prior to effusion drainage, which could allow appropriate choice of definitive management (pleurodesis versus indwelling catheter), reducing the number of interventions required to treat malignant pleural effusion.

PMID: 25010364 [PubMed - as supplied by publisher]

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