Diagnostic value of endobronchial ultrasound elastography for the differentiation of benign and malignant intrathoracic lymph nodes

• Published in: Respirology (Carlton, Vic.) Vic.), 2017-07, Vol.22 (5), p.972-977
• Main Authors: Korrungruang, Potjanee, Boonsarngsuk, Viboon
• Format: Article
• Language: English
• Subjects: Adult; Aged; Benign; Elasticity Imaging Techniques; elastography; endobronchial ultrasound; endobronchial ultrasound‐guided transbronchial needle aspiration; Female; Humans; Image-Guided Biopsy; Lymph nodes; Lymph Nodes - diagnostic imaging; Lymph Nodes - pathology; Lymphadenopathy; Lymphadenopathy - diagnostic imaging; Lymphadenopathy - pathology; Lymphatic system; Male; malignancy; Mediastinum - diagnostic imaging; Mediastinum - pathology; Middle Aged; Prospective Studies; Respiratory diseases; Sensitivity and Specificity; strain ratio; Ultrasonic imaging; Ultrasound
• ISSN: 1323-7799; 1440-1843
• DOI: 10.1111/resp.12979

ABSTRACT Background and objective Endobronchial ultrasound (EBUS) findings can be used for benign/malignant differentiation of lymph nodes (LNs). Recently, EBUS elastography has been introduced as a complementary modality in the evaluation of intrathoracic lymphadenopathy. We evaluated the ability of EBUS elastography to differentiate between benign and malignant LNs. Methods A prospective study was conducted on patients sent for evaluation of intrathoracic lymphadenopathy. LNs were classified qualitatively according to elastographic colour pattern: type 1, predominantly non‐blue; type 2, partly blue, partly non‐blue and type 3, predominantly blue. Quantitative elastography of LNs was measured by the strain ratio (SR). Qualitative and quantitative elastographies were compared for the final diagnosis of LNs. Results There were 120 LNs from 72 patients who underwent EBUS elastography. The final diagnosis included 96 malignant and 24 benign LNs. All of the 16 type 1 LNs proved to be benign diseases, while 95 of the 101 type 3 LNs were finally diagnosed as malignancies. Three LNs classified as type 2 proved to be two benign and one malignant. Malignant LNs presented a higher median SR than benign LNs (73.50 vs 1.29, P = 0.001). An SR of >2.5 and non‐type 1 elastographic pattern achieved similar diagnostic performance in benign/malignant differentiation (sensitivity, 100% vs 100%; specificity, 70.8% vs 66.7%; positive predictive value, 93.2% vs 92.3%; negative predictive value, 100% vs 100%). Conclusion EBUS elastography is a promising diagnostic modality for the differentiation of benign and malignant LNs during EBUS‐guided transbronchial needle aspiration (TBNA). Qualitative and quantitative EBUS elastographies provide similar diagnostic performance. Endobronchial ultrasound elastography has been introduced as a complementary modality in benign/malignant differentiation of intrathoracic lymphadenopathy. We found that a strain ratio of >2.5 and non‐type 1 elastographic pattern achieved similar high diagnostic performance in benign/malignant differentiation. It can be useful for targeting a suspicious lymph node for sampling. See Editorial, page 843