Outcome of ultrasound-guided, single session pleurodesis in malignant pleural effusion

Abstract

Background Chemical pleurodesis is frequently indicated to relieve symptoms imposed by large/recurrent malignant pleural effusion (MPE). Traditionally, a drain is left in the pleural space till the cessation of fluid accumulation before pleurodesis. Chest ultrasound can detect an amount of pleural fluid as less as 50 ml and can confirm apposition of the pleural surfaces which is required for successful pleurodesis. This work assessed the efficiency and safety of ultrasound-guided, single-session pleurodesis in cases with MPE. Results Seventeen of the patients completed a 2-month follow-up. The technique demonstrated a high success rate (88.2%). The mean duration from the start of pleural drainage till pleurodesis was 1.65 ± 0.70 h ranging from 1 to 3 h. A duration of 2.5 h or less was statistically proposed as a cutoff value not to exceed to predict success (sensitivity 100%, specificity 100%). The mean time for total hospital stay related to pleurodesis was 9.88 ± 3.12 h (range 4–12 h). No complications attributed to the procedure were recorded. Pleural Adherence Score and Absent Sliding Score (ASS) had a highly statistically significant correlation (p value < 0.001). Conclusions An ultrasound-guided completion of the process of pleurodesis in a single session with a shorter duration of pleural fluid drainage and shorter hospital stay (can be done on a day-care basis) is efficient, safe, and cost-effective. This technique is strongly recommended to replace the traditional practice of keeping the indwelling pleural drain for several days waiting for the cessation of pleural fluid reaccumulation. An ultrasound-derived ASS can be used as early as day 1 and day 15 to confirm pleural adherence and to expect the outcome of pleurodesis.

Transthoracic sonographic scores in evaluating the success of different scelerosing modalities in patients with malignant pleural effusion

“…These results agreed with Farouk et al [32] who found that 60% of patients with MPE were males and 57% patients were smokers. To the contrary, Magdy and Hieba [14] reported that 75% were females, and this discrepancy as regards gender in comparison to our study may be attributed to their small sample size.…”

“…Also, in concordance, Farouk et al [32] found a significant reduction (p˂0.001) in lung sliding among all scanned areas by TUS after povidone iodine pleurodesis. One month after pleurodesis, the iodopovidone group showed the lowest mean lung sliding score in comparison to the spontaneous, tetracycline solution, and tetracycline powder groups (3.35±1.8, p=0.031) Magdy and Hieba [14] illustrated that 2 weeks after doxycycline pleurodesis, absent lung sliding in more than 6 areas was found in 58.8% of cases and mentioned 14.27 ± 2.02 mean Pleural Adherence Score in cases of successful pleurodesis and Pleural Adherence Score of ≥11 after 24h from pleurodesis had sensitivity 93% and 50% specificity. Chaddha et al [37] agreed to the current results and illustrated a Pleural Adherence Score ˃ 10 showed a sensitivity of 100% and specificity of 86% for the prediction of pleurodesis success.…”

“…The scanned hemithorax was subdivided into eight areas; infraclavicular, mammary, and inframammary areas on the front; upper and lower axillary areas laterally; and suprascapular, infrascapular, and interscapular areas on the back [7,14,15].…”

“…It was estimated in eight zones (upper, lower, and middle zones in the anterior and posterior chest wall; lower and upper zones in the lateral chest wall) throughout the scanned hemithorax by TUS. It was recorded 24 h after pleurodesis [6,14].…”