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Shehata SM, Almalki YE, Basha MAA, Hendy RM, Mahmoud EM, Abd Elhamed ME, Alduraibi SK, Aboualkheir M, Almushayti ZA, Alduraibi AK, Basha AMA, Alsadik ME. Comparative Evaluation of Chest Ultrasonography and Computed Tomography as Predictors of Malignant Pleural Effusion: A Prospective Study. Diagnostics (Basel) 2024; 14:1041. [PMID: 38786339 PMCID: PMC11120087 DOI: 10.3390/diagnostics14101041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Revised: 05/14/2024] [Accepted: 05/16/2024] [Indexed: 05/25/2024] Open
Abstract
Malignant pleural effusion (MPE) is a manifestation of advanced cancer that requires a prompt and accurate diagnosis. Ultrasonography (US) and computed tomography (CT) are valuable imaging techniques for evaluating pleural effusions; however, their relative predictive ability for a malignant origin remains debatable. This prospective study aimed to compare chest US with CT findings as predictors of malignancy in patients with undiagnosed exudative pleural effusion. Fifty-four adults with undiagnosed exudative pleural effusions underwent comprehensive clinical evaluation including chest US, CT, and histopathologic biopsy. Blinded radiologists evaluated the US and CT images for features suggestive of malignancy, based on predefined criteria. Diagnostic performance measures were calculated using histopathology as a reference standard. Of the 54 patients, 33 (61.1%) had MPEs confirmed on biopsy. No significant differences between US and CT were found in detecting parietal pleural abnormalities, lung lesions, chest wall invasion, or liver metastasis. US outperformed CT in identifying diaphragmatic pleural thickening ≥10 mm (33.3% vs. 6.1%, p < 0.001) and nodularity (45.5% vs. 3%, p < 0.001), whereas CT was superior for mediastinal thickening (48.5% vs. 15.2%, p = 0.002). For diagnosing MPE, diaphragmatic nodularity detected by US had 45.5% sensitivity and 100% specificity, whereas CT mediastinal thickening had 48.5% sensitivity and 90.5% specificity. Both US and CT demonstrate reasonable diagnostic performance for detecting MPE, with particular imaging findings favoring a malignant origin. US may be advantageous for evaluating diaphragmatic pleural involvement, whereas CT is more sensitive to mediastinal abnormalities.
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Affiliation(s)
- Samah M. Shehata
- Department of Chest Disease, Faculty of Human Medicine, Zagazig University, Zagazig 44519, Egypt; (S.M.S.); (M.E.A.)
| | - Yassir Edrees Almalki
- Division of Radiology, Department of Internal Medicine, Medical College, Najran University, Najran 61441, Saudi Arabia
| | - Mohammad Abd Alkhalik Basha
- Department of Diagnostic Radiology, Faculty of Human Medicine, Zagazig University, Zagazig 44519, Egypt; (M.A.A.B.); (M.E.A.E.)
| | - Rasha Mohamed Hendy
- Department of Chest Disease, Faculty of Human Medicine, Benha University, Benha 13511, Egypt;
| | - Eman M. Mahmoud
- Department of Chest Disease, Faculty of Human Medicine, Port Said University, Port Said 42511, Egypt;
| | - Marwa Elsayed Abd Elhamed
- Department of Diagnostic Radiology, Faculty of Human Medicine, Zagazig University, Zagazig 44519, Egypt; (M.A.A.B.); (M.E.A.E.)
| | - Sharifa Khalid Alduraibi
- Department of Radiology, College of Medicine, Qassim University, Buraidah 52571, Saudi Arabia; (S.K.A.); (Z.A.A.); (A.K.A.)
| | - Mervat Aboualkheir
- Department of Internal Medicine, College of Medicine, Taibah University, Madinah 42353, Saudi Arabia;
| | - Ziyad A. Almushayti
- Department of Radiology, College of Medicine, Qassim University, Buraidah 52571, Saudi Arabia; (S.K.A.); (Z.A.A.); (A.K.A.)
| | - Alaa K. Alduraibi
- Department of Radiology, College of Medicine, Qassim University, Buraidah 52571, Saudi Arabia; (S.K.A.); (Z.A.A.); (A.K.A.)
| | | | - Maha E. Alsadik
- Department of Chest Disease, Faculty of Human Medicine, Zagazig University, Zagazig 44519, Egypt; (S.M.S.); (M.E.A.)
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Kent BD. Diagnosing and managing pleural disease. Breathe (Sheff) 2023; 19:230230. [PMID: 38127543 PMCID: PMC10729826 DOI: 10.1183/20734735.0230-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 11/30/2023] [Indexed: 12/23/2023] Open
Abstract
This issue of Breathe focuses on the management of pleural disease https://bit.ly/4a7dh1S.
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Affiliation(s)
- Brian D. Kent
- Dept of Respiratory Medicine, St James’ Hospital, Dublin, Ireland
- School of Medicine, Trinity College Dublin, Dublin, Ireland
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