Diagnostic accuracy of lung ultrasound with elastography in predicting malignant origin of pleural effusions in an emergency department

IF 0.8 Q4 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING Ultrasound Pub Date : 2023-09-09 DOI:10.1183/13993003.congress-2023.pa1824
Rune Wiig, Casper Falster, Niels Jacobsen, Stefan Posth, August Emil Licht, Christian Laursen
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Abstract

Aims: Ultrasound is a valuable diagnostic tool in the diagnostic work-up of dyspnea and can identify even small pleural effusions. Incorporating Shear Wave Elastography (SWE) represents a possible tool in stratifying pleural effusions by risk of underlying malignancy. No previous studies have been conducted in an emergency department (ED), where it might have a clinical impact by hastening referral for diagnostic work-up of underlying malignancy. The aim of this study was to appraise the diagnostic accuracy of ultrasonographic findings associated with thoracic malignancy, as well as calculating optimal cut-off values for SWE in this regard. Methods: Patients with unilateral pleural effusion of unknown origin were included in the ED and subjected to a Focused Lung Ultrasound (FLUS) scan during their first 48 hours after admittance. Two index tests were applied: i) traditional 2D FLUS examination registering presence of diaphragmatic noduli, pleural thickenings and other findings associated with malignancy, and ii) a SWE examination of different Regions of Interest. Reference test was defined as subsequent diagnosis of malignant pleural effusion (MPE) in the three months following inclusion. Results: 39 patients were included. The 2D index test yielded a sensitivity of 28.57% (95%CI 3.67-70.96%) and a specificity of 90.62% (95%CI 74.98%-98.02%). The SWE max of intercostal space yielded a sensitivity of 100% (95%CI 47.82-100%) and a specificity of 59.09% (95%CI 36.35%-79.29%). Conclusion: FLUS with integrated SWE may aid in identifying MPE9s and improving referral to diagnostic work-up of underlying malignancy. Larger adequately powered studies are warranted.
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肺超声弹性成像预测急诊科胸腔积液恶性来源的准确性
目的:超声在呼吸困难的诊断工作中是一种有价值的诊断工具,甚至可以识别少量的胸腔积液。结合横波弹性成像(SWE)是一种可能的工具,在分层的潜在恶性肿瘤的风险胸膜积液。以前没有在急诊科(ED)进行的研究,在那里它可能通过加速转诊诊断潜在恶性肿瘤的临床影响。本研究的目的是评估超声检查结果与胸部恶性肿瘤的诊断准确性,并计算SWE在这方面的最佳临界值。方法:将来历不明的单侧胸腔积液患者纳入急诊科,并在入院后48小时内接受肺部聚焦超声(FLUS)扫描。应用了两种指标测试:i)传统的二维超声检查显示膈结节、胸膜增厚和其他与恶性肿瘤相关的发现,ii)不同感兴趣区域的超声检查。参考试验定义为入选后三个月内诊断为恶性胸腔积液(MPE)。结果:纳入39例患者。2D指标检测的灵敏度为28.57% (95%CI 3.67 ~ 70.96%),特异性为90.62% (95%CI 74.98% ~ 98.02%)。肋间隙SWE max的敏感性为100% (95%CI 47.82 ~ 100%),特异性为59.09% (95%CI 36.35% ~ 79.29%)。结论:流感合并SWE可能有助于识别mpe9,并改善对潜在恶性肿瘤的诊断检查。更大规模的充分有力的研究是有必要的。
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来源期刊
Ultrasound
Ultrasound RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING-
CiteScore
1.70
自引率
0.00%
发文量
55
期刊介绍: Ultrasound is the official journal of the British Medical Ultrasound Society (BMUS), a multidisciplinary, charitable society comprising radiologists, obstetricians, sonographers, physicists and veterinarians amongst others.
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