Abstract
This study aimed to semi-quantitatively evaluate the elastographic imaging color distribution of mediastinal and hilar lymph nodes (LNs), and explored its utility in helping define malignant and benign LNs for lung cancer patients. We prospectively collected patients who underwent preoperative mediastinal staging of suspected lung cancer by EBUS-TBNA. We analyzed the elastography color distribution of each LN and calculated the blue color proportion (BCP). The LN elastographic patterns were compared with the final EBUS-TBNA pathological results. A receiver operating characteristic (ROC) curve was constructed to evaluate the diagnostic value of BCP. We sampled and analyzed 79 LNs from 60 patients. The average BCP in malignant LNs was remarkably higher than that in benign LNs (57.1% versus 30.8%, P < 0.001). The area under the ROC curve (AUC) for the BCP was 0.86 (95% CI: 0.78–0.94). The best cutoff BCP for differentiating between benign and malignant LNs was determined as 36.7%. All the 16 LNs (20.3%) with a BCP lower than 27.9% were diagnosed as benign tissues. Our study suggests that elastography is a feasible technique that may safely help to predict LN metastasis during EBUS-TBNA. We found a clear BCP cutoff value to help define positive and negative LNs.
Highlights
Introductionlymph nodes (LNs) containing neoplastic components are of higher cellularity and vascularity, which would cause more areas of the tissue to be relatively stiff, compared to normal ones
EUS elastography was reported to be a highly sensitive and specific method for detecting malignant involvement of pancreatic lesions and lymph nodes (LNs)
We conducted this study to investigate the utility of elastography in diagnosing hilar and mediastinal LNs during EBUS-TBNA, and to identify a threshold to distinguish between benign and malignant lesions based on pathological results of EBUS-TBNA and the color distributions of elastographic images, using a newly developed semi-quantitative method
Summary
LNs containing neoplastic components are of higher cellularity and vascularity, which would cause more areas of the tissue to be relatively stiff, compared to normal ones. With only some small-scale papers published to date on the topic of EBUS elastography[9,10,11,12,13,14,15], the quantitative method of evaluating elastography’s role in differentiating benign and malignant mediastinal and hilar LNs is still not well delineated. We conducted this study to investigate the utility of elastography in diagnosing hilar and mediastinal LNs during EBUS-TBNA, and to identify a threshold to distinguish between benign and malignant lesions based on pathological results of EBUS-TBNA and the color distributions of elastographic images, using a newly developed semi-quantitative method
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