title: Ultrasound guidance reduces pneumothorax rate and improves safety of thoracentesis in malignant pleural effusion: report on 445 consecutive patients with advanced cancer.
abstract: BACKGROUND
  Malignant 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.
  
  
  METHODS
  A 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.
  
  
  RESULTS
  From 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.
  
  
  CONCLUSIONS
  The 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.
authors.affiliation: Oncology-Hematology Department, Piacenza Hospital, Via Taverna, 49, 29121 Piacenza, Italy. l.cavanna@ausl.pc.it.
authors.forename: Luigi
authors.initials: L
authors.lastname: Cavanna
authors.forename: Patrizia
authors.initials: P
authors.lastname: Mordenti
authors.forename: Raffaella
authors.initials: R
authors.lastname: Bertè
authors.forename: Maria Angela
authors.initials: MA
authors.lastname: Palladino
authors.forename: Claudia
authors.initials: C
authors.lastname: Biasini
authors.forename: Elisa
authors.initials: E
authors.lastname: Anselmi
authors.forename: Pietro
authors.initials: P
authors.lastname: Seghini
authors.forename: Stefano
authors.initials: S
authors.lastname: Vecchia
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Civardi
authors.forename: Camilla
authors.initials: C
authors.lastname: Di Nunzio
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D015505:Chest Tubes / Q000009:adverse effects; D004322:Drainage; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D019152:Paracentesis / Q000009:adverse effects*; D016066:Pleural Effusion, Malignant / Q000000981:diagnostic imaging / Q000601:surgery*; D011030:Pneumothorax / Q000209:etiology / Q000517:prevention & control*; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control*; D011379:Prognosis; D012189:Retrospective Studies; D025321:Surgery, Computer-Assisted; D019616:Thoracic Surgical Procedures / Q000009:adverse effects*; D018084:Ultrasonography, Interventional / Q000706:statistics & numerical data*; D055815:Young Adult