Dijagnostička vrijednost ultrazvučnoga pregleda prsnoga koša u razlikovanju pleuralnih izljeva maligne i nemaligne etiologije [Diagnostic validity of thoracic ultrasound in distinguishing malignant and nonmalignant pleural effusions]

Thoracic ultrasound is a diagnostic procedure that may help in the prediction of the pleural effusion etiology. Analyzing the ultrasound characteristics of pleural effusion, visceral and parietal pleura, the best predicting parameters for malignant pleural effusion (MPI) were pleural nodularity (sensitivity of 76,19 %, specificity of 71,43 %, accuracy of 73,81 %). Using various combinations of ultrasound and macroscopic characteristics of typical MPI (nodular pleura together with hemorrhagic/sanguinolent effusion; nodular pleura together with the fibrin absence in pleural effusion; pleural thickness over 10 mm together with hemorrhagic/sanguinolent effusion) finding accuracy in prediction of MPI increased up to 82,50 %. Using integrated statistical analyses of ultrasound, macroscopic and biochemical parameters (logistic regression), the three parameters were obtained (pleural nodularity, fibrin absence, serum proteins) which were the best predictors for MPI (sensitivity of 81,58 %, specificity of 76,09 %, accuracy of 89,64 %). The best single predicting parameter for non-malignant pleural effusion (NMPI) was the fibrinous remodeling (sensitivity of 45,24 %, specificity of 90,48 %, accuracy of 67,86 %). Using various combinations of ultrasound and macroscopic characteristics of typical NMPI (clear/serous pleural effusion together with fibrinous remodeling; pleural effusion fibrinous remodeling together with absent pleural nodularity; pleural effusion fibrinous remodeling together with pleural thickness less than 10 mm), finding accuracy in prediction of NMPI increased up to 88,24 %. Based on these findings, together with results of previous studies, a simple diagnostic algorithm for lymphocytic pleural effusions was proposed.