Ultrasound guidance reduces pneumothorax rate and improves safety of thoracentesis in malignant pleural effusion: report on 445 consecutive patients with advanced cancer

Abstract

BackgroundMalignant pleural effusion (MPE) is an extremely common problem affecting cancer patients, and thoracentesis is an essential procedure in an attempt to delineate the etiology of the fluid collections and to relieve symptoms in affected patients. One of the most common complications of thoracentesis is pneumothorax, which has been reported to occur in 20% to 39% of thoracenteses, with 15% to 50% of patients with pneumothorax requiring tube thoracostomy.The present study was carried out to assess whether thoracenteses in cancer patients performed with ultrasound (US) guidance are associated with a lower rates of pneumothorax and tube thoracostomy than those performed without US guidance.MethodsA total of 445 patients were recruited in this retrospective study. The medical records of 445 consecutive patients with cancer and MPE evaluable for this study, undergoing thoracentesis at the Oncology-Hematology and Internal Medicine Departments, Piacenza Hospital (Italy) were reviewed.ResultsFrom January 2005 to December 2011, in 310 patients (69.66%) thoracentesis was performed with US guidance and in 135 (30.34%) without it. On post-thoracentesis imaging performed in all these cases, 15 pneumothoraces (3.37%) were found; three of them (20%) required tube thoracostomy. Pneumothorax occurred in three out of 310 procedures (0.97%) performed with US guidance and in 12 of 135 procedures (8.89%) performed without it (P <0.0001). It must be emphasized that in all three patients with pneumothorax requiring tube thoracostomy, thoracentesis was performed without US guidance.ConclusionsThe routine use of US guidance during thoracentesis drastically reduces the rate of pneumothorax and tube thoracostomy in oncological patients, thus improving safety as demonstrated in this study.

Incidence and risk factors of iatrogenic pneumothorax after thoracentesis in emergency department settings

“…Despite previous studies reporting the incidence of pneumothorax as high as 19%, recent studies have found pneumothorax to be uncommon following thoracentesis, with reported incidences ranging from 0% to 3% (6,9,19,20). A recent meta-analysis reported a summarized pneumothorax rate of 6.0%, which is comparatively higher than our result (5).…”

Intrapleural Trastuzumab Therapy for Malignant Pleural Effusion from HER2 Overexpression in Metastatic Gastric Cancer

“…Malignant pleural effusion (MPE) is an extremely common problem affecting cancer patients with advanced disease [1]. In metastatic gastric cancer, patients with pleural or lymphangitic metastasis have shorter survival with a 1.5- to 2-fold increased risk of death [2].…”

Lung ultrasound: a new basic, easy, multifunction imaging diagnostic tool in children undergoing pediatric cardiac surgery

“…Large studies conducted in adults have shown how the routine use of LUS may drastically reduce (i.e., from 8.8% to 0.97%, P<0.0001) the risk of pneumothorax in thoracentesis (15). LUS may be used also to monitor the occurrence of pneumothorax after drainage removal, avoiding the repetition of chest X-RAY examinations (that is a routine practice in many Centers) (6,15). Utility of LUS has been proved also for tracheal tube verification in NICU (14).…”

“…Our group (5) recently described a new potential application of chest ultrasound in the diagnosis of retrosternal clots after pediatric cardiac surgery, that are common cause of hemodynamic unbalance and often difficult to diagnosis with conventional echocardiography. LUS may also guide interventional procedures such as drainage insertion for pleural effusion and pneumothorax (8,15). Large studies conducted in adults have shown how the routine use of LUS may drastically reduce (i.e., from 8.8% to 0.97%, P<0.0001) the risk of pneumothorax in thoracentesis (15).…”

“…LUS may also guide interventional procedures such as drainage insertion for pleural effusion and pneumothorax (8,15). Large studies conducted in adults have shown how the routine use of LUS may drastically reduce (i.e., from 8.8% to 0.97%, P<0.0001) the risk of pneumothorax in thoracentesis (15). LUS may be used also to monitor the occurrence of pneumothorax after drainage removal, avoiding the repetition of chest X-RAY examinations (that is a routine practice in many Centers) (6,15).…”