Clinical Research Papers:
The role of endobronchial ultrasound elastography in the diagnosis of mediastinal and hilar lymph nodes
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Ye Gu1,*, Hong Shi2,*, Chunxia Su3, Xiaoxia Chen3, Shijia Zhang3, Wei Li3, Fengying Wu3, Guanghui Gao3, Hao Wang1, Haiqing Chu4, Caicun Zhou3, Fei Zhou3 and Shengxiang Ren3
1 Department of Endoscopy, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
2 Department of Anesthesiology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
3 Department of Medical Oncology, Shanghai Pulmonary Hospital, Tongji University School of Medicine & Tongji University School of Medicine Thoracic Cancer Institute, Shanghai, China
4 Department of Respirology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
* These authors have contributed equally to this work
Shengxiang Ren, email:
Fei Zhou, email:
Keywords: elastography, EBUS-TBNA, diagnosis, lung cancer, lymph nodes
Received: October 19, 2016 Accepted: March 15, 2017 Published: July 06, 2017
Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has been widely used for diagnosis and mediastinal lymph nodes staging in patients with suspicious lung cancer. Ultrasound elastography is a novel sonographical technique that can evaluate tissue compressibility. The aim of the present study was to investigate the diagnostic yield of elastography for differentiating malignant and benign mediastinal lymph nodes. Conventional EBUS B-mode features, including size, shape, border distinction, echogenicity, central hilar structure with central blood vessel and coagulation necrosis were also evaluated. The ultrasonic features were compared with the pathological results from EBUS-TBNA. 133 lymph nodes in 60 patients were assessed. Elastography displayed the highest area under the curve (AUC) (type 3 versus type 1: AUC, 0.825; 95% confidence interval [CI], 0.707-0.910) with an impressive sensitivity (100%) and an acceptable specificity (65%). The combined model covering the four positive criteria (elastography, heterogeneity, size, and shape) showed that the odds ratio for malignance is 9.44 with a 95% CI of 3.99 to 22.32 (p <0.0001). The combined model was superior to elastography alone (AUC, 0.851; sensitivity, 89.89%; specificity, 72.73%; p <0.0001). This prospective study showed that elastography is a feasible technique for classifying mediastinal lymph nodes, especially in combination with conventional EBUS imaging.
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