Differentiating malignant and benign lymph nodes using endobronchial ultrasound elastography

Abstract

EBUS elastography is a valuable tool in discriminating benign and malignant mediastinal LNs.

Quantitative analysis of endobronchial ultrasound elastography in computed tomography‐negative mediastinal and hilar lymph nodes

“…LNs can be hardened due to calcification in patients with a history of pulmonary tuberculosis, pneumoconiosis, or anthracosis; this can result in false positive results for malignancy on EBUS elastography. 15,17,19,20 In this study, all six benign LNs with a SAR >0.6 were found in patients with a history of pulmonary tuberculosis or apparent exposure to mineral dusts such as coal or asbestos. The effectiveness of EBUS elastography has been reported in a population with a high prevalence of anthracosis 32 ; however, the effects of other occupational inhalation exposures and a prior history of pulmonary tuberculosis on EBUS elastography remain poorly studied.…”

“…Various EBUS elastography evaluation methods for mediastinal and hilar LNs have been described. [14][15][16][17][18][19][20][21][22][23] No differences were found in the diagnostic yields between quantitative and qualitative evaluations of EBUS elastography in a prospective study. 21 In a comparison of quantitative evaluation (SAR or strain ratio) and qualitative evaluation (3-image pattern classifications) of EBUS elastography, a meta-analysis reported a significantly higher specificity for qualitative evaluation (90% vs. 81%, P = 0.001); however, the sensitivities were equivocal (92% The stiffness area ratio of benign and malignant lymph nodes on EBUS elastography.…”

“…A retrospective study of 1061 mediastinal and hilar LNs reported that 96.0% (381/397) were benign, based on the following features: round shape, distinct margin, heterogeneous echogenicity, and CNS. 12 However, the categorizations of each B-mode finding have resulted in large differences in the diagnostic yields between studies, 12,18,19,22,23 and the assessments have required appropriate training and experience. 16 In contrast, EBUS elastography has demonstrated a high DAR in all studies, [14][15][16][17][18][19][20][21][22][23] and has been preferred by the operators due to the coloration of the tissues and their easy evaluation.…”

“…Similar to the present study, recent reports have found improved diagnostic yields with the combination of elastography and B-mode sonography. 18,19 Currently, the evaluation of LNs using the multiple EBUS image mode is indispensable for efficient EBUS-TBNA.…”

“…Qualitative elastography measures include the 3and 5-image pattern classifications. [14][15][16][17][18][19][20][21][22][23] The 3-image pattern classification is often problematic, as the definition of the pattern is ambiguous. In general, unlike qualitative tests, quantitative tests can avoid the problems associated with subjective evaluations by using specific numerical values.…”