Comparative Evaluation of Chest Ultrasonography and Computed Tomography as Predictors of Malignant Pleural Effusion: A Prospective Study.
Samah M ShehataYassir Edrees AlmalkiMohammad Abd Alkhalik BashaRasha Mohamed HendyEman M MahmoudMarwa Elsayed Abd ElhamedSharifa Khalid AlduraibiMervat AboualkheirZiyad A AlmushaytiAlaa Khalid AlduraibiAhmed M Abdelkhalik BashaMaha E AlsadikPublished in: Diagnostics (Basel, Switzerland) (2024)
Malignant pleural effusion (MPE) is a manifestation of advanced cancer that requires a prompt and accurate diagnosis. Ultrasonography (US) and computed tomography (CT) are valuable imaging techniques for evaluating pleural effusions; however, their relative predictive ability for a malignant origin remains debatable. This prospective study aimed to compare chest US with CT findings as predictors of malignancy in patients with undiagnosed exudative pleural effusion. Fifty-four adults with undiagnosed exudative pleural effusions underwent comprehensive clinical evaluation including chest US, CT, and histopathologic biopsy. Blinded radiologists evaluated the US and CT images for features suggestive of malignancy, based on predefined criteria. Diagnostic performance measures were calculated using histopathology as a reference standard. Of the 54 patients, 33 (61.1%) had MPEs confirmed on biopsy. No significant differences between US and CT were found in detecting parietal pleural abnormalities, lung lesions, chest wall invasion, or liver metastasis. US outperformed CT in identifying diaphragmatic pleural thickening ≥10 mm (33.3% vs. 6.1%, p < 0.001) and nodularity (45.5% vs. 3%, p < 0.001), whereas CT was superior for mediastinal thickening (48.5% vs. 15.2%, p = 0.002). For diagnosing MPE, diaphragmatic nodularity detected by US had 45.5% sensitivity and 100% specificity, whereas CT mediastinal thickening had 48.5% sensitivity and 90.5% specificity. Both US and CT demonstrate reasonable diagnostic performance for detecting MPE, with particular imaging findings favoring a malignant origin. US may be advantageous for evaluating diaphragmatic pleural involvement, whereas CT is more sensitive to mediastinal abnormalities.
Keyphrases
- computed tomography
- dual energy
- contrast enhanced
- image quality
- positron emission tomography
- magnetic resonance imaging
- magnetic resonance
- lymph node
- end stage renal disease
- clinical evaluation
- ejection fraction
- deep learning
- clinical trial
- advanced cancer
- study protocol
- machine learning
- newly diagnosed
- peritoneal dialysis
- fluorescence imaging
- mass spectrometry
- double blind
- prognostic factors