Endobronchial Ultrasound Elastography for Diagnosing Mediastinal and Hilar Lymph Nodes

• Published in: Chinese medical journal Vol. 128; no. 20; pp. 2720 - 2725
• Main Authors: He, Hai-Yan, Huang, Mao, Zhu, Jie, Ma, Hang, Lyu, Xue-Dong
• Format: Journal Article
• Language: English
• Published: China Medknow Publications Pvt Ltd 20.10.2015; Medknow Publications and Media Pvt. Ltd; Lippincott Williams & Wilkins Ovid Technologies; Department of Respiratory, The First People's Hospital of Nantong, Nantong, Jiangsu 226001, China%Department of Respiratory, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China; Medknow Publications & Media Pvt Ltd; Wolters Kluwer
• Subjects: Aged; Bronchoscopy; Care and treatment; Clinical medicine; Diagnosis; Elasticity Imaging Techniques - methods; Elastography; Endobronchial Ultrasound; Lung Cancer; Mediastinal and Hilar Lymph Node; Strain Ratio; Endoscopy; Endosonography - methods; Female; Health aspects; Humans; Limited liability companies; Lung cancer; Lung Neoplasms - diagnosis; Lymph Nodes - pathology; Lymphatic system; Male; Mediastinum - pathology; Middle Aged; Original; Ostomy; Tumors; Ultrasonic imaging; 应变率敏感; 恶性肿瘤; 检查标准; 淋巴结病变; 病理诊断; 管内; 肺癌; 超声弹性成像; China; Strain Ratio; Lung Cancer; Endobronchial Ultrasound; Mediastinal and Hilar Lymph Node; Elastography
• ISSN: 0366-6999; 2542-5641
• DOI: 10.4103/0366-6999.167296

Background： Pathophysiological processes, such as malignancy, can lead to the formation of stiffer tissue in lung cancers. Endobronchial ultrasound rEBUS） elastography is a novel technique for measuring tissue stiffness during EBUS-guided transbronchial needle aspiration （EBUS-TBNA）. The current study was conducted to investigate the diagnostic value of EBUS elastography tbr mediastinal and hilar lymph node metastasis in lung cancers. Methods： From January 2014 to January 2015, 40 patients suspected of lung cancer were enrolled, and a total of 68 lymph nodes were evaluated by EBUS-TBNA. EBUS-guided elastography of lymph nodes was perfornaed prior to EBUS-TBNA. Standard EBUS characteristics were also described. Pathological determination of malignant or benign lymph nodes was used as the gold standard for this study. If EBUS-TBNA did not result in a tbrmal pathological diagnosis of malignancy, patients were referred for a surgical procedure. Comparisons of elastography and standard EBUS characteristics were made between benign and malignant lymph nodes. Results： Elastography grading scores and strain ratios showed significant differences between benign and malignant lymph nodes （P = 0.000）. The elastography strain ratio was more sensitive and specific for determining malignant lymph nodes than elastography grading score or standard EBUS criteria. The receiver operating characteristic curve for the elastography strain ratio showed an area under the curve of 0.933. The best cut-off point of the strain ratio for differentiating malignant from benign lymph nodes was 32.07. The elastography strain ratio had a sensitivity of 88.1%, the specificity of 80.8%, positive predictive value of 88.1%, and negative predictive value of 80.8% for distinguishing malignant from benign nodes. The overall accuracy of elastography strain ratio was 85.3%. The strain ratio of malignant and benign lymph nodes positively correlated with the elastography grading score （r = 0.561, P = 0.000）. Conclusions： EBUS elastography can be effectively used to predict mediastinal and hilar lymph node metastases in lung cancer. This noninvasive technique may thus complement standard EBUS and help guide EBUS-TBNA procedures.