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. 2023 Jul 27;31(3):358-366.
doi: 10.5606/tgkdc.dergisi.2023.23568. eCollection 2023 Jul.

A valuable endobronchial ultrasound scoring system predicting malignant lymph nodes

Nurcan Guler  1 , Kemal Can Tertemiz  1 , Duygu Gurel  2
Affiliations

A valuable endobronchial ultrasound scoring system predicting malignant lymph nodes

Nurcan Guler et al. Turk Gogus Kalp Damar Cerrahisi Derg. .

Abstract

Background: This study aims to determine the sonographic criteria of lymph nodes to predict malignancy with endobronchial ultrasound.

Methods: A total of 1,987 lymph nodes of 967 patients (666 males, 301 females; mean age: 62.1±11.9 years; range, 21 to 90 years) between May 2016 and July 2020 were retrospectively analyzed. The endobronchial ultrasound images of lymph nodes were evaluated according to the following criteria: size (short axis >1 cm), shape (round or oval), margin (distinct or indistinct), coagulation necrosis sign (present or absent), central hilar structure (present or absent) and echogenicity (homogeneous or heterogeneous). A scoring system was developed for predicting malignancy.

Results: A total of 765 (38.5%) of the lymph nodes were malignant. In the univariate analysis, size >1 cm, round shape, distinct margin, absence of central hilar structure, presence of coagulation necrosis sign, and heterogeneity were significant predictors of malignancy (p<0.001 for all). In the multivariate analysis, the main independent predictors were heterogeneity and presence of coagulation necrosis sign (odds ratio=5.9, 95% confidence interval: 4.2-8.2 vs. odds ratio=3.1 95% confidence interval: 2.2-4.5, respectively). A cut-off value for endobronchial ultrasound score of ≥4 increased the malignancy risk 30 times with a sensitivity of 84.7%, and specificity of 84.5%.

Conclusion: Our study results show that endobronchial ultrasound scoring system with six criteria has a high sensitivity and specificity for predicting malignant lymph nodes.

Keywords: Endobronchial ultrasound; lymph node; malignancy; score..

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Conflict of interest statement

Conflict of Interest: The authors declared no conflicts of interest with respect to the authorship and/or publication of this article.

Figures

Figure 1
Figure 1. Study flowchart. EBUS: Endobronchial ultrasound; TBNA: Transbronchial needle aspiration.
Figure 2
Figure 2. The ultrasound images of lymph nodes.
Figure 3
Figure 3. (a) Cut-off value for EBUS lymph node size in predicting malignancy. (b) Cut-off value for EBUS score in predicting malignancy. EBUS: Endobronchial ultrasound.
See this image and copyright information in PMC

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