Preoperative Lung Ultrasound to Detect Pleural Adhesions: A Systematic Review and Meta-Analysis

Abstract

The usage of lung ultrasound as a preoperative examination for thoracic surgeries remains controversial. Our systematic review and meta-analysis aimed to evaluate preoperative lung ultrasound diagnostic accuracy for detecting pleural adhesions. We searched articles published in MEDLINE, Embase, CENTRAL, and the International Clinical Trials Registry Platform until October 2020. Inclusion criteria were observational studies, case-control studies, and case series assessing preoperative lung ultrasound diagnostic accuracy. The study quality of included articles was evaluated using the modified quality assessment of diagnostic accuracy studies-2 tool. The pooled sensitivity and specificity were calculated using the bivariate random-effects model. The overall quality of evidence was summarized using the grading of recommendations, assessment, development, and evaluation approach. Eleven articles were included in our systematic review. A high risk of bias was noted regarding undefined pleural adhesions and non-predefined pathological diagnosis. Based on the ten articles included for meta-analysis, the pooled sensitivity and specificity were 71% [95% confidence interval (CI), 56%-82%], and 96% (95% CI, 89%-99%), respectively. The overall quality of evidence was moderate. Our systematic review revealed that lung ultrasound had high specificity. It may serve as a rule-in test for detecting pleural adhesions before thoracic surgeries, which may assist surgeons in preparation for a prolonged surgery or increased risk of complications that occurred by trocar insertion such as bleeding and persistent air leak.

Preoperative detection of pleural adhesions using dynamic chest radiography: prospective analysis

“…On the other hand, the utility of preoperative lung ultrasound is also reported useful to detect pleural adhesions (24)(25)(26). A systematic review by Shiroshita et al showed very good results with the sensitivity of 70% and the specificity of 96% using ultrasound (24). Sasaki et al reported the negative predictive value of 87.7% and the positive predictive value of 50.0% (25).…”

“…We determined DCR to have a high specificity and negative predictive value, and the results of the examination was equal to or better than that of dynamic CT or dynamic MRI ( 19 , 20 ). On the other hand, the utility of preoperative lung ultrasound is also reported useful to detect pleural adhesions ( 24 - 26 ). A systematic review by Shiroshita et al showed very good results with the sensitivity of 70% and the specificity of 96% using ultrasound ( 24 ).…”

Potential of dynamic chest radiography for preoperative evaluation of pleural adhesions

“…The options available for accurately diagnosing pleural adhesions are limited. To date, transthoracic ultrasound (US) ( 3 ), respiratory dynamic computed tomography (CT) ( 4 - 6 ), and dynamic cine magnetic resonance imaging (MRI) ( 7 - 9 ) have been proposed as diagnostic methods for pleural adhesions. However, these imaging modalities have constraints that make their universal application in preoperative testing impractical.…”