Diagnostic utility of endobronchial ultrasound (EBUS) features in differentiating malignant and benign lymph nodes - A systematic review and meta-analysis

Agrawal, Sumita; Goel, Akhil Dhanesh; Gupta, Nitesh; Lohiya, Ayush; Gonuguntla, Hari Kishan

doi:10.1016/j.rmed.2020.106097

Cited by 24 publications

(32 citation statements)

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“…Therefore, the shape related to both long and short axes was less credible. Study found that coagulation necrosis sign had the maximum pooled specificity of 0.93 amongst grayscale features [27]. Both necrosis and liquefaction had high specificities but low sensitivities in our study, similar to other studies [7,26,27].…”

Section: Discussionsupporting

confidence: 90%

“…Study found that coagulation necrosis sign had the maximum pooled specificity of 0.93 amongst grayscale features [27]. Both necrosis and liquefaction had high specificities but low sensitivities in our study, similar to other studies [7,26,27]. Matting indicates fusion of multiple LNs due to the damage of LN capsule [22].…”

Section: Discussionsupporting

confidence: 88%

“…Zhi/Chen/Wang/Xie/Zheng/Li/Sun liable criterion for abnormal LNs [26,27]. Through the analysis of 5 grayscale features with the highest diagnostic accuracies, it was found that 3 features were sufficient to achieve a good diagnostic effect, superior to any single grayscale feature or blood flow distribution.…”

Section: Discussionmentioning

confidence: 99%

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Endobronchial Ultrasound Multimodal Imaging for the Diagnosis of Intrathoracic Lymph Nodes

et al. 2021

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Background: Endobronchial ultrasound (EBUS) imaging is valuable in diagnosing intrathoracic lymph nodes (LNs), but there has been little analysis of multimodal imaging. This study aimed to comprehensively compare the diagnostic performance of single and multimodal combinations of EBUS imaging in differentiating benign and malignant intrathoracic LNs. Methods: Subjects from July 2018 to June 2019 were consecutively enrolled in the model group and July 2019 to August 2019 in the validation group. Sonographic features of three EBUS modes were analysed in the model group for the identification of malignant LNs from benign LNs. The validation group was used to verify the diagnostic efficiency of single and multimodal diagnostic methods built in the model group. Results: 373 LNs (215 malignant and 158 benign) from 335 subjects and 138 LNs (79 malignant and 59 benign) from 116 subjects were analysed in the model and validation groups, respectively. For single mode, elastography had the best diagnostic value, followed by grayscale and Doppler. The corresponding accuracies in the validation group were 83.3%, 76.8%, and 71.0%, respectively. Grayscale with elastography had the best diagnostic efficiency of multimodal methods. When at least two of the three features (absence of central hilar structure, heterogeneity, and qualitative elastography score 4–5) were positive, the sensitivity, specificity, and accuracy in the validation group were 88.6%, 78.0%, and 84.1%, respectively. Conclusions: In both model and validation groups, elastography performed the best in single EBUS modes, as well as grayscale combined with elastography in multimodal imaging. Elastography alone or combined with grayscale are feasible to help predict intrathoracic benign and malignant LNs.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionsupporting

confidence: 88%

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Endobronchial Ultrasound Multimodal Imaging for the Diagnosis of Intrathoracic Lymph Nodes

et al. 2021

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“…To further improve the diagnostic sensitivity of EBUS-TBNA and decrease procedure-related complications, some studies were performed by analyzing lymph nodes' shape, echogenicity (homogeneous or heterogeneous), margin status, presence or absence of central hilar structure (CHS), short axis diameter, and coagulative necrosis under B-mode ultrasound to evaluate the lesions (Evison et al 2015;Fujiwara et al 2010;Garcia-Olive et al 2012). Even including multiple values, discrepancies still existed among different studies (Agrawal et al 2020). So far, none of the EBUS features were proved to be consistently with the diagnosis of malignant lymph nodes.…”

Section: Discussionmentioning

confidence: 99%

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

Huang¹,

Lü²,

Wang³

et al. 2021

Preprint

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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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“…In certain conditions such as lymphoma and sarcoidosis, the diagnostic yield of EBUS-TBNA is low compared to the diagnostic yield for malignancy or other benign conditions [2]. Studies have shown that tissue sample is essential for making definite diagnosis as ultrasound features are overlapping in both benign and malignant lymph nodes [3,4]. There is also an increased demand for additional or larger samples in some instances due to the increasing need for molecular analysis [5].…”

Section: Introductionmentioning

confidence: 99%

Endobronchial ultrasound‐guided transbronchial cryo‐nodal biopsy: a novel approach for mediastinal lymph node sampling

Gonuguntla

Shah

Gupta

et al. 2021

Respirology Case Reports

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Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is preferred for evaluating malignant lymph nodes and staging of lung cancer. Nevertheless, larger tissue samples are increasingly needed, particularly for molecular analysis. We describe the feasibility, technical details, and complications of EBUS-guided transbronchial cryo-node biopsy (TBCNB) in four patients with mediastinal adenopathy. The samples obtained by EBUS-TBCNB in all cases were adequate for histopathological examination (HPE) and immunohistochemistry (IHC) staining. In case 1, HPE showed non-caseating epithelioid granuloma with giant cells and fibrosis consistent with sarcoidosis. Case 2 was diagnosed with adenocarcinoma with positivity for ROS1(D4D6). Case 3 showed features of metastatic adenocarcinoma from the breast (positive for Her2, ER, and GATA3). Case 4 was diagnosed with tuberculosis (necrotizing granuloma in histopathology, stain with Ziehl-Neelsen that showed few rodshaped bacilli). Only one patient had minimal bleeding at the puncture site controlled with cold saline. There were no adverse events such as major bleeding, pneumomediastinum, or pneumothorax.

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Diagnostic utility of endobronchial ultrasound (EBUS) features in differentiating malignant and benign lymph nodes - A systematic review and meta-analysis

Cited by 24 publications

References 50 publications

Endobronchial Ultrasound Multimodal Imaging for the Diagnosis of Intrathoracic Lymph Nodes

Endobronchial Ultrasound Multimodal Imaging for the Diagnosis of Intrathoracic Lymph Nodes

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

Endobronchial ultrasound‐guided transbronchial cryo‐nodal biopsy: a novel approach for mediastinal lymph node sampling

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