Predicting malignancy in mediastinal lymph nodes by endobronchial ultrasound: A new ultrasound scoring system

Schmid-Bindert, Gerald; Huang, Jiang; Kähler, Georg; Saur, Joachim; Henzler, Thomas; Wang, Hao; Ren, Shengxiang; Zhou, Caicun; Pilz, Lothar R.

doi:10.1111/j.1440-1843.2012.02223.x

Cited by 57 publications

(79 citation statements)

References 37 publications

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“…EBUS-TBNA on the other hand is a very safe method with a complication rate near to zero [22], thus repeated needle aspirations for higher diagnostic yields are possible without compromising the patient. Moreover, needle aspirations are taken under direct vision and by using power Doppler imaging and general morphological ultrasound criteria, thus necrotic areas of lymph nodes can be avoided for biopsy most of the time [23].…”

Section: Discussionmentioning

confidence: 99%

EBUS-TBNA Provides Highest RNA Yield for Multiple Biomarker Testing from Routinely Obtained Small Biopsies in Non-Small Cell Lung Cancer Patients - A Comparative Study of Three Different Minimal Invasive Sampling Methods

et al. 2013

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BackgroundMultiple biomarker testing is necessary to facilitate individualized treatment of lung cancer patients. More than 80% of lung cancers are diagnosed based on very small tumor samples. Often there is not enough tissue for molecular analysis. We compared three minimal invasive sampling methods with respect to RNA quantity for molecular testing.Methods106 small biopsies were prospectively collected by three different methods forceps biopsy, endobronchial ultrasound (EBUS) guided transbronchial needle aspiration (TBNA), and CT-guided core biopsy. Samples were split into two halves. One part was formalin fixed and paraffin embedded for standard pathological evaluation. The other part was put in RNAlater for immediate RNA/DNA extraction. If the pathologist confirmed the diagnosis of non-small cell lung cancer(NSCLC), the following molecular markers were tested: EGFR mutation, ERCC1, RRM1 and BRCA1.ResultsOverall, RNA-extraction was possible in 101 out of 106 patients (95.3%). We found 49% adenocarcinomas, 38% squamouscarcinomas, and 14% non-otherwise-specified(NOS). The highest RNA yield came from endobronchial ultrasound guided needle aspiration, which was significantly higher than bronchoscopy (37.74±41.09 vs. 13.74±15.53 ng respectively, P = 0.005) and numerically higher than CT-core biopsy (37.74±41.09 vs. 28.72±44.27 ng respectively, P = 0.244). EGFR mutation testing was feasible in 100% of evaluable patients and its incidence was 40.8%, 7.9% and 14.3% in adenocarcinomas, squamouscarcinomas and NSCLC NOS subgroup respectively. There was no difference in the feasibility of molecular testing between the three sampling methods with feasibility rates for ERCC1, RRM1 and BRCA1 of 91%, 87% and 81% respectively.ConclusionAll three methods can provide sufficient tumor material for multiple biomarkers testing from routinely obtained small biopsies in lung cancer patients. In our study EBUS guided needle aspiration provided the highest amount of tumor RNA compared to bronchoscopy or CT guided core biopsy. Thus EBUS should be considered as an acceptable option for tissue acquisition for molecular testing.

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Section: Discussionmentioning

confidence: 99%

EBUS-TBNA Provides Highest RNA Yield for Multiple Biomarker Testing from Routinely Obtained Small Biopsies in Non-Small Cell Lung Cancer Patients - A Comparative Study of Three Different Minimal Invasive Sampling Methods

et al. 2013

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“…Although EBUS imaging of conventional B-mode and power Doppler are very useful for the detection of intrathoracic LNs, the differential diagnosis between benign and malignant lesions remains difficult and has its limitations [8][9][10] . In our study, the most commonly used criteria for differential diagnosis in the decreasing order of importance according to diagnostic accuracy are as follows: nonhilar perfusion of vascular pattern (70.31%), absence of CHS (66.67%), echogenicity (56.06%), round shape (54.55%), short axis >1 cm (53.03%), and distinct margin (50.00%).…”

Section: Discussionmentioning

confidence: 99%

“…Few studies have evaluated various ultrasound characteristics including gray scale and power Doppler noted on EBUS to predict the malignancy of LNs [7][8][9] . However, these features are limited either in sensitivity or specificity, and no single criterion for malignant LNs had a satisfactory predictive value.…”

Section: Introductionmentioning

confidence: 99%

Endobronchial Ultrasound Elastography for Evaluation of Intrathoracic Lymph Nodes: A Pilot Study

Sun

Zheng²,

Mao³

et al. 2017

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Background: Endobronchial ultrasound (EBUS) elastography is a new imaging procedure for describing the elasticity of intrathoracic lesions and providing important additional diagnostic information. Objectives: The aim of this study was to utilize the feasibility of qualitative and quantitative methods to evaluate the ability of EBUS elastography to differentiate between benign and malignant mediastinal and hilar lymph nodes (LNs) during EBUS-guided transbronchial needle aspiration (EBUS-TBNA). Methods: Patients with enlarged intrathoracic LNs required for EBUS-TBNA examination at a clinical center for thoracic medicine from January 2014 to April 2014 were prospectively enrolled. EBUS sonographic characteristics on B-mode, vascular patterns and elastography, EBUS-TBNA procedures, pathological findings, and microbiological results were recorded. Furthermore, elastographic patterns (qualitative method) and the mean gray value inside the region of interest (quantitative method) were analyzed. Both methods were compared with a definitive diagnosis of the involved LNs. Results: Fifty-six patients including 68 LNs (33 benign and 35 malignant nodes) were prospectively enrolled into this study and retrospectively analyzed. Using qualitative and quantitative methods, we were able to differentiate between benign and malignant LNs with high sensitivity, specificity, positive and negative predictive values, and accuracy (85.71, 81.82, 83.33, 84.38, and 83.82% vs. 91.43, 72.73, 78.05, 88.89, and 82.35%, respectively). Conclusions: EBUS elastography is potentially capable of further differentiating between benign and malignant LNs. These proposed qualitative and quantitative methods might be useful tools for describing EBUS elastography during EBUS-TBNA.

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“…Many studies have found EBUS/transbronchial needle aspiration with a convex probe useful for differentiating between benign and malignant lesions [6,7,8,9,10,11]. These studies included comparing lymph node size and shape.…”

Section: Discussionmentioning

confidence: 99%

Histogram-Based Quantitative Evaluation of Endobronchial Ultrasonography Images of Peripheral Pulmonary Lesion

Morikawa¹,

Kurimoto²,

Inoue³

et al. 2015

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Background: Endobronchial ultrasonography using a guide sheath (EBUS-GS) is an increasingly common bronchoscopic technique, but currently, no methods have been established to quantitatively evaluate EBUS images of peripheral pulmonary lesions. Objectives: The purpose of this study was to evaluate whether histogram data collected from EBUS-GS images can contribute to the diagnosis of lung cancer. Methods: Histogram-based analyses focusing on the brightness of EBUS images were retrospectively conducted: 60 patients (38 lung cancer; 22 inflammatory diseases), with clear EBUS images were included. For each patient, a 400-pixel region of interest was selected, typically located at a 3- to 5-mm radius from the probe, from recorded EBUS images during bronchoscopy. Histogram height, width, height/width ratio, standard deviation, kurtosis and skewness were investigated as diagnostic indicators. Results: Median histogram height, width, height/width ratio and standard deviation were significantly different between lung cancer and benign lesions (all p < 0.01). With a cutoff value for standard deviation of 10.5, lung cancer could be diagnosed with an accuracy of 81.7%. Other characteristics investigated were inferior when compared to histogram standard deviation. Conclusions: Histogram standard deviation appears to be the most useful characteristic for diagnosing lung cancer using EBUS images.

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Predicting malignancy in mediastinal lymph nodes by endobronchial ultrasound: A new ultrasound scoring system

Cited by 57 publications

References 37 publications

EBUS-TBNA Provides Highest RNA Yield for Multiple Biomarker Testing from Routinely Obtained Small Biopsies in Non-Small Cell Lung Cancer Patients - A Comparative Study of Three Different Minimal Invasive Sampling Methods

EBUS-TBNA Provides Highest RNA Yield for Multiple Biomarker Testing from Routinely Obtained Small Biopsies in Non-Small Cell Lung Cancer Patients - A Comparative Study of Three Different Minimal Invasive Sampling Methods

Endobronchial Ultrasound Elastography for Evaluation of Intrathoracic Lymph Nodes: A Pilot Study

Histogram-Based Quantitative Evaluation of Endobronchial Ultrasonography Images of Peripheral Pulmonary Lesion

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