Diagnostic value of endobronchial ultrasound elastography for differentiating benign and malignant hilar and mediastinal lymph nodes: a systematic review and meta-analysis

Abstract

Aims: In the present study, a meta-analysis was performed to evaluate the diagnostic value of endobronchial ultrasound (EBUS) elastography for differentiating benign and malignant hilar and mediastinal lymph nodes (LNs). Material and methods: A comprehensive literature search was carried out through PubMed, Embase, and Cochrane Library. Two authors screened the papers and extracted the data independently and any discrepancies were resolved by discussion. The methodolog-ical quality of each included study was assessed by the Quality Assessment of Diagnostic Accuracy Studies 2 tool. Sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and area under the curve were calculated to evaluate the value of EBUS elastography for hilar and mediastinal LNs. Results: Seventeen studies with the number of 2307 LNs were included. There was significant heterogeneity across the included studies. The pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio and diagnostic odds ratio for the diagnosis of hilar and mediastinal LNs by EBUS elastography were 0.90 (95% confidence interval [CI], 0.84-0.94), 0.78 (95% CI, 0.74-0.81), 4.1 (95% CI, 3.4-4.9), 0.12 (95% CI, 0.07-0.21) and 33 (95% CI, 17-64), respectively. Furthermore, area under the curve was calculated to be 0.86 (95% CI, 0.82-0.88). Conclusion: EBUS elastography is a valuable technology in the differentiation of benign and malignant hilar and mediastinal LNs and could provide supplementary diagnostic information during endobronchial ultrasound-guided transbronchial needle aspiration. The combination of EBUS elastography and B-mode EBUS could improve the diagnostic accuracy for hilar and mediastinal LNs.

Diagnostic Accuracy of Elastography to Differentiate Between Benign and Malignant Lymph Nodes of Head and Neck Region taking Histopathology as the Gold Standard

“…Still, this modality might not have a confident diagnostic value due to the possibility that some benign and malignant nodes are visually indistinguishable. 11,12 For the assessment of cervical Lymph nodes, FNAC is stated to have a sensitivity of 82 % and a specificity of 97 % per cent. 13,14 Conversely, FNAC is intrusive and sometimes provides a decisive investigative outcome.…”

Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration (EBUS-TBNA): Technical Updates and Pathological Yield

“…A meta-analysis of 17 studies for differentiating benign versus malignant adenopathy found a pooled sensitivity of 0.90 (95% confidence interval (CI), 0.84–0.94) and specificity of 0.78 (95% CI, 0.74–0.81) [ 38 ], suggesting that this modality could be important in real-time differentiation of benign versus malignant lymphadenopathy.…”

The evolution of endobronchial ultrasound usage in modern era

“…However, the ideal and established assessment approach for EBUS elastography remains uncertain, and there is a requirement for improvements in the performance of this technique as highlighted in much of the published research ( 5 , 27 , 28 ). In a metaanalysis including seventeen studies to investigate the impact of EBUS elastography for discrimination between benign and malignant hilar and mediastinal LNs., the authors showed the diagnostic performance of EBUS elastography for hilar and mediastinal lymph nodes is well-established, with a sensitivity of 0.90 (95% CI, 0.84-0.94) and a specificity of 0.78 (95% CI, 0.74-0.81) respectively ( 29 ). Concerning benign lesions, Madan et al indicated that the diagnostic utility of elastographic lymph node features for distinguishing between tuberculosis and sarcoidosis during EBUS-TBNA is limited ( 30 ).…”