Endobronchial ultrasound elastography for diagnosing mediastinal and hilar lymph nodes

Roca, María Hernández; Pallarés, Javier Pérez; Salas, María del Mar Valdivia; García‐Solano, José; Prieto‐Merino, David; Díaz, Janepsy; Siminiani, Antonio Santa Cruz

doi:10.1016/j.medcle.2019.03.030

Cited by 1 publication

(5 citation statements)

References 17 publications

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“…The frequency histograms and blue proportion are less variable (< 10%) than the SR (30.8%). 31 Qualitative versus quantitative method did not influence the heterogeneity in sensitivity in our meta-analysis.…”

Section: Discussionmentioning

confidence: 67%

“…13,21,23,30 However, this method has considerable heterogeneity in the cutoffs used and is one of the most variable parameters. 31 Also, there is ambiguity in the perinodal area to be selected for its calculation. Cutoff values ranging from 2.47 to 32.07 are described, yielding variable sensitivity, specificity, and diagnostic accuracy.…”

Section: Discussionmentioning

confidence: 99%

“…5 However, a significant drawback of this method is that the type 2 pattern is not included in diagnostic comparison (only type 3 was compared with type 1 for malignancy). 5,7,22,25,28,31 This choice leaves a large proportion of lymph nodes (part blue part nonblue) as unclassified and does not add to clinical decisions. A large percentage of nodes in real-life settings will not fit into either a type 3 or type 1 pattern.…”

Section: Discussionmentioning

confidence: 99%

“…In the initial study, there was also a good correlation between FDG-PET SUV max and the color classifications 5. However, a significant drawback of this method is that the type 2 pattern is not included in diagnostic comparison (only type 3 was compared with type 1 for malignancy) 5,7,22,25,28,31. This choice leaves a large proportion of lymph nodes (part blue part nonblue) as unclassified and does not add to clinical decisions.…”

Section: Discussionmentioning

confidence: 99%

“…The SR is the most reported (4 studies) quantitative elastography method 13,21,23,30. However, this method has considerable heterogeneity in the cutoffs used and is one of the most variable parameters 31. Also, there is ambiguity in the perinodal area to be selected for its calculation.…”

Section: Discussionmentioning

confidence: 99%

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Utility of Elastography for Differentiating Malignant and Benign Lymph Nodes During EBUS-TBNA

Madan

Iyer

et al. 2021

Journal of Bronchology &Amp; Interventional Pulmonology

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Background: Ultrasound elastography noninvasively estimates tissue hardness. Studies have evaluated elastography for differentiating malignant from benign lymph nodes during endobronchial ultrasound-guided transbronchial needle aspiration. Several methods of performing elastography are described with variable diagnostic accuracy.Methods: The aim of this study was to evaluate endobronchial ultrasound-guided elastography in differentiating malignant from benign mediastinal lymphadenopathy. We performed a systematic search of the PubMed and Embase databases to extract the relevant studies. A diagnostic accuracy meta-analysis was carried out to calculate the pooled sensitivity and specificity [with 95% confidence intervals (CIs)], and positive and negative likelihood ratios of elastography.Results: After a systematic search, 20 studies (1600 patients, 2712 nodes) were selected. The pooled sensitivity and specificity of elastography were 0.90 (95% CI, 0.84-0.94) and 0.79 (95% CI, 0.73-0.84), respectively. The summary receiver operating curve demonstrated an area under the curve for elastography of 0.90 (0.88-0.93). The positive and negative likelihood ratios and the diagnostic odds ratio were 4.3 (95% CI, 3.3-5.5), 0.12 (95% CI, 0.07-0.20), and 35 (95% CI, 19-63), respectively. Of the most commonly described methods, the color classification method (type 3 malignant vs. type 1 benign) demonstrated the highest area under the curve of 0.91 (0.88-0.93). There was significant heterogeneity and publication bias. Subgroup analyses indicated no significant difference between the sensitivity and specificity of quantitative and qualitative elastography methods.Conclusions: Ultrasound elastography is useful in differentiating malignant and benign lymph nodes during endobronchial ultrasound-guided transbronchial needle aspiration. However, elastography does not replace the requirement of lymph node aspiration.

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Section: Discussionmentioning

confidence: 67%