The role of endobronchial ultrasound elastography in the diagnosis of mediastinal lymph nodes

The role of endobronchial ultrasound elastography in the diagnosis of mediastinal lymph nodes: Adel S Bediwy, Mohamed S Hantira, Dalia El Sharawy, Ayman El Saqa



Egyptian Journal of Bronchology 2017 11(3):238-243



Background Endobronchial ultrasound (EBUS) has become a powerful tool for the diagnosis of mediastinal and hilar lymph nodes (LNs). Elastography has been introduced recently to provide more accurate data about the lesions seen during EBUS.

Aim The aim of this study was to evaluate the role of elastography during EBUS for the diagnosis of hilar and mediastinal LN.

Patients and methods We carried out a prospective, cross-sectional study. Patients with hilar/mediastinal LN enlargement on computed tomography examination were included. Convex probe EBUS was performed using conventional B-mode and elastography with transbronchial needle aspiration from the examined LN. All data are presented as mean±SD. Receiver operating characteristic analysis was carried out to find the relative sensitivity and specificity of EBUS elastography and to compare the results with other B-mode findings such as mediastinal LNs.

Results A total of 147 LNs from 56 patients were examined. Malignancy was found in 111 of them. The strain ratio was found to be more accurate when compared with other findings of B-mode when comparing malignant and benign LNs with a cut-off value of 7.5, giving a sensitivity of 95.5% and a specificity of 91.67%. About 63% of malignant LNs were diagnosed from the first pass with the help of elastography.

Conclusion Elastography is a very helpful tool for diagnosing mediastinal LNs with a strain ratio above 7.5, having a strong suggestion of malignancy. Elastography can help in directing the needle during EBUS-transbronchial needle aspiration to reach the final diagnosis with the least possible number of passes and avoiding unnecessary punctures (ClinicalTrials.gov Identifier: NCT02724059).

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