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

Salamonsen, Matthew R., Lo, Ada K. C., Ng, Arnold C. T., Bashirzadeh, Farzad, Wang, William Y. S. and Fielding, David I. K. (2014) Novel use of pleural ultrasound can identify malignant entrapped lung prior to effusion drainage. Chest, 146 5: 1286-1293. doi:10.1378/chest.13-2876

Author Salamonsen, Matthew R.
Lo, Ada K. C.
Ng, Arnold C. T.
Bashirzadeh, Farzad
Wang, William Y. S.
Fielding, David I. K.
Title Novel use of pleural ultrasound can identify malignant entrapped lung prior to effusion drainage
Journal name Chest   Check publisher's open access policy
ISSN 1931-3543
Publication date 2014-11-01
Sub-type Article (original research)
DOI 10.1378/chest.13-2876
Open Access Status Not Open Access
Volume 146
Issue 5
Start page 1286
End page 1293
Total pages 8
Place of publication Glenview, IL United States
Publisher American College of Chest Physicians
Language eng
Formatted abstract
BACKGROUND: 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. Our objectives were to develop a method to identify entrapped lung using tissue movement and deformation (strain) analysis with ultrasonography and compare it to the existing technique of pleural elastance (PEL).

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 analyzed using motion mode (M mode) and speckle-tracking imaging, respectively. PEL was measured during effusion drainage. The gold-standard diagnosis of entrapped lung was the consensus opinion of two interventional pulmonologists according to postdrainage imaging. Participants were randomly divided into development and validation sets.

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 (M mode), and 0.69 (PEL). Using respective cutoffs of 6%, 1 mm, and 19 cm H2O on the validation set, the sensitivity/specificity was 71%/85% (speckle tracking), 50%/85% (M mode), and 40%/100% (PEL).

CONCLUSIONS: This novel ultrasound technique can identify entrapped lung prior to effusion drainage, which could allow appropriate choice of definitive management (pleurodesis vs indwelling catheter), reducing the number of interventions required to treat malignant pleural effusion.
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status Unknown

Document type: Journal Article
Sub-type: Article (original research)
Collections: School of Medicine Publications
Centre for Advanced Imaging Publications
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Citation counts: TR Web of Science Citation Count  Cited 12 times in Thomson Reuters Web of Science Article | Citations
Scopus Citation Count Cited 11 times in Scopus Article | Citations
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Created: Mon, 14 Dec 2015, 17:59:41 EST by William Wang on behalf of Medicine - Princess Alexandra Hospital