19. Diagnostic performance of lung ultrasound in detecting pneumothorax after CT- Guided transthoracic biopsy

Mai Thi Ngoc, Dam Thuy Trang, Nguyen Thi Thu Thao, Nguyen Thi Khoi, Nguyen Thanh Thuy, Nguyen Phuong Anh, Vu Dang Luu

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Abstract

This study aimed to describe the diagnostic performance of lung ultrasound (LUS) in detecting and semi-quantifying pneumothorax (PTX), using computed tomography (CT) as the reference standard. The study included 150 patients who underwent CT-guided transthoracic biopsy (TTB) for lung lesions. Within 30 minutes, two radiologists blinded to the participant’s prior information performed LUS in asymptomatic patients. The results showed that PTX was present on CT in 49/150 (32.3%) cases. LUS was positive in 40/150 (26.7%) patients, with a substantial agreement between the two radiologists (Cohen κ statistics = 0.8). The sensitivity and specificity of LUS were 100% (95%CI 97.6% to 100%) and 91.8% (95%CI 87.4% to 96.2%), respectively. Moreover, the positive and negative predictive values were 87.5% (95%CI 82.2% to 92.8%) and 96.4% (95%CI 92.4% to 98.9%), respectively. In the semi-quantification of PTX by LUS, the location of lung point was described in 36/49 (73.5%) patients. The sensitivity and specificity of this sign were 87.5% (95%CI 82.2% to 92.8%) and 96.4% (95%CI 92.4% to 98.9%), respectively. The positive and negative predictive values were 87.5% (95%CI 82.2% to 92.8%) and 96.4% (95%CI 92.4% to 98.9%), respectively. In conclusion, LUS is a susceptible and specific diagnostic method for diagnosing and semi-quantifying PTX.

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References

1. Liao WY, Chen MZ, Chang YL, et al. US-guided transthoracic cutting biopsy for peripheral thoracic lesions less than 3 cm in diameter. Radiology. 2000; 217(3): 685-691. doi:10.1148/radiology.217.3.r00dc21685.
2. Vorwerk D. Percutaneous nonvascular thoracic interventions. Syllabus. 2000; 11: 235-6. Hally Project 1998–2000.
3. Morello FA, Wright KC, Lembo TM. New suction guide needle designed to reduce the incidence of biopsy-related pneumothorax: experimental evaluation in canine model. Radiology. 2005; 235(3): 1045-1049. doi:10.1148/ radiol.2353040433.
4. Kazerooni EA, Lim FT, Mikhail A, et al. Risk of pneumothorax in CT-guided transthoracic needle aspiration biopsy of the lung. Radiology. 1996; 198(2): 371-375. doi:10.1148/radiology.198.2.8596834.
5. Bobbio A, Dechartres A, Bouam S, et al. Epidemiology of spontaneous pneumothorax: gender-related differences. Thorax. 2015; 70(7): 653-658. doi:10.1136/thoraxjnl-2014-206577.
6. Abdulrahman Y, Musthafa S, Hakim SY, et al. Utility of extended FAST in blunt chest trauma: is it the time to be used in the ATLS algorithm? World J Surg. 2015; 39(1): 172-178. doi:10.1007/s00268-014-2781-y.
7. Soult MC, Weireter LJ, Britt RC, et al. Can routine trauma bay chest x-ray be bypassed with an extended focused assessment with sonography for trauma examination? Am Surg. 2015; 81(4): 336-340.
8. Lichtenstein DA. Ultrasound examination of the lungs in the intensive care unit: Pediatric Critical Care Medicine. 2009; 10(6): 693-698. doi:10.1097/PCC.0b013e3181b7f637.
9. Mayo PH, Beaulieu Y, Doelken P, et al. American College of Chest Physicians/La Société de Réanimation de Langue Française statement on competence in critical care ultrasonography. Chest. 2009; 135(4): 1050- 1060. doi:10.1378/chest.08-2305.
10. Lichtenstein DA. BLUE-Protocol and FALLS-Protocol. Chest. 2015; 147(6): 1659- 1670. doi:10.1378/chest.14-1313.
11. MacDuff A, Arnold A, Harvey J, et al. Management of spontaneous pneumothorax: British Thoracic Society pleural disease guideline 2010. Thorax. 2010; 65(Suppl 2):ii18- ii31. doi:10.1136/thx.2010.136986.
12. Department of Anaesthesiology and Intensive Care, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, UP, India, Danish M, Agarwal A, et al. Diagnostic Performance of 6-Point Lung Ultrasound in ICU Patients: A Comparison with Chest X-Ray and CT Thorax. Turk J Anaesthesiol Reanim. 2019; 47(4):307-319. doi:10.5152/TJAR.2019.73603
13. Lung Ultrasound Made Easy: Step-By-Step Guide. POCUS 101. Accessed October 4, 2022. https://www.pocus101.com/lung-ultrasound-made-easy-step-by-step-guide/
14. Chung MJ, Goo JM, Im JG, et al. Value of high-resolution ultrasound in detecting a pneumothorax. Eur Radiol. 2005; 15(5): 930- 935. doi:10.1007/s00330-004-2518-7.
15. Viglietta L, Inchingolo R, Pavano C, et al. Ultrasonography for the Diagnosis of Pneumothorax after Transbronchial Lung Cryobiopsy in Diffuse Parenchymal Lung Diseases. Respiration. 2017; 94(2): 232-236. doi:10.1159/000477818.
16. Sartori S, Tombesi P, Trevisani L, et al. Accuracy of transthoracic sonography in detection of pneumothorax after sonographically guided lung biopsy: prospective comparison with chest radiography. AJR Am J Roentgenol. 2007; 188(1): 37-41. doi:10.2214/AJR.05.1716.
17. Volpicelli G, Boero E, Sverzellati N, et al. Semi-quantification of pneumothorax volume by lung ultrasound. Intensive Care Med. 2014; 40(10): 1460-1467. doi:10.1007/s00134-014- 3402-9.
18. Oveland NP, Lossius HM, Wemmelund K, et al. Using Thoracic Ultrasonography to Accurately Assess Pneumothorax Progression During Positive Pressure Ventilation. Chest. 2013; 143(2): 415-422. doi:10.1378/ chest.12-1445.
19. Hosseini-Nik H, Bayanati H, Souza CA, et al. Limited Chest Ultrasound to Replace CXR in Diagnosis of Pneumothorax Post Image-Guided Transthoracic Interventions. Can Assoc Radiol J. 2022; 73(2): 403-409. doi:10.1177/08465371211034016.