The utility of elastography during EBUS‐TBNA in a population with a high prevalence of anthracosis

Abedini, Atefeh; Razavi, Fatemeh; Farahani, Mehrdad; Hashemi, Marzieh; Emami, Habib; Mohammadi, Forouzan; Kiani, Arda

doi:10.1111/crj.13159

Cited by 14 publications

(9 citation statements)

References 16 publications

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“…calci cation or necrosis in the lymph nodes (He et al 2017). False positive results have been reported in previous studies, mostly due to the increased stiffness in tuberculosis, pneumoconiosis, or sarcoidosis (Abedini et al 2020;Dong et al 2018;Trisolini et al 2020) (Livi et al 2019). In our study, we observed that 6 cases had blue images in elastography, however, the nal pathological diagnosis were calci cation or brosis in the lymph nodes.…”

Section: Discussionsupporting

confidence: 44%

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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Section: Discussionsupporting

confidence: 44%

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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“…15,17,19,20 In this study, all six benign LNs with a SAR >0.6 were found in patients with a history of pulmonary tuberculosis or apparent exposure to mineral dusts such as coal or asbestos. The effectiveness of EBUS elastography has been reported in a population with a high prevalence of anthracosis 32 ; however, the effects of other occupational inhalation exposures and a prior history of pulmonary tuberculosis on EBUS elastography remain poorly studied. It is important for bronchoscopists to acknowledge that a patient's occupational and medical history may affect the results of EBUS elastography; therefore, careful review and modification of the SAR cutoff value, based on each individual patient's history, are necessary.…”

Section: Figurementioning

confidence: 99%

Quantitative analysis of endobronchial ultrasound elastography in computed tomography‐negative mediastinal and hilar lymph nodes

et al. 2020

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Background Endobronchial ultrasound (EBUS) elastography assists in the differentiation of benign and malignant lymph nodes (LNs) during transbronchial needle aspiration (TBNA). However, previous studies have not compared B‐mode sonographic images (BSIs) and EBUS elastography images (EEIs) with final pathological diagnoses in radiologically normal‐sized (computed tomography [CT]‐negative) LNs. Methods Consecutive patients with CT‐negative LNs, who received EBUS‐TBNA, were retrospectively reviewed. Images of BSIs and EEIs of each LN were stored and independently evaluated. EEIs were assessed by calculating the stiffness area ratio (SAR, blue/overall areas). The receiver operating characteristic curve was used to calculate the cutoff value for the SAR. Diagnostic test parameters were evaluated for each EBUS finding. Results A total of 132 patients (149 LNs) were enrolled, and the median SAR of malignant LNs was significantly higher than that of benign LNs (0.58 vs. 0.32, P < 0.001). At the SAR cutoff of 0.41, the sensitivity, specificity, positive predictive value, negative predictive value (NPV), and diagnostic accuracy rate (DAR) of elastography were 88.2%, 80.2%, 78.9%, 89.0%, and 83.9%, respectively. The logistic regression analysis showed that elastography was the strongest predictor of malignancy (odds ratio, 18.5; 95% confidence interval [CI]: 6.48–52.6; P < 0.001). The highest NPV (96.6%) was achieved with a combination of BSIs and EEIs. Conclusions EBUS elastography predicted malignant LNs with a high DAR and NPV in CT‐negative LNs. The NPV was highest when EEIs were combined with BSIs. Therefore, the combined evaluation of CT‐negative LNs using EEIs and BSIs may help bronchoscopists perform EBUS‐TBNA more efficiently. Key points Significant findings of the study Endobronchial ultrasound elastography accurately predicted malignancy with a high diagnostic accuracy rate and negative predictive value in radiologically normal‐sized lymph nodes. The additional use of B‐mode sonographic features resulted in a higher negative predictive value. What this study adds Endobronchial ultrasound elastography can guide the accurate collection of specimens with transbronchial needle aspiration, even in radiologically normal‐sized lymph nodes. It can also readily distinguish benign and malignant lymph nodes, thus avoiding unnecessary punctures.

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“…One study on EBUS elastography was excluded due to lack of sufficient information to verify and extract the true positive, FP, false negative, and true negative values required for summary statistics of diagnostic accuracy. 20…”

Section: Resultsmentioning

confidence: 99%

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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The utility of elastography during EBUS‐TBNA in a population with a high prevalence of anthracosis

Cited by 14 publications

References 16 publications

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

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

Quantitative analysis of endobronchial ultrasound elastography in computed tomography‐negative mediastinal and hilar lymph nodes

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

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