J Cancer 2017; 8(10):1843-1848. doi:10.7150/jca.19819

Research Paper

Effectiveness of the Benign and Malignant Diagnosis of Mediastinal and Hilar Lymph Nodes by Endobronchial Ultrasound Elastography

Haidong Huang1*, Zhiang Huang2*, Qin Wang1*, Xinan Wang3*, Yuchao Dong1, Wei Zhang1, Paul Zarogoulidis4✉, Yan-Gao Man5, Wolfgang Hohenforst Schmidt6, Chong Bai1✉

1. Department of Respiratory & Critical Care Medicine, Changhai Hospital, the Second Military Medical University, China
2. Department of Respiratory, The first affiliated hospital of henan university, China.
3. Department of Respiratory Medicine, Binzhou People 's Hospital, China
4. Pulmonary Oncology Unit, “G. Papanikolaou” General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
5. Research Laboratory and International Collaboration, Bon Secours Cancer Institute, VA, USA
6. Sana Clinic Group Franken, Department of Cardiology / Pulmonology / Intensive Care / Nephrology, “Hof” Clinics, University of Erlangen, Hof, Germany
* Haidong Huang, Zhiang Huang, Qin Wang, Xinan Wang, equally contributed to this work.

Abstract

Background and Objectives: Endobronchial ultrasound elastography is a new technique for describing the stiffness of tissue during endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA). The aims of this study were to investigate the diagnostic value of Endobronchial ultrasound (EBUS) elastography for distinguishing the difference between benign and malignant lymph nodes among mediastinal and hilar lymph nodes.

Materials and Methods: From June 2015 to August 2015, 47 patients confirmed of mediastinal and hilar lymph node enlargement through examination of Computed tomography (CT) were enrolled, and a total of 78 lymph nodes were evaluated by endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA). EBUS-guided elastography of lymph nodes was performed prior to EBUS-TBNA. A convex probe EBUS was used with a new EBUS processor to assess elastographic patterns that were classified based on color distribution as follows: Type 1, predominantly non-blue (green, yellow and red); Type 2, part blue, part non-blue (green, yellow and red); Type 3, predominantly blue. Pathological determination of malignant or benign lymph nodes was used as the gold standard for this study. The elastographic patterns were compared with the final pathologic results from EBUS-TBNA.

Results: On pathological evaluation of the lymph nodes, 45 were benign and 33 were malignant. The lymph nodes that were classified as Type 1 on endobronchial ultrasound elastography were benign in 26/27 (96.3%) and malignant in 1/27 (3.7%); for Type 2 lymph nodes, 15/20 (75.0%) were benign and 5/20 (25.0%) were malignant; Type 3 lymph nodes were benign in 4/31 (12.9%) and malignant in 27/31 (87.1%). In classifying Type 1 as 'benign' and Type 3 as 'malignant,' the sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy rates were 96.43%, 86.67%, 87.10%, 96.30%, 91.38%, respectively.

Conclusion: EBUS elastography of mediastinal and hilar lymph nodes is a noninvasive technique that can be performed reliably and may be helpful in the prediction of benign and malignant lymph nodes among mediastinal and hilar lymph node during EBUS-TBNA.

Keywords: Bronchoscope, Ultrasound Elastography, Mediastinal and Hilar Lymph Nodes, Diagnosis

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How to cite this article:
Huang H, Huang Z, Wang Q, Wang X, Dong Y, Zhang W, Zarogoulidis P, Man YG, Schmidt WH, Bai C. Effectiveness of the Benign and Malignant Diagnosis of Mediastinal and Hilar Lymph Nodes by Endobronchial Ultrasound Elastography. J Cancer 2017; 8(10):1843-1848. doi:10.7150/jca.19819. Available from http://www.jcancer.org/v08p1843.htm