Endobronchial Ultrasound Elastography for Differentiating Benign and Malignant Lymph Nodes.
Diagnosis, Differential
Elasticity Imaging Techniques
Endoscopic Ultrasound-Guided Fine Needle Aspiration
Humans
Lung
/ diagnostic imaging
Lung Neoplasms
/ pathology
Lymph Nodes
/ diagnostic imaging
Lymphatic Metastasis
/ diagnostic imaging
Mediastinum
/ diagnostic imaging
Neoplasm Staging
Observer Variation
Prospective Studies
Sensitivity and Specificity
Endobronchial ultrasound, Elastography, Bronchoscopy
Journal
Respiration; international review of thoracic diseases
ISSN: 1423-0356
Titre abrégé: Respiration
Pays: Switzerland
ID NLM: 0137356
Informations de publication
Date de publication:
Historique:
received:
26
03
2020
accepted:
10
06
2020
pubmed:
8
10
2020
medline:
14
10
2021
entrez:
7
10
2020
Statut:
ppublish
Résumé
Endobronchial ultrasound elastography that provides information on tissue stiffness may help distinguish malignant from benign mediastinal and hilar lymph nodes. In this prospective trial, we assessed the diagnostic value of elastographic images and the interobserver agreement in its evaluation. Elastographic images from 77 lymph nodes in 65 patients were reviewed by 3 pneumologists. The elastographic image was classified based on the predominant colour: predominantly green, intermediary, and predominantly blue. With 2 or 3 interobserver matches, the corresponding elastographic image was correlated with the pathological result obtained from endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) and/or other invasive procedures. All 3 reviewers had agreement in classifying elastographic images in 45% (35/77). Overall, the interobserver agreement among the 3 readers for classifying elastographic pattern was found to be moderate (Fleiss Kappa index = 0.519; 95% CI = [0.427; 0.611]). On cytological/histological evaluation, 55 lymph nodes were malignant and 22 were benign. In classifying "green" as benign and "blue" as malignant, the sensitivity and specificity were 71% (95% CI = [54%; 85%]) and 67% (95%-CI = [35%; 90%]), respectively. Elastography will not replace invasive EBUS-TBNA due to a moderate interobserver agreement and insufficient sensitivity and specificity. However, elastography will, maybe, present an additional feature to identify malignant lymph nodes in the context of clinical, radiological, and cytological results.
Sections du résumé
BACKGROUND
BACKGROUND
Endobronchial ultrasound elastography that provides information on tissue stiffness may help distinguish malignant from benign mediastinal and hilar lymph nodes.
OBJECTIVES
OBJECTIVE
In this prospective trial, we assessed the diagnostic value of elastographic images and the interobserver agreement in its evaluation.
METHOD
METHODS
Elastographic images from 77 lymph nodes in 65 patients were reviewed by 3 pneumologists. The elastographic image was classified based on the predominant colour: predominantly green, intermediary, and predominantly blue. With 2 or 3 interobserver matches, the corresponding elastographic image was correlated with the pathological result obtained from endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) and/or other invasive procedures.
RESULTS
RESULTS
All 3 reviewers had agreement in classifying elastographic images in 45% (35/77). Overall, the interobserver agreement among the 3 readers for classifying elastographic pattern was found to be moderate (Fleiss Kappa index = 0.519; 95% CI = [0.427; 0.611]). On cytological/histological evaluation, 55 lymph nodes were malignant and 22 were benign. In classifying "green" as benign and "blue" as malignant, the sensitivity and specificity were 71% (95% CI = [54%; 85%]) and 67% (95%-CI = [35%; 90%]), respectively.
CONCLUSIONS
CONCLUSIONS
Elastography will not replace invasive EBUS-TBNA due to a moderate interobserver agreement and insufficient sensitivity and specificity. However, elastography will, maybe, present an additional feature to identify malignant lymph nodes in the context of clinical, radiological, and cytological results.
Identifiants
pubmed: 33027791
pii: 000509297
doi: 10.1159/000509297
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
779-783Informations de copyright
© 2020 S. Karger AG, Basel.