Diagnostic Accuracy of B-Mode- and Contrast-Enhanced Ultrasound in Differentiating Malignant from Benign Pleural Effusions.

Johanna Weide,Andreas Rembert Koczulla,Christoph Frank Dietrich,Christian Görg,Corinna Trenker,Ehsan Safai Zadeh

doi:10.3390/diagnostics11071293

Abstract

Purpose: To evaluate the value of CEUS in differentiating malignant from benign pleural effusions (PEs). Methods: From 2008 to 2017, 83 patients with PEs of unknown cause were examined using B-mode thoracic ultrasound (B-TUS), CEUS, and cytological examination. The extent of enhancement of the pleural thickening, the presence of enhancement of septa or a solid mass within the PE, and the homogeneity of the enhancement in the associated lung consolidation, were examined. Subsequently, the diagnostic value of cytology, B-TUS, and CEUS in differentiating malignant from benign PEs was determined. Results: With CEUS, markedly enhanced pleural thickening and inhomogeneous enhanced lung consolidation were significantly more frequently associated with malignancy (p < 0.05). In the subgroup analysis, the use of CEUS increased the sensitivity from 69.2 to 92.3 in patients with initial negative cytology but clinical suspicion of malignant PE; it also increased the specificity from 63.0 to 90.0, the positive predictive value from 69.2 to 92.3, the negative predictive value from 63.0 to 90.0, and the diagnostic accuracy from 66.7 to 87.5, in the evaluation of PE malignancy. Conclusion: The use of clinically based B-TUS and CEUS as a complementary method to cytological evaluation may be beneficial for evaluating a PE of unknown cause. CEUS patterns of enhanced pleural thickening and inhomogeneous enhanced lung consolidation may suggest a malignant PE.

Highlights

In addition to contrastenhanced computed tomography (CT), B-mode thoracic ultrasound (B-TUS) is widely used as a cost-effective method without radiation exposure for the evaluation of pleural effusions (PEs) [1,9,15]
We investigated the diagnostic accuracy of B-TUS and contrast-enhanced ultrasound (CEUS) for 83 patients with PEs of unknown cause
We investigated the diagnostic value of B-TUS and CEUS for evaluating PE malignancy in all the patients, as well as in a subgroup of 24 with initial negative cytology and clinical suspicion of malignant PE

Summary

Introduction

B-mode thoracic ultrasound (B-TUS) plays an important role in the assessment of pleural and pulmonary pathologies [1]. Due to its high sensitivity, absence of radiation exposure, and easy availability, B-TUS is the method of choice for detecting pleural effusions (PEs) [1,2]. Pleural effusions have many different causes, which may be benign or malignant [3]. For malignant PEs, the cytological examination obtained by ultrasound-guided thoracocentesis is the key to diagnosis, but it has variable sensitivity from 45.5% to 87.9%, depending on the type of disease [4]. Repeated specimen collection, invasive procedures such as pleural biopsy, and, thoracoscopy are recommended for improving the diagnosis if the first specimen does not provide a definitive diagnosis [5,6,7]

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Methods

Conclusion