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

Abstract

BackgroundPositron emission tomography–computed tomography (PET/CT) and convex probe endobronchial ultrasound (CP-EBUS) elastography are important diagnostic methods in predicting intrathoracic lymph nodes (LNs) metastasis, but a joint analysis of the two examinations is still lacking. This study aimed to compare the diagnostic efficiency of the two methods and explore whether the combination can improve the diagnostic efficiency in differentiating intrathoracic benign LNs from malignant LNs.Materials and MethodsLNs examined by EBUS-guided transbronchial needle aspiration (EBUS-TBNA) and PET/CT from March 2018 to June 2019 in Shanghai Chest Hospital were retrospectively analyzed as the model group. Four PET/CT parameters, namely, maximal standardized uptake value mean standardized uptake value (SUVmean), SUVmean, metabolic tumor volume (MTV), and tumor lesion glycolysis (TLG); four quantitative elastography indicators (stiff area ratio, mean hue value, RGB, and mean gray value); and the elastography grading score of targeted LNs were analyzed. A prediction model was constructed subsequently and the dataset from July to November 2019 was used to validate the diagnostic capability of the model.ResultsA total of 154 LNs from 135 patients and 53 LNs from 47 patients were enrolled in the model and validation groups, respectively. Mean hue value and grading score were independent malignancy predictors of elastography, as well as SUVmax and TLG of PET/CT. In model and validation groups, the combination of PET/CT and elastography demonstrated sensitivity, specificity, positive and negative predictive values, and accuracy for malignant LNs diagnosis of 85.87%, 88.71%, 91.86%, 80.88%, and 87.01%, and 94.44%, 76.47%, 89.47%, 86.67%, and 88.68%, respectively. Moreover, elastography had better diagnostic accuracies than PET/CT in both model and validation groups (85.71% vs. 79.22%, 86.79% vs. 75.47%).ConclusionEBUS elastography demonstrated better efficiency than PET/CT and the combination of the two methods had the best diagnostic efficacy in differentiating intrathoracic benign from malignant LNs, which may be helpful for clinical application.

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

“…[ 35 ] In this study, the sensitivity and specificity of the size criteria were 86.76% and 31.15%, respectively, similar to a previous study. [ 19 ] The number of PET/CT performed on reactive LNs was only 31, of which 29 LNs were diagnosed as malignant based on SUVmax >2.5; thus, the specificity of SUVmax was low at 6.45%, but the sensitivity was 95.83%. Compared with CT and PET/CT, our EBUS multimodal imaging had a higher diagnostic accuracy.…”

“…The maximum standardized uptake value (SUVmax) was obtained by drawing regions of interest on attenuation-corrected fluorodeoxyglucose-PET fusion images around the involved LN group. [ 19 ] SUVmax >2.5 was used to predict malignant LNs. The time interval between CT or PET/CT and EBUS-TBNA was less than 1 month.…”