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

Abstract

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.

The Utility of the Ultrasonographic Characteristics in Differentiating Between Malignant and Tuberculous Mediastinal Lymphadenopathy During EBUS-TBNA

“…Apart from sonographic characteristics, another imaging modality during EBUS is elastography. A recent meta-analysis concluded that elastography might help differentiate malignant from benign lymph nodes, but lymph node aspiration is still required 14,15. It has also been highlighted that the performance characteristics of elastography may be variable, with a significant overlap between malignant and benign node features in settings where granulomatous nodes are common 16…”

“…A recent meta-analysis concluded that elastography might help differentiate malignant from benign lymph nodes, but lymph node aspiration is still required. 14,15 It has also been highlighted that the performance characteristics of elastography may be variable, with a significant overlap between malignant and benign node features in settings where granulomatous nodes are common. 16 A combination of sonographic characteristics may be more useful in predicting malignancy than either sign alone.…”

The diagnostic utility of ultrasound elastography to differentiate tuberculosis and sarcoidosis during endobronchial ultrasound–guided transbronchial needle aspiration (EBUS-TBNA)

“…Quantitative estimation of hardness is also possible by various methods, and many elastographic patterns have been studied. [ 10 ] The most commonly reported methods include the qualitative three-colour classification method and the quantitative strain ratio method. [ 9 11 ] Elastography may help differentiate malignant and benign lymph nodes, and among the available elastography assessment methods, the three-color classification method may be preferable.…”

“…[ 9 11 ] Elastography may help differentiate malignant and benign lymph nodes, and among the available elastography assessment methods, the three-color classification method may be preferable. [ 10 ]…”

Proposed quality indicators and recommended standard reporting items in performance of EBUS bronchoscopy: An official World Association for Bronchology and Interventional Pulmonology Expert Panel consensus statement

“…Numerous international guidelines recommend mediastinoscopy in cases where the suspicion of nodal metastases remains high despite the negative staging EBUS. No definition of 'high suspicion' has been provided and sonographic 49,81,82 or elastographic 83 features can play an important part of assessing this risk. It also provides appropriate governance and documentation in the event of adverse events.…”