Shiroshita Akihiro, Nozaki Sayumi, Tanaka Yu, Luo Yan, Kataoka Yuki
Dept of Respiratory Medicine, Ichinomiyanishi Hospital, Ichinomiya, Japan.
Dept of Pulmonology, Kameda Medical Center, Kamogawa, Japan.
ERJ Open Res. 2020 Nov 10;6(4). doi: 10.1183/23120541.00464-2020. eCollection 2020 Oct.
This systematic review aimed to evaluate the diagnostic accuracy of thoracic ultrasound in malignant pleural effusion. Articles published until December 2019 in MEDLINE, Embase, the Cochrane Central Register of Controlled Trials and the International Clinical Trials Registry Platform were screened by two authors independently to extract data and evaluate the risks of bias and applicability using the modified Quality Assessment of Diagnostic Accuracy Studies-2 tool. We described the forest plots of each thoracic ultrasound finding. We estimated the pooled sensitivity and specificity of pleural nodularity using the bivariate random-effects model. We included seven articles and found that each thoracic ultrasound finding had low sensitivity. The pooled specificity of pleural nodularity was 96.9% (95% CI 93.2%-98.6%). In conclusion, thoracic ultrasound is not useful in ruling out malignant pleural effusion. Physicians can proceed rigorously to repeat thoracentesis or other invasive procedures when pleural nodularity is detected.
本系统评价旨在评估胸部超声对恶性胸腔积液的诊断准确性。两名作者独立筛选了截至2019年12月发表在MEDLINE、Embase、Cochrane对照试验中央注册库和国际临床试验注册平台上的文章，以提取数据，并使用改良的诊断准确性研究质量评估-2工具评估偏倚风险和适用性。我们描述了每项胸部超声检查结果的森林图。我们使用双变量随机效应模型估计了胸膜结节的合并敏感性和特异性。我们纳入了7篇文章，发现每项胸部超声检查结果的敏感性都较低。胸膜结节的合并特异性为96.9%（95%CI 93.2%-98.6%）。总之，胸部超声对排除恶性胸腔积液无用。当检测到胸膜结节时，医生可以严格进行重复胸腔穿刺或其他侵入性操作。
