Abstract
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.
Highlights
Lung cancer is one of the most common diagnosed malignant tumors and the leading cause of cancerrelated deaths worldwide, with a dismal 5-year survival rate of only 16% [1]
A total of 60 patients that were candidates for EBUS-TBNA examination were enrolled in the current study at Shanghai Pulmonary Hospital, Tongji University
Histologic examinations of the EBUS-TBNA specimens revealed that 66.9% (89/133) of the lymph nodes were malignant (20 were adenocarcinoma, 17 were squamous cell carcinoma, 17 were small cell lung cancer, 10 were non-small cell lung cancer (NSCLC) and 25 were NSCLC-not otherwise specific [NSCLC-NOS]) and 33.1% (44/133) were benign lymph nodes
Summary
Lung cancer is one of the most common diagnosed malignant tumors and the leading cause of cancerrelated deaths worldwide, with a dismal 5-year survival rate of only 16% [1]. The presence of epidermal growth factor receptor (EGFR) activating mutations and anaplastic lymphoma kinase (ALK) chromosomic rearrangements with corresponding tyrosine kinase inhibitors (TKIs) has revolutionized the treatment strategies of patients with advanced non-small cell lung cancer (NSCLC) [3, 4]. It is noteworthy that precise molecular testing for genetic alterations needs adequate specimens For these inoperable patients, endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has been demonstrated to be a minimally invasive technique for mediastinal node sampling and EBUS-TBNA specimens show high clinical utility for molecular testing, including EGFR mutations, KRAS mutations and ALK rearrangements [5,6,7,8,9,10,11,12]
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