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Iglesias Heras M, Juárez Moreno E, Ortiz de Saracho Bobo J, Cascón Hernández J, Fernández García-Hierro JM, Yagüe Zapatero E, Cordovilla Pérez R. Usefulness of thoracic ultrasound in the assessment of removal of indwelling pleural catheter in patients with malignant pleural effusion. RADIOLOGIA 2024; 66 Suppl 1:S24-S31. [PMID: 38642957 DOI: 10.1016/j.rxeng.2023.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Accepted: 04/20/2023] [Indexed: 04/22/2024]
Abstract
INTRODUCTION There are no defined criteria for deciding to remove a non-functioning indwelling pleural catheter (IPC) when lung re-expansion on chest X-ray is incomplete. Chest computed tomography (chest CT) is usually used. The objective of this work is to validate the usefulness of chest ultrasound performed by a pulmonologist and by a radiologist compared to chest CT. PATIENTS AND METHODS Prospective, descriptive, multidisciplinary and multicenter study including patients with malignant pleural effusion and non-functioning IPC without lung reexpansion. Decisions made on the basis of chest ultrasound performed by a pulmonologist, and performed by a radiologist, were compared with chest CT as the gold standard. RESULTS 18 patients were analyzed, all of them underwent ultrasound by a pulmonologist and chest CT and in 11 of them also ultrasound by a radiologist. The ultrasound performed by the pulmonologist presents a sensitivity of 60%, specificity of 100%, PPV 100% and NPV 66% in the decision of the correct removal of the IPC. The concordance of both ultrasounds (pulmonologist and radiologist) was 100%, with a kappa index of 1. The 4 discordant cases were those in which the IPC was not located on the ultrasound. CONCLUSIONS Thoracic ultrasound performed by an expert pulmonologist is a valid and simple tool to determine spontaneous pleurodesis and remove a non-functioning IPC, which would make it possible to avoid chest CT in those cases in which lung reexpansion is observed with ultrasonography.
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Affiliation(s)
- M Iglesias Heras
- Servicio de Neumología, Hospital Universitario de Salamanca, Salamanca. Spain.
| | - E Juárez Moreno
- Servicio de Neumología, Hospital El Bierzo, Ponferrada, León, Spain
| | | | - J Cascón Hernández
- Servicio de Neumología, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | | | - E Yagüe Zapatero
- Servicio de Radiodiagnóstico, Hospital El Bierzo, Ponferrada, León, Spain
| | - R Cordovilla Pérez
- Servicio de Neumología, Hospital Universitario de Salamanca, Salamanca. Spain
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Kim SJ, Azour L, Moore WH. Pleural Disease: A Review for the General Radiologist. APPLIED RADIOLOGY 2020. [DOI: 10.37549/ar2689] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Petrella F, Maisonneuve P, Borri A, Casiraghi M, Donghi S, Durkovic S, Filippi N, Galetta D, Gasparri R, Guarize J, Lo Iacono G, Mariolo AV, Tessitore A, Spaggiari L. Pleural catheters after thoracoscopic treatment of malignant pleural effusion: a randomized comparative study on quality of life. J Thorac Dis 2018; 10:2999-3004. [PMID: 29997967 DOI: 10.21037/jtd.2018.05.49] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Background Malignant pleural effusion (MPE) complicates many neoplasms and its incidence is expected to rise in parallel with the aging population and longer survival of cancer patients. Although a clear consensus exists on indwelling catheters in patients with poor performance status, no study has hitherto compared different devices in patients requiring temporary or definitive drainage following talc poudrage. Methods This is a prospective, two-arm, pilot study on patients with MPE undergoing talc poudrage, comparing two different catheters (PleurX® versus Pleurocath®) positioned because of the inefficacy of the procedure or the high risk of short-term failure. End points of the study were quality of life (QoL), median dyspnea and chest pain assessment by EORTC questionnaires and a 100 mm visual analog scale, total in-hospital length of stay and frequency of serious adverse events. Results No difference was observed between the two groups in in mean dyspnea and mean chest pain in any questions of the EORTC QLQ-C30 and QLQ-LC13 questionnaires. Duration of the procedure was significantly longer in the PleurX® group versus the Pleurocath® group (72±33 versus 44±13 minutes; P=0.03). No difference was observed between the two groups in total length of hospital stay (P=1.00) or complication rate (P=1.00). Conclusions For the cohort of patients still needing indwelling pleural catheters (PC) after thoracoscopic talc poudrage, PleurX® is suggested when drain removal is unlikely due to short life expectancy or the high chance of pleurodesis failure. Conversely, Pleurocath® should be recommended in all other patients as it is faster to place and easier to remove. Keywords Malignant pleural effusion (MPE); talc poudrage; indwelling pleural catheter (indwelling PC).
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Affiliation(s)
- Francesco Petrella
- Department of Thoracic Surgery, European Institute of Oncology, Milan, Italy.,Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
| | - Patrick Maisonneuve
- Division of Epidemiology and Biostatistics, European Institute of Oncology, Milan, Italy
| | - Alessandro Borri
- Department of Thoracic Surgery, European Institute of Oncology, Milan, Italy
| | - Monica Casiraghi
- Department of Thoracic Surgery, European Institute of Oncology, Milan, Italy
| | - Stefano Donghi
- Department of Thoracic Surgery, European Institute of Oncology, Milan, Italy
| | - Sava Durkovic
- Department of Thoracic Surgery, European Institute of Oncology, Milan, Italy
| | - Niccolo Filippi
- Department of Thoracic Surgery, European Institute of Oncology, Milan, Italy
| | - Domenico Galetta
- Department of Thoracic Surgery, European Institute of Oncology, Milan, Italy
| | - Roberto Gasparri
- Department of Thoracic Surgery, European Institute of Oncology, Milan, Italy
| | - Juliana Guarize
- Department of Thoracic Surgery, European Institute of Oncology, Milan, Italy
| | - Giorgio Lo Iacono
- Department of Thoracic Surgery, European Institute of Oncology, Milan, Italy
| | | | - Adele Tessitore
- Department of Thoracic Surgery, European Institute of Oncology, Milan, Italy
| | - Lorenzo Spaggiari
- Department of Thoracic Surgery, European Institute of Oncology, Milan, Italy.,Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
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