2018 Nov - Thoracic Ultrasound as an Early Predictor of Pleurodesis Success in Malignant Pleural Effusion
John P. Corcoran, BMBCh, Robert J. Hallifax, DPhil, Rachel M. Mercer, MBChB, Ahmed Yousuf, MBChB, Rachelle Asciak, MD, Maged Hassan, MBChB, Hania E. Piotrowska, BA, Ioannis Psallidas, PhD, Najib M. Rahman, DPhil
Chest 2018;154(5):1115–1120
Background
Malignant pleural effusion (MPE) is common and imposes a significant burden on patients and health-care providers. Most patients require definitive treatment, usually drainage and chemical pleurodesis, to relieve symptoms and prevent fluid recurrence. Thoracic ultrasound (TUS) can identify the presence of pleural adhesions in other clinical scenarios, and could therefore have a role in predicting long-term pleurodesis success or failure in MPE.
Methods
Patients undergoing chest tube drainage and talc slurry pleurodesis for symptomatic MPE were recruited to a prospective observational cohort pilot study assessing whether TUS findings pre-talc and post-talc instillation predicted treatment outcome. Participants underwent TUS examination immediately before, and 24 h after talc slurry administration to derive pleural adherence scores for the affected hemithorax. The recorded TUS scans were additionally scored by two independent assessors blinded to the patient’s clinical status. The primary outcome was pleurodesis success at 1-month and 3-month follow-up.
Results
Eighteen participants were recruited to the pilot study. Participants who suffered pleurodesis failure had a lower pleural adherence score at 24 h post-talc instillation than those who were successful (difference of 6.27; 95% CI, 3.94-8.59). TUS examination was acceptable to patients, while TUS scoring was highly consistent across all assessors (intraclass correlation coefficient, 0.762; 95% CI, 0.605-0.872).
Conclusion
A TUS-derived pleural adherence score may facilitate early prediction of long-term outcomes following chemical pleurodesis, with implications for personalized care and decision making in MPE. Further research is needed to evaluate this novel finding.
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