Endobronchial Ultrasound Elastography Combined With Computed Tomography in Differentiating Benign from Malignant Intrathoracic Lymph Nodes

Objective. This study was to combine endobronchial ultrasound elastography (UE) with computed tomography (CT) to identify benign and malignant thoracic lymph nodes (LNs) more objectively and accurately. Methods. A total of 42 patients with intrathoracic lymphadenopathy required for endobronchial ultrasound with real-time guided transbronchial needle aspiration (EBUS-TBNA) examination were enrolled. All patients were examined by enhanced chest CT, B-mode ultrasound, and endobronchial ultrasound (EBUS)-guided elastography before EBUS-TBNA. Each lymph node was assessed by describing the characteristics of CT image (short diameter, texture, shape, boundary, and mean CT value), B-mode ultrasound (short diameter, echo characteristic, shape, and boundary), and elastography (image type, grading score, strain rate, and blue area ratio). The pathological results were used as the gold standard. The characteristics were compared alone and in combination between benign and malignant LNs. Results. The blue area ratio of elastography combined with CT had better diagnostic value in differentiating benign and malignant LNs than elastography alone, with the accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) being 92%, 96%, 80%, 94%, and 86% vs 81%, 77%, 93%, 97%, and 56%, respectively. Elastography combined with B-mode ultrasound and CT characteristics showed the highest diagnostic value. Accuracy, sensitivity, specificity, PPV, and NPV were all 100%. Conclusions. Endobronchial UE combined with CT and B-mode ultrasound imaging shows a greater diagnostic value in differentiating benign and malignant intrathoracic LNs than either imaging alone.

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Diagnostic value of endobronchial ultrasound elastography combined with rapid onsite cytological evaluation in endobronchial ultrasound-guided transbronchial needle aspiration

10.21203/rs.3.rs-426462/v1 ◽

2021 ◽

Author(s):

Jing Huang ◽

Yuan Lu ◽

Xihua Wang ◽

Xiaoli Zhu ◽

Ping Li ◽

...

Keyword(s):

Lymph Nodes ◽

Likelihood Ratio ◽

Positive Likelihood Ratio ◽

Negative Likelihood Ratio ◽

Diagnostic Value ◽

Needle Aspiration ◽

Endobronchial Ultrasound ◽

Transbronchial Needle Aspiration ◽

Sensitivity Specificity ◽

Malignant Lymph Nodes

Abstract Background: Endobronchial ultrasound (EBUS) elastography has been applied in EBUS-guided transbronchial needle aspiration (EBUS-TBNA) to identify malignant lymph nodes based on the tissue stiffness. Rapid onsite cytological evaluation (ROSE) has been widely used for onsite evaluation of the adequacy of the samples and guiding the sampling during EBUS-TBNA. The aim of the study is to investigate the diagnostic value of combined EBUS elastography and ROSE in evaluating of mediastinal and hilar lymph nodes status.Methods: A retrospective chart review was performed from December 2018 to September 2020. Patients’ demographic, EBUS elastography score, ROSE, pathologic and clinical outcomes were collected. The EBUS elastography scores were classified as follows: Type 1, predominantly non-blue; Type 2, partially blue and partially non-blue; Type 3, predominantly blue. Receiver operating characteristic (ROC) curve was used to compare the sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, and negative likelihood ratio among EBUS elastography, ROSE, and EBUS combined with ROSE groups for evaluation of malignant lymph nodes.Results: A total of 247 patients (345 lymph nodes) were included in our study. The sensitivity and specificity of EBUS elastography group in the diagnosis of malignant lymph nodes were 90.51% and 57.26%, respectively. The sensitivity and specificity in the ROSE alone group were 96.32% and 79.05%, respectively. The sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio of EBUS elastography combined with ROSE group were 86.61%, 92.65%, 11.78, and 0.14, respectively, and the area under curve was 0.942.Conclusions: The combination of EBUS elastography and ROSE significantly increased the diagnostic value of EBUS-TBNA in evaluating mediastinal and hilar lymph nodes status.

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Diagnostic value of endobronchial ultrasound elastography combined with rapid onsite cytological evaluation in endobronchial ultrasound-guided transbronchial needle aspiration

BMC Pulmonary Medicine ◽

10.1186/s12890-021-01748-4 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Jing Huang ◽

Yuan Lu ◽

Xihua Wang ◽

Xiaoli Zhu ◽

Ping Li ◽

...

Keyword(s):

Lymph Nodes ◽

Likelihood Ratio ◽

Positive Likelihood Ratio ◽

Negative Likelihood Ratio ◽

Diagnostic Value ◽

Endobronchial Ultrasound ◽

Lymph Node Status ◽

Transbronchial Needle Aspiration ◽

Hilar Lymph Node ◽

Malignant Lymph Nodes

Abstract Background Endobronchial ultrasound (EBUS) elastography has been used in EBUS-guided transbronchial needle aspiration (EBUS-TBNA) to identify malignant lymph nodes based on tissue stiffness. Rapid onsite cytological evaluation (ROSE) has been widely utilized for onsite evaluation of sample adequacy and for guiding sampling during EBUS-TBNA. The aim of this study was to investigate the diagnostic value of combined EBUS elastography and ROSE in evaluating mediastinal and hilar lymph node status. Methods Retrospective chart review was performed from December 2018 to September 2020. Patient demographics, EBUS elastography scores, and ROSE, pathologic, and clinical outcome data were collected. The EBUS elastography scores were classified as follows: Type 1, predominantly nonblue; Type 2, partially blue and partially nonblue; and Type 3, predominantly blue. A receiver operating characteristic curve was used to compare the sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, and negative likelihood ratio for evaluation of malignant lymph nodes among the EBUS elastography, ROSE, and EBUS combined with ROSE groups. Results A total of 245 patients (345 lymph nodes) were included. The sensitivity and specificity of the EBUS elastography group for the diagnosis of malignant lymph nodes were 90.51% and 57.26%, respectively. The sensitivity and specificity in the ROSE group were 96.32% and 79.05%, respectively. The sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio of EBUS elastography combined with ROSE were 86.61%, 92.65%, 11.78, and 0.14, respectively, and the area under the curve was 0.942. Conclusions Combining EBUS elastography and ROSE significantly increased the diagnostic value of EBUS-TBNA in evaluating mediastinal and hilar lymph node status compared to each method alone.

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Diagnostic value of endobronchial ultrasound elastography for the differentiation of benign and malignant intrathoracic lymph nodes

10.1183/13993003.congress-2016.pa3861 ◽

2016 ◽

Author(s):

Viboon Boonsarngsuk ◽

Potjanee Korrungruang

Keyword(s):

Lymph Nodes ◽

Diagnostic Value ◽

Ultrasound Elastography ◽

Endobronchial Ultrasound

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Endobronchial Ultrasound-guided Transbronchial Needle Aspiration in Anthracosis of Mediastinal Lymph Nodes: Correlation with Computed Tomography Findings

Hong Kong Journal of Radiology ◽

10.12809/hkjr1413225 ◽

2014 ◽

pp. 162-167

Author(s):

J Kirchner ◽

◽

M Broll ◽

C Murach ◽

P Müller ◽

...

Keyword(s):

Computed Tomography ◽

Lymph Nodes ◽

Needle Aspiration ◽

Endobronchial Ultrasound ◽

Mediastinal Lymph Nodes ◽

Ultrasound Guided ◽

Transbronchial Needle Aspiration

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Value of SPECT/CT for Sentinel Lymph Node Localization in the Parotid and External Jugular Chain

Otolaryngology ◽

10.1177/0194599818786946 ◽

2018 ◽

Vol 159 (5) ◽

pp. 866-870

Author(s):

Rosh K.V. Sethi ◽

Nicholas B. Abt ◽

Aaron Remenschneider ◽

Yingbing Wang ◽

Kevin S. Emerick

Keyword(s):

Computed Tomography ◽

Lymph Nodes ◽

Head And Neck ◽

Predictive Value ◽

Ct Imaging ◽

Sternocleidomastoid Muscle ◽

Head And Neck Malignancy ◽

Level Ii ◽

Neck Malignancy ◽

Sensitivity Specificity

Objective Preoperative single-photon emission computed tomography/computed tomography (SPECT/CT) imaging may aid in the localization of sentinel lymph nodes (SLNs) in cutaneous head and neck malignancy and has been rigorously evaluated for deep cervical lymph nodes. The purpose of this study was to assess the sensitivity, specificity, and positive predictive value (PPV) of SPECT/CT for preoperative localization of nodal basins superficial to the sternocleidomastoid muscle, with comparison to deep nodal basins of the neck. Study Design Retrospective review. Setting Tertiary care center. Subjects and Methods SPECT/CT images obtained preoperatively for patients undergoing SLN biopsy for cutaneous head and neck malignancy between June 2015 and June 2016 were reviewed by a blinded nuclear medicine physician and head and neck surgeon. SPECT/CT imaging was compared to intraoperatively determined SLN location via gamma probe. Sensitivity, specificity, and positive and negative predictive values were determined and compared for superficial (external jugular [EJ] and parotid) nodes vs level II nodes. Results Fifty-three patients were included in the study. Most had cutaneous melanoma (69.8%). The PPV of EJ/parotid node identification by SPECT/CT imaging was 85.7%, specificity was 88.9%, and sensitivity was 69.2%. Comparatively, the PPV for level II nodes was 76.9%, specificity was 50%, and sensitivity was 85.7%. No significant difference in SPECT/CT predictive value was identified between EJ/parotid and level II node identification ( P > .05). Conclusion SPECT/CT imaging has strong specificity and positive predictability for preoperative localization of SLN superficial to the sternocleidomastoid muscle in cutaneous head and neck malignancy. SPECT/CT imaging may be a useful radiographic aid for preoperative SLN mapping in this patient population.

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A comparision of endobronchial ultrasound-guided transbronchial needle aspiration and integrated positron emission tomography-computed tomography in the diagnosis of malignant mediastinal/hilar lymph nodes

Turkish Journal of Thoracic and Cardiovascular Surgery ◽

10.5606/tgkdc.dergisi.2012.164 ◽

2012 ◽

Vol 20 (4) ◽

pp. 843-849

Author(s):

Sevda Şener Cömert

Keyword(s):

Computed Tomography ◽

Positron Emission Tomography ◽

Lymph Nodes ◽

Needle Aspiration ◽

Emission Tomography ◽

Endobronchial Ultrasound ◽

Ultrasound Guided ◽

Transbronchial Needle Aspiration ◽

Positron Emission

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Diagnostic Yield of Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration Cytological Smears and Cell Blocks: A Single-Institution Experience

Medicina ◽

10.3390/medicina54020019 ◽

2018 ◽

Vol 54 (2) ◽

pp. 19 ◽

Cited By ~ 6

Author(s):

Marius Žemaitis ◽

Greta Musteikienė ◽

Skaidrius Miliauskas ◽

Darius Pranys ◽

Raimundas Sakalauskas

Keyword(s):

Lung Cancer ◽

Lymph Nodes ◽

Diagnostic Accuracy ◽

Predictive Value ◽

Diagnostic Yield ◽

Needle Aspiration ◽

Endobronchial Ultrasound ◽

Medical Documentation ◽

Ultrasound Guided ◽

Transbronchial Needle Aspiration

Background and Objective: Endobronchial ultrasound (EBUS) is a minimally invasive endobronchial technique, which uses ultrasound along with a bronchoscope to visualize the airway wall and structures that are adjacent to it. Indications for endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) are samplings of mediastinal, hilar lymph nodes, and tumors adjacent to airway walls. EBUS-TBNA has been used in our clinic since 2009. The aim of the study is to evaluate the sensitivity, specificity, positive and negative predictive value, and diagnostic accuracy of cytological and histological specimens, and the safety of EBUS-TBNA in an unselected patient population that has been referred to our hospital. Materials and Methods: We have retrospectively analyzed the medical documentation of 215 patients who had EBUS-TBNA performed in our clinic from April 2009 to February 2014. Results: There were 215 patients who underwent EBUS-TBNA. A total of 296 lymph nodes were sampled. EBUS-TBNA was diagnostic in 176 (81.9%) cases of cytological, 147 (68.4%) cases of histological, and 191 (88.9%) cases of the combined evaluation. In the lung cancer patients, EBUS-TBNA cytology had a sensitivity of 72.9% and histology of 72.9%, and in the sarcoidosis group, it had a cytology of 55.8% and histology of 64.5%. As all positive cytology and histology specimens were assumed to be true positive, specificity and positive predictive value (PPV) were 100%. The sensitivity and diagnostic accuracy was significantly higher when cytology and histology specimens were combined, compared with cytology or histology results evaluated separately (p < 0.05) (for lung cancer 84.1% and for sarcoidosis 78.8%). The sensitivity and diagnostic accuracy of EBUS-TBNA procedures increased significantly over time, with increased experience. There were no complications with EBUS-TBNA in our clinical practice. Conclusions: EBUS-TBNA had a high diagnostic yield and was safe in the diagnosis of lung cancer and sarcoidosis. It was most informative when cytology and histology were combined. The informative value of EBUS-TBNA histology increased with our experience.

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