Thoracic ultrasound as a predictor of pleurodesis success at the time of indwelling pleural catheter removal

Abstract

Background and objective: IPC in patients with MPE are removed within 3 months in 30-58% of cases, usually due to decreased pleural fluid output as a result of pleurodesis. Disease control can also account for the lack of fluid output, potentially explaining why 4-14% of patients undergo repeat pleural intervention for fluid re-accumulation (at the time of disease recurrence or progression). The aim of our pilot study is to determine the accuracy of thoracic ultrasound (TUS) in predicting pleurodesis success in patients with MPE at the time of IPC removal. Methods: This is a single-centre, prospective observational cohort study that enrolled consecutive patients with confirmed MPE treated with IPC at the time of IPC removal. TUS was performed to calculate a PAS. Patients were followed up for a minimum of 3 months. Failure was defined as pleural fluid recurrence within 3 months. Results: Twenty-seven patients were screened and 25 were included in the final analysis. Pleurodesis success was observed in 88% (n = 22) and failure in 12% (n = 3) of patients. The mean PAS was higher in patients with pleurodesis success (22.0 vs 9.3, P = 0.01). A PAS greater than 10 predicted pleurodesis success with a sensitivity of 100% and specificity of 86%. Conclusion: This pilot study suggests that TUS at the time of IPC removal accurately identifies patients who have achieved pleurodesis and therefore will not have re-accumulation of pleural effusion or require an ipsilateral pleural intervention for at least 3 months post-IPC removal.

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

“…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. These results agreed with the current study.…”

Ambulatory Thoracoscopic Pleurodesis Combined With Indwelling Pleural Catheter in Malignant Pleural Effusion

“…Our study was limited by its retrospective design and small sample size. Moreover, despite using ultrasound to assess for evidence of pleurodesis, a validated protocol such as that published by Chaddha et al was not utilized ( 14 ). Consequently, the possibility that the resolution of effusion was due to disease control could not be excluded and future trials should be designed to address these factors.…”

Role of thoracic ultrasonography in pleurodesis pathways for malignant pleural effusions (SIMPLE): an open-label, randomised controlled trial

“…The absence of lung sliding on TUS within 24 hours of talc slurry pleurodesis in patients with MPE was a predictor of pleurodesis success at one month 16 . Similarly, in patients with MPE who presented for IPC removal due to cessation of drainage, the presence of lung sliding was a predictor of fluid re-accumulation and need for further procedures within three months 17 . This randomised controlled trial aimed to investigate whether the use of TUS before and after pleurodesis, in comparison to current BTS guideline management, could shorten length of hospital stay (primary outcome) without reducing overall pleurodesis success at three months, and the time to chest tube removal, use of healthcare resources, cost-effectiveness of the procedure, symptoms and quality of life in the study groups (secondary outcomes).…”