Quantitative analysis of endobronchial ultrasound elastography in computed tomography‐negative mediastinal and hilar lymph nodes
Background Endobronchial ultrasound (EBUS) elastography assists in the differentiation of benign and malignant lymph nodes (LNs) during transbronchial needle aspiration (TBNA). However, previous studies have not compared B‐mode sonographic images (BSIs) and EBUS elastography images (EEIs) with final...
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doaj-2ae570ee90544c858b098654b1cc1bc52020-11-25T03:18:29ZengWileyThoracic Cancer1759-77061759-77142020-09-011192590259910.1111/1759-7714.13579Quantitative analysis of endobronchial ultrasound elastography in computed tomography‐negative mediastinal and hilar lymph nodesKeigo Uchimura0Kei Yamasaki1Shinji Sasada2Sachika Hara3Issei Ikushima4Yosuke Chiba5Takashi Tachiwada6Toshinori Kawanami7Kazuhiro Yatera8Department of Respiratory Medicine University of Occupational and Environmental Health Fukuoka JapanDepartment of Respiratory Medicine University of Occupational and Environmental Health Fukuoka JapanDepartment of Respiratory Medicine Tokyo Saiseikai Central Hospital Tokyo JapanDepartment of Respiratory Medicine University of Occupational and Environmental Health Fukuoka JapanDepartment of Respiratory Medicine University of Occupational and Environmental Health Fukuoka JapanDepartment of Respiratory Medicine University of Occupational and Environmental Health Fukuoka JapanDepartment of Respiratory Medicine University of Occupational and Environmental Health Fukuoka JapanDepartment of Respiratory Medicine University of Occupational and Environmental Health Fukuoka JapanDepartment of Respiratory Medicine University of Occupational and Environmental Health Fukuoka JapanBackground Endobronchial ultrasound (EBUS) elastography assists in the differentiation of benign and malignant lymph nodes (LNs) during transbronchial needle aspiration (TBNA). However, previous studies have not compared B‐mode sonographic images (BSIs) and EBUS elastography images (EEIs) with final pathological diagnoses in radiologically normal‐sized (computed tomography [CT]‐negative) LNs. Methods Consecutive patients with CT‐negative LNs, who received EBUS‐TBNA, were retrospectively reviewed. Images of BSIs and EEIs of each LN were stored and independently evaluated. EEIs were assessed by calculating the stiffness area ratio (SAR, blue/overall areas). The receiver operating characteristic curve was used to calculate the cutoff value for the SAR. Diagnostic test parameters were evaluated for each EBUS finding. Results A total of 132 patients (149 LNs) were enrolled, and the median SAR of malignant LNs was significantly higher than that of benign LNs (0.58 vs. 0.32, P < 0.001). At the SAR cutoff of 0.41, the sensitivity, specificity, positive predictive value, negative predictive value (NPV), and diagnostic accuracy rate (DAR) of elastography were 88.2%, 80.2%, 78.9%, 89.0%, and 83.9%, respectively. The logistic regression analysis showed that elastography was the strongest predictor of malignancy (odds ratio, 18.5; 95% confidence interval [CI]: 6.48–52.6; P < 0.001). The highest NPV (96.6%) was achieved with a combination of BSIs and EEIs. Conclusions EBUS elastography predicted malignant LNs with a high DAR and NPV in CT‐negative LNs. The NPV was highest when EEIs were combined with BSIs. Therefore, the combined evaluation of CT‐negative LNs using EEIs and BSIs may help bronchoscopists perform EBUS‐TBNA more efficiently. Key points Significant findings of the study Endobronchial ultrasound elastography accurately predicted malignancy with a high diagnostic accuracy rate and negative predictive value in radiologically normal‐sized lymph nodes. The additional use of B‐mode sonographic features resulted in a higher negative predictive value. What this study adds Endobronchial ultrasound elastography can guide the accurate collection of specimens with transbronchial needle aspiration, even in radiologically normal‐sized lymph nodes. It can also readily distinguish benign and malignant lymph nodes, thus avoiding unnecessary punctures.https://doi.org/10.1111/1759-7714.13579Bronchoscopyelastographyendobronchial ultrasound‐guided transbronchial needle aspiration (EBUS‐TBNA)lung cancer |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Keigo Uchimura Kei Yamasaki Shinji Sasada Sachika Hara Issei Ikushima Yosuke Chiba Takashi Tachiwada Toshinori Kawanami Kazuhiro Yatera |
spellingShingle |
Keigo Uchimura Kei Yamasaki Shinji Sasada Sachika Hara Issei Ikushima Yosuke Chiba Takashi Tachiwada Toshinori Kawanami Kazuhiro Yatera Quantitative analysis of endobronchial ultrasound elastography in computed tomography‐negative mediastinal and hilar lymph nodes Thoracic Cancer Bronchoscopy elastography endobronchial ultrasound‐guided transbronchial needle aspiration (EBUS‐TBNA) lung cancer |
author_facet |
Keigo Uchimura Kei Yamasaki Shinji Sasada Sachika Hara Issei Ikushima Yosuke Chiba Takashi Tachiwada Toshinori Kawanami Kazuhiro Yatera |
author_sort |
Keigo Uchimura |
title |
Quantitative analysis of endobronchial ultrasound elastography in computed tomography‐negative mediastinal and hilar lymph nodes |
title_short |
Quantitative analysis of endobronchial ultrasound elastography in computed tomography‐negative mediastinal and hilar lymph nodes |
title_full |
Quantitative analysis of endobronchial ultrasound elastography in computed tomography‐negative mediastinal and hilar lymph nodes |
title_fullStr |
Quantitative analysis of endobronchial ultrasound elastography in computed tomography‐negative mediastinal and hilar lymph nodes |
title_full_unstemmed |
Quantitative analysis of endobronchial ultrasound elastography in computed tomography‐negative mediastinal and hilar lymph nodes |
title_sort |
quantitative analysis of endobronchial ultrasound elastography in computed tomography‐negative mediastinal and hilar lymph nodes |
publisher |
Wiley |
series |
Thoracic Cancer |
issn |
1759-7706 1759-7714 |
publishDate |
2020-09-01 |
description |
Background Endobronchial ultrasound (EBUS) elastography assists in the differentiation of benign and malignant lymph nodes (LNs) during transbronchial needle aspiration (TBNA). However, previous studies have not compared B‐mode sonographic images (BSIs) and EBUS elastography images (EEIs) with final pathological diagnoses in radiologically normal‐sized (computed tomography [CT]‐negative) LNs. Methods Consecutive patients with CT‐negative LNs, who received EBUS‐TBNA, were retrospectively reviewed. Images of BSIs and EEIs of each LN were stored and independently evaluated. EEIs were assessed by calculating the stiffness area ratio (SAR, blue/overall areas). The receiver operating characteristic curve was used to calculate the cutoff value for the SAR. Diagnostic test parameters were evaluated for each EBUS finding. Results A total of 132 patients (149 LNs) were enrolled, and the median SAR of malignant LNs was significantly higher than that of benign LNs (0.58 vs. 0.32, P < 0.001). At the SAR cutoff of 0.41, the sensitivity, specificity, positive predictive value, negative predictive value (NPV), and diagnostic accuracy rate (DAR) of elastography were 88.2%, 80.2%, 78.9%, 89.0%, and 83.9%, respectively. The logistic regression analysis showed that elastography was the strongest predictor of malignancy (odds ratio, 18.5; 95% confidence interval [CI]: 6.48–52.6; P < 0.001). The highest NPV (96.6%) was achieved with a combination of BSIs and EEIs. Conclusions EBUS elastography predicted malignant LNs with a high DAR and NPV in CT‐negative LNs. The NPV was highest when EEIs were combined with BSIs. Therefore, the combined evaluation of CT‐negative LNs using EEIs and BSIs may help bronchoscopists perform EBUS‐TBNA more efficiently. Key points Significant findings of the study Endobronchial ultrasound elastography accurately predicted malignancy with a high diagnostic accuracy rate and negative predictive value in radiologically normal‐sized lymph nodes. The additional use of B‐mode sonographic features resulted in a higher negative predictive value. What this study adds Endobronchial ultrasound elastography can guide the accurate collection of specimens with transbronchial needle aspiration, even in radiologically normal‐sized lymph nodes. It can also readily distinguish benign and malignant lymph nodes, thus avoiding unnecessary punctures. |
topic |
Bronchoscopy elastography endobronchial ultrasound‐guided transbronchial needle aspiration (EBUS‐TBNA) lung cancer |
url |
https://doi.org/10.1111/1759-7714.13579 |
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