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. 2023 Jun;53(3):712-720.
doi: 10.55730/1300-0144.5634. Epub 2023 Jun 19.

The role of endobronchial ultrasonography elastography in the diagnosis of hilar and mediastinal lymph nodes

Barış Demirkol  1 , Elif Tanrıverdi  2 , Şule Gül  2 , Aysu Sinem Koç  3 , Elife Akgün  4 , Aytül Hande Yardımcı  5 , Kürşad Nuri Baydili  6 , Erdoğan Çetinkaya  2
Affiliations

The role of endobronchial ultrasonography elastography in the diagnosis of hilar and mediastinal lymph nodes

Barış Demirkol et al. Turk J Med Sci. 2023 Jun.

Abstract

Background: Endobronchial ultrasonography (EBUS) is a minimally invasive diagnostic tool in the diagnosis of mediastinal lymph nodes (LNs) and has sonographic features. We aimed to investigate the diagnostic accuracy of EBUS elastography, which evaluates tissue compressibility integrated into EBUS, on malignant vs. benign mediastinal-hilar LNs.

Methods: A single-center, prospective study was conducted at the University of Health Sciences Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital between 01/10/2019 and 15/11/2019. The features of 219 LNs evaluated by thoracic computed tomography (CT), positron emission tomography (PET)/CT, EBUS sonography and EBUS elastography were recorded. The LNs sampled by EBUS-guided fine needle aspiration were classified according to EBUS elastography color distribution findings as follows: type 1, predominantly nonblue (green, yellow, and red); type 2, part blue, part nonblue; type 3, predominantly blue. The strain ratio (SR) was calculated based on normal tissue with the relevant region.

Results: The average age of 131 patients included in the study was 55.86 ± 13 years, 76 (58%) were male. Two hundred and nineteen lymph nodes were sampled from different stations. Pathological diagnosis of 75 (34.2%) LNs was malignant, the rest was benign. When EBUS B-mode findings and pathological results were compared, sensitivity was 65.33%, specificity 63.19%, positive predictive value (PPV) 48%, negative predictive value (NPV) 77.8%, and diagnostic yield (DY) 64%. When the pathological diagnoses and EBUS elastography findings were compared, while type 1 LNs were considered to be benign and type 3 LNs malignant, sensitivity 94.12%, specificity 86.54%, PPV 82.1%, NPV 95.7%, and DY 89.5%. SR of malignant LNs was significantly higher than benign LNs (p < 0.001). When the classification according to color scale and SR were compared, no difference was found in DY (p = 0.155).

Discussion: The diagnostic accuracy of EBUS elastography is high enough to distinguish malignant LN from benign ones with the SR option. When compared with EBUS-B mode sonographic findings, it was found to have a higher diagnostic yield.

Keywords: Elastography; endobronchial ultrasonography; lymph node; mediastinum; strain ratio.

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Figures

Figure 1
Figure 1
Classification of the lymph nodes according to color distribution with EBUS elastography. Type 1: predominantly not a blue lymph node, pathological diagnosis: reactive lymph node (A). Type 2: part blue, part not blue (green, yellow, red), pathological diagnosis: chronic granulomatous lymphadenitis (sarcoid) (B). Type 3: predominantly blue, malignant lymph node (C).
Figure 2
Figure 2
Calculation of the strain ratio (B/A) in the lymph node (A: pathological area; B: normal tissue area).
Figure 3
Figure 3
Distribution of lymph nodes according to Izumo classification and pathology results.
See this image and copyright information in PMC

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