Real-time prediction of mediastinal lymph node malignancy by endobronchial ultrasound

Shafiek, Hanaa; Fiorentino, Federico; Peralta, Alejandro; Serra, Enrique; Esteban, Blanca; Martínez, Rocio; Noguera, Maria Angels; Moyano, Pere; Sala, Ernest; Sauleda, Jaume; Cosío, Borja G.

doi:10.1016/j.arbr.2014.05.003

Cited by 16 publications

(29 citation statements)

References 24 publications

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“…The definitions used in the educational module are listed in Box 1. 6,7,9 A didactic approach was used to develop the educational program, which comprised 6 sections: a pre-education assessment, educational videos, ultrasonographic criteria identification with corrective feedback, practice with corrective feedback, a summary of learned concepts, and a posteducation assessment. Original still images and videos of mediastinal LNs from EBUS pro cedures were selected by an experienced endoscopist to generate a representative sample of malignant and benign LNs to be used in the module.…”

Section: Designmentioning

confidence: 99%

“…Participants were tested with the score developed by Shafiek and colleagues 10 times during the module: at 2 separate points during the module, they scored 5 LNs consecutively. 6…”

Section: Application Of the Educational Theories Within The Educationmentioning

confidence: 99%

“…18 Additionally, approximately 40% of LNs biopsied during EBUS transbronchial needle aspiration are negative, which suggests that a significant proportion of LNs are undergoing tissue sampling procedures that may not be necessary. Ultrasonographic features have been shown to be accurate and valid in predicting LN malignancy; [6][7][8][9] thus, the application of feature interpretation during mediastinal staging has the potential to reduce the number of biopsies required and to shorten the diagnostic pathway length in the case of inconclusive biopsy results. An educational module capable of improving knowledge retention and confidence in clinicians is necessary for the identification of ultrasonographic features of LNs to be used in clinical settings.…”

Section: E67mentioning

confidence: 99%

“…Predictive scores based on these features have been developed; however, their development has often lacked methodologic rigour, prospective data collection and adequate sample size. [6][7][8] Our laboratory has developed and validated a 4-point score using several ultrasonographic features to accurately predict LN malignancy (specificity 96.34% and negative predictive value 86.50%). 9 Despite the possible added clinical benefit and validity of using ultrasonographic features, their use has not been widely adopted in clinical practice.…”

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confidence: 99%

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A novel online education module to teach clinicians how to correctly identify ultrasonographic features of mediastinal lymph nodes during endobronchial ultrasound

Hylton

Shargall

Finley

et al. 2020

CJS

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Background: Ultrasonographic features can be used to predict mediastinal lymph node malignancy during endobronchial ultrasonography. Despite the validity of using these features for this purpose, the features are not being widely used in clinical practice. This may be attributable to the absence of educational programs that teach clinicians how to identify the features. To address this knowledge gap, we developed an online educational module to teach clinicians how to correctly interpret ultrasonographic features. Methods: The module was designed using corrective feedback and test-enhanced learning theories and distributed to clinicians in relevant specialties. The efficacy of the program was determined by comparing the percentages of correctly identified ultrasonographic features as each clinician progressed through the module. Participants were also asked to self-rate their confidence during the module. Analysis of variance was conducted, and a learning curve and descriptive statistics were generated. Results: Twenty-two of the 29 participants (76%) completed the module. Analysis of variance indicated that the percentage of correctly identified features increased significantly as clinicians completed the module (p = 0.004); this finding is supported by the positive slope of the learning curve. Even though they initially reported some difficulty with identifying certain features, their confidence increased as they progressed through the module. When asked, 86% of participants reported that they found the educational module helpful and 90% reported that they would recommend it to others. Conclusion: Participating clinicians were receptive to the interactive educational module. It enhances clinician skill and confidence in interpreting ultrasonographic features. The results of this study provide the foundation needed to test the validity of the educational module in clinical settings and to further explore clinician preferences for educational programs. Contexte : Les caractéristiques échographiques permettent de prédire la malignité des ganglions lymphatiques médiastinaux durant l'échographie endobronchique. Malgré leur validité à cette fin, ces caractéristiques ne sont pas très utilisées dans la pratique clinique. Cela pourrait être attribuable à l'absence de programmes de formation pour enseigner aux médecins comment repérer ces caractéristiques. Pour répondre à cette lacune au plan des connaissances, nous avons conçu un module de formation en ligne pour enseigner aux médecins comment interpréter correctement les caractéristiques échographiques. Méthodes : Le module a été conçu selon les théories de rétroaction corrective et d'apprentissage par test et a été distribué aux médecins des spécialités concernées. L'efficacité du programme a été déterminée en comparant les pourcentages de caractéristiques échographiques correctement identifiées à mesure que chaque médecin progressait d'une étape à l'autre du module. Les participants ont aussi été invités à autoévaluer leur degré de confiance pendant la réalisation du...

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Section: Designmentioning

confidence: 99%

“…Participants were tested with the score developed by Shafiek and colleagues 10 times during the module: at 2 separate points during the module, they scored 5 LNs consecutively. 6…”

Section: Application Of the Educational Theories Within The Educationmentioning

confidence: 99%

Section: E67mentioning

confidence: 99%

mentioning

confidence: 99%

See 2 more Smart Citations

A novel online education module to teach clinicians how to correctly identify ultrasonographic features of mediastinal lymph nodes during endobronchial ultrasound

Hylton

Shargall

Finley

et al. 2020

CJS

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“…The diagnostic value of a single feature is finite, and the combined application of multiple sonographic features can achieve more comprehensive diagnostic performance. For intrathoracic LNs, previous studies examined the combination of grayscale features [11, 12], grayscale and blood flow [13, 14], and grayscale and elastography [15, 16]. Meanwhile, a combination of three EBUS modes associated with intrapulmonary lesions has been studied previously [17].…”

Section: Introductionmentioning

confidence: 99%

Endobronchial Ultrasound Multimodal Imaging for the Diagnosis of Intrathoracic Lymph Nodes

et al. 2021

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Background: Endobronchial ultrasound (EBUS) imaging is valuable in diagnosing intrathoracic lymph nodes (LNs), but there has been little analysis of multimodal imaging. This study aimed to comprehensively compare the diagnostic performance of single and multimodal combinations of EBUS imaging in differentiating benign and malignant intrathoracic LNs. Methods: Subjects from July 2018 to June 2019 were consecutively enrolled in the model group and July 2019 to August 2019 in the validation group. Sonographic features of three EBUS modes were analysed in the model group for the identification of malignant LNs from benign LNs. The validation group was used to verify the diagnostic efficiency of single and multimodal diagnostic methods built in the model group. Results: 373 LNs (215 malignant and 158 benign) from 335 subjects and 138 LNs (79 malignant and 59 benign) from 116 subjects were analysed in the model and validation groups, respectively. For single mode, elastography had the best diagnostic value, followed by grayscale and Doppler. The corresponding accuracies in the validation group were 83.3%, 76.8%, and 71.0%, respectively. Grayscale with elastography had the best diagnostic efficiency of multimodal methods. When at least two of the three features (absence of central hilar structure, heterogeneity, and qualitative elastography score 4–5) were positive, the sensitivity, specificity, and accuracy in the validation group were 88.6%, 78.0%, and 84.1%, respectively. Conclusions: In both model and validation groups, elastography performed the best in single EBUS modes, as well as grayscale combined with elastography in multimodal imaging. Elastography alone or combined with grayscale are feasible to help predict intrathoracic benign and malignant LNs.

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Performance of endobronchial ultrasound transbronchial needle aspiration as the first nodal staging procedure for the determination of programmed death ligand-1 expression in non-small cell lung cancer patients

Polanco

Pinilla

Gràcia-Lavedán

et al. 2023

J Cancer Res Clin Oncol

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The determination of the Programmed Death Ligand-1 (PD-L1) expression is part of the diagnostic algorithm for advanced non-small-cell lung cancer (NSCLC) patients. We aimed to analyze the diagnostic performance of EBUS-TBNA performed as rst-choice nodal staging procedure for the determination of PD-L1 expression in NSCLC patients. MethodsLongitudinal-prospective study including NSCLC patients diagnosed between January 2018 and October 2019, for whom a primary tumor biopsy sample and an EBUS-TBNA cytological malignant sample were available. Samples with fewer than 100 malignant cells were considered inadequate. PDL-1 IHC 22C3 pharmDx antibody was used. The percentage of tumor cells expressing PD-L1, setting 1% and 50% as cutoff points, was collected. The weighted kappa coe cient was used to assess the concordance of PD-L1 expression. The PD-L1 expression was compared precision terms. ResultsFrom a total of 43 patients, 53 pairs of samples were obtained, of which 23 (43.4%) were adequate and included for analysis. The weighted kappa coe cient for PD-L1 expression was 0.41 (95% CI: 0.15-0.68) and 0.56 (95% CI: 0.23-0.9) for cutoff values ≥ 1% and ≥ 50%, respectively. In advanced stages, the weighted kappa coe cient was 0.6 (95% CI: 0.3-0.9) and 1 (95% CI: 1-1) for PD-L1 expression cutoff values ≥ 1% and ≥ 50%, respectively. EBUS-TBNA showed a sensitivity, speci city, positive predictive value, and negative predictive value of 1 to detect PDL-1 expression ≥ 50% in advanced stages. ConclusionEBUS-TBNA performed as rst nodal staging procedure provides reliable specimens for the detection of PD-L1 expression ≥ 50% in advanced NSCLC patients and could guide immunotherapy.

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Real-time prediction of mediastinal lymph node malignancy by endobronchial ultrasound

Cited by 16 publications

References 24 publications

A novel online education module to teach clinicians how to correctly identify ultrasonographic features of mediastinal lymph nodes during endobronchial ultrasound

A novel online education module to teach clinicians how to correctly identify ultrasonographic features of mediastinal lymph nodes during endobronchial ultrasound

Endobronchial Ultrasound Multimodal Imaging for the Diagnosis of Intrathoracic Lymph Nodes

Performance of endobronchial ultrasound transbronchial needle aspiration as the first nodal staging procedure for the determination of programmed death ligand-1 expression in non-small cell lung cancer patients

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