Differentiating malignant and benign lymph nodes using endobronchial ultrasound elastography
Journal
Journal of the Formosan Medical Association
Journal Volume
118
Journal Issue
1P3
Pages
436-443
Date Issued
2019
Author(s)
Abstract
Background/Purpose: Endobronchial ultrasound (EBUS) elastography is a new technique that provides information on tissue compressibility during endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA). The purposes of this study were to evaluate the utility of EBUS elastography in differentiating malignant and benign mediastinal lymph nodes (LNs) and to explore the factors that influence its accuracy. Methods: A retrospective chart review of patients who underwent EBUS-TBNA from October 2016 to July 2017 was performed. EBUS with conventional B-mode features and elastographic patterns were compared with the final pathology results or clinical follow-up. We used the following EBUS elastographic patterns for classification: type 1, predominantly non-blue (green, yellow and red); type 2, part blue, part non-blue; type 3, predominantly blue. The potential impacts of the characteristics of LNs, the underlying lung diseases and obtaining fibrotic components from EBUS-TBNA specimens were evaluated relative to the accuracy of EBUS elastography. Results: A total of 206 LNs from 94 patients were retrospectively evaluated. In classifying type 1 as ‘benign’ and type 3 as ‘malignant,’ the sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy rate were 90.6, 82.6, 71.6, 94.7 and 85.2%, respectively. The EBUS elastographic patterns had higher diagnostic yields and negative predictive values than conventional B-mode features. Logistic regression analysis revealed that central necrosis was a factor that influenced the accuracy of elastography in malignant LNs. The fibrotic component within benign LNs could cause an incorrect elastographic pattern. Conclusion: EBUS elastography is a valuable tool in discriminating benign and malignant mediastinal LNs. ? 2018
Other Subjects
fentanyl; midazolam; adult; aged; Article; B scan; bronchoscopy; computer assisted tomography; diagnostic accuracy; diagnostic value; elastography; female; human; lymph node; lymphadenopathy; major clinical study; male; mediastinum lymph node; medical record review; predictive value; retrospective study; sensitivity and specificity; transbronchial aspiration; unselected mediastinal lymphadenopathy; very elderly; diagnostic imaging; echography; fine needle aspiration biopsy; lymph node; lymphadenopathy; mediastinum; middle aged; pathology; statistical model; Taiwan; young adult; Adult; Aged; Aged, 80 and over; Biopsy, Fine-Needle; Elasticity Imaging Techniques; Female; Humans; Logistic Models; Lymph Nodes; Lymphadenopathy; Male; Mediastinum; Middle Aged; Retrospective Studies; Sensitivity and Specificity; Taiwan; Ultrasonography; Young Adult
Publisher
Elsevier B.V.
Type
journal article