Clinical applications of contrast-enhanced thoracic ultrasound (CETUS) compared to standard reference tests: a systematic review

Introduction: Contrast-enhanced ultrasound is utilized in an increasing array of medical fields, including respiratory medicine. However, the technique is still relatively new and only sporadically mentioned in current guidelines and recommendations.Aims and Objective: The aim of this systematic review is to provide a literature overview and critical appraisal of the current clinical applications of contrast-enhanced thoracic ultrasound (CETUS).Methods: A systematic literature search using major electronic databases and in accordance with PRISMA guidelines was performed. Studies with primary focus of CETUS of thoracic disorders compared to standard reference test were included. The QUADAS-2 tool was used for quality assessment of the studies.Results: The search identified 43 articles. One randomized controlled study, six non-randomized controlled studies, 16 non-randomized non-controlled studies, five case series, 10 single case reports, and five animal studies. The risk of bias was overall judged high. The most frequent clinical application of CETUS was guidance during biopsy procedures. Six studies compared CETUS-guided vs. ultrasound-guided transthoracic needle biopsy of thoracic masses. CETUS-guidance increased the diagnostic accuracy by 14.6 percentage points on average, but the studies were too heterogeneous for meta-analysis.Conclusions: The current literature of CETUS is overall heterogeneous with few high evidence level studies, small study populations and high risk of bias. CETUS-guided biopsy is the most frequent clinical application and increases diagnostic accuracy compared to ultrasound-guidance.FootnotesCite this article as: European Respiratory Journal 2020; 56: Suppl. 64, 2785.This abstract was presented at the 2020 ERS International Congress, in session textquotedblleftRespiratory viruses in the "pre COVID-19" eratextquotedblright.This is an ERS International Congress abstract. No full-text version is available. Further material to accompany this abstract may be available at www.ers-education.org (ERS member access only).