Preoperative Lung Ultrasound to Detect Pleural Adhesions: A Systematic Review and Meta-Analysis

The usage of lung ultrasound as a preoperative examination for thoracic surgeries remains controversial. Our systematic review and meta-analysis aimed to evaluate preoperative lung ultrasound diagnostic accuracy for detecting pleural adhesions. We searched articles published in MEDLINE, Embase, CENTRAL, and the International Clinical Trials Registry Platform until October 2020. Inclusion criteria were observational studies, case-control studies, and case series assessing preoperative lung ultrasound diagnostic accuracy. The study quality of included articles was evaluated using the modified quality assessment of diagnostic accuracy studies-2 tool. The pooled sensitivity and specificity were calculated using the bivariate random-effects model. The overall quality of evidence was summarized using the grading of recommendations, assessment, development, and evaluation approach. Eleven articles were included in our systematic review. A high risk of bias was noted regarding undefined pleural adhesions and non-predefined pathological diagnosis. Based on the ten articles included for meta-analysis, the pooled sensitivity and specificity were 71% [95% confidence interval (CI), 56%-82%], and 96% (95% CI, 89%-99%), respectively. The overall quality of evidence was moderate. Our systematic review revealed that lung ultrasound had high specificity. It may serve as a rule-in test for detecting pleural adhesions before thoracic surgeries, which may assist surgeons in preparation for a prolonged surgery or increased risk of complications that occurred by trocar insertion such as bleeding and persistent air leak.