Endobronchial Ultrasound Multimodal Imaging for the Diagnosis of Intrathoracic Lymph Nodes

Abstract

<b><i>Background:</i></b> 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. <b><i>Methods:</i></b> 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. <b><i>Results:</i></b> 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. <b><i>Conclusions:</i></b> 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.

A risk-scoring model based on endobronchial ultrasound multimodal imaging for predicting metastatic lymph nodes in lung cancer patients

“…For size, a short axis of >10 mm was considered as an independent risk predictor, consistent with most studies. [ 20 , 21 , 27 ] An increase in nodal size may suggest metastatic involvement in patients with a known primary lung cancer. However, reactive LNs can be as large as metastatic LNs, whereas malignancy can be found in small nodes.…”

“…If the image is not ideal, an up-down angle lever of the bronchoscope will be used at a frequency of 3 to 5 times per second. [ 15 , 20 ] After the operation, bronchoscopists saved the following videos: a 10-second grayscale video, a 20-second blood flow Doppler video, and two 20-second elastography videos.…”

“…The following manifestations were considered metastatic LNs based on our previous studies [ 14 , 15 , 20 ] : short axis >10 mm, round shape, distinct margin, heterogeneity, absence of CHS, presence of necrosis, presence of matting, presence of calcification, nonhilar vascularity, and elastography score of 4 to 5. These sonographic features, CT short diameter, and SUVmax on PET/CT were compared with the final pathology outcomes to calculate the diagnostic accuracies.…”

Combination of 18F-FDG PET/CT and convex probe endobronchial ultrasound elastography for intrathoracic malignant and benign lymph nodes prediction

“…The qualitative grading score method was used: 1 (scattered soft, mixed green-yellow-red); 2 (homogeneous soft, predominantly green); 3 (intermediate, mixed blue-green yellow-red); 4 (scattered hard, mixed blue-green); and 5 (homogeneous hard, predominantly blue). A score of 1-3 denotes benign and a score of 4-5 indicates malignant (14,20). Three experienced doctors (LW, JC, and XZ) with EBUS imaging observation of more than 500 LNs reviewed elastography videos twice independently blind to the final diagnosis of LNs, and determined the final qualitative evaluation result of each expert subsequently.…”

Diagnostic Accuracy of Elastography to Differentiate Between Benign and Malignant Lymph Nodes of Head and Neck Region taking Histopathology as the Gold Standard

“…8,9 Strain elastography uses long and low-intensity pulses, but shear wave elastography uses shorter, high-intensity and focused pulses. 10 The rationale of our study was to sum up the diagnostic accuracy of elastography to differentiate benign and malignant lymphadenopathy of the cervical region. At the same time, FANC/biopsy was kept as the gold standard.…”