Endobronchial Ultrasound Elastography Differentiates Intrathoracic Lymph Nodes: A Meta-Analysis

Chen, Yefeng; Mao, Xiaowei; Zhang, Yujun; Zhang, Chunyi; YueFang, Yu; Qin, Enqiang; Chen, Xing; Shen, Juxin

doi:10.1016/j.athoracsur.2018.04.003

Cited by 14 publications

(15 citation statements)

References 35 publications

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“…To our knowledge, this is the first study utilizing a standardized assessment protocol to show the added predictive value of EBUS-SE in relevant daily clinical scenarios in multiple centers. We confirm earlier single-center studies that showed an association between relative strain and presence of lymph node malignancy [10,11]. In this study, we show that SE is an independent predictive variable.…”

Section: Discussionsupporting

confidence: 92%

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Predictive Value of Endobronchial Ultrasound Strain Elastography in Mediastinal Lymph Node Staging: The E-Predict Multicenter Study Results

et al. 2020

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Background: Systematic assessment of lymph node status by endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is indicated in (suspected) lung cancer. Sampling is herein guided by nodal size and FDG-PET characteristics. Ultrasound strain elastography (SE) might further improve risk stratification. By imaging tissue deformation over time, SE computes relative tissue strain. In several tissues, a lower strain (deformation) has been associated with a higher likelihood of malignancy. Objectives: To assess if EBUS-SE can independently help predict malignancy, and when combined with size and FDG uptake information. Methods: This multicenter (n = 5 centers) prospective trial included patients with suspected or proven lung cancer using a standardized measurement protocol. Cytopathology combined with surgery or follow-up imaging (> 6 months) were used as reference standard. Results: Between June 2016 and July 2018, 327 patients and 525 lymph nodes were included (mean size 12.3 mm, malignancy prevalence 0.48). EBUS-SE had an overall AUC of 0.77. A mean strain < 115 (range 0-255) showed 90% sensitivity, 43% specificity, 60% positive predictive value, and 82% negative predictive value. Combining EBUS-SE (< 115) with size (< 8 mm) and FDG-PET information into a risk stratification algorithm increased the accuracy. Combining size and SE showed that the 48% a priori chance of malignancy changed to 11 and 70% in double negative or positive nodes, respectively. In the subset where FDG-PET was available (n = 370), triple negative and positive nodes went from a 42% a priori chance of malignancy to 9 and 73%, respectively. Conclusions: EBUS-SE can help predict lymph node malignancy and may be useful for risk stratification when combined with size and PET information.

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Section: Discussionsupporting

confidence: 92%

“…EBUS-strain elastography (EBUS-SE) is one of the relatively new ultrasound features. It has proven promising in risk stratification of likely malignant lymph nodes among different studies [11]. EBUS-SE derives tissue strain by monitoring how tissue deforms over time as a force is being applied.…”

Section: Introductionmentioning

confidence: 99%

Predictive Value of Endobronchial Ultrasound Strain Elastography in Mediastinal Lymph Node Staging: The E-Predict Multicenter Study Results

et al. 2020

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“…Based on a two-sided hypothesis, comparisons between the two groups were examined using the Fisher's exact test or Mann-Whitney U test. All B-mode sonographic and EBUS elastographic parameters, which were potentially predictive of malignant LNs, 12,14 were analyzed with multivariate logistic regression. The Cochran-Armitage test was used to identify the trend with one-sided P-values.…”

Section: Discussionmentioning

confidence: 99%

“…A recent meta-analysis characterized the differences between benign LNs and malignant LNs when evaluated using EBUS elastography. 14 Quantitative elastography measures include the stiffness area ratio (SAR, blue area/overall area) or mean strain value of the LN, and the strain ratio between the LN and surrounding tissues. Qualitative elastography measures include the 3and 5-image pattern classifications.…”

Section: Introductionmentioning

confidence: 99%

“…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.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2020

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Background Endobronchial ultrasound (EBUS) elastography assists in the differentiation of benign and malignant lymph nodes (LNs) during transbronchial needle aspiration (TBNA). However, previous studies have not compared B‐mode sonographic images (BSIs) and EBUS elastography images (EEIs) with final pathological diagnoses in radiologically normal‐sized (computed tomography [CT]‐negative) LNs. Methods Consecutive patients with CT‐negative LNs, who received EBUS‐TBNA, were retrospectively reviewed. Images of BSIs and EEIs of each LN were stored and independently evaluated. EEIs were assessed by calculating the stiffness area ratio (SAR, blue/overall areas). The receiver operating characteristic curve was used to calculate the cutoff value for the SAR. Diagnostic test parameters were evaluated for each EBUS finding. Results A total of 132 patients (149 LNs) were enrolled, and the median SAR of malignant LNs was significantly higher than that of benign LNs (0.58 vs. 0.32, P < 0.001). At the SAR cutoff of 0.41, the sensitivity, specificity, positive predictive value, negative predictive value (NPV), and diagnostic accuracy rate (DAR) of elastography were 88.2%, 80.2%, 78.9%, 89.0%, and 83.9%, respectively. The logistic regression analysis showed that elastography was the strongest predictor of malignancy (odds ratio, 18.5; 95% confidence interval [CI]: 6.48–52.6; P < 0.001). The highest NPV (96.6%) was achieved with a combination of BSIs and EEIs. Conclusions EBUS elastography predicted malignant LNs with a high DAR and NPV in CT‐negative LNs. The NPV was highest when EEIs were combined with BSIs. Therefore, the combined evaluation of CT‐negative LNs using EEIs and BSIs may help bronchoscopists perform EBUS‐TBNA more efficiently. Key points Significant findings of the study Endobronchial ultrasound elastography accurately predicted malignancy with a high diagnostic accuracy rate and negative predictive value in radiologically normal‐sized lymph nodes. The additional use of B‐mode sonographic features resulted in a higher negative predictive value. What this study adds Endobronchial ultrasound elastography can guide the accurate collection of specimens with transbronchial needle aspiration, even in radiologically normal‐sized lymph nodes. It can also readily distinguish benign and malignant lymph nodes, thus avoiding unnecessary punctures.

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Endobronchial Ultrasound‐Guided Transbronchial Needle Aspiration

Fielding¹

2020

Endobronchial Ultrasonography

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Endobronchial Ultrasound Elastography Differentiates Intrathoracic Lymph Nodes: A Meta-Analysis

Abstract: The results revealed endobronchial ultrasound elastography is a new technique with high sensitivity and specificity. It has a fine performance in diagnosing intrathoracic lymph nodes.

Cited by 14 publications

References 35 publications

Predictive Value of Endobronchial Ultrasound Strain Elastography in Mediastinal Lymph Node Staging: The E-Predict Multicenter Study Results

Predictive Value of Endobronchial Ultrasound Strain Elastography in Mediastinal Lymph Node Staging: The E-Predict Multicenter Study Results

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

Endobronchial Ultrasound‐Guided Transbronchial Needle Aspiration

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