Accuracy and Reproducibility of Endoscopic Ultrasound B-Mode Features for Observer-Based Lymph Nodal Malignancy Prediction.
Bronchoscopy
/ methods
Endoscopic Ultrasound-Guided Fine Needle Aspiration
/ methods
Endosonography
Humans
Lung Neoplasms
/ diagnostic imaging
Lymph Nodes
/ diagnostic imaging
Lymphatic Metastasis
/ diagnostic imaging
Lymphoma
/ pathology
Mediastinum
Neoplasm Staging
Reproducibility of Results
Retrospective Studies
Bronchoscopy
Cancer
Endobronchial ultrasound
Endobronchial ultrasound-transbronchial needle aspiration
Endoscopic ultrasound
Esophageal ultrasound
Lung cancer staging
Lymph node staging
Nonsmall-cell lung cancer
Observer variability
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:
16
11
2020
accepted:
06
04
2021
pubmed:
25
6
2021
medline:
17
5
2022
entrez:
24
6
2021
Statut:
ppublish
Résumé
Endoscopic ultrasound routinely guides lymph node evaluation for the staging of a known or suspected lung cancer. Characteristics seen on B-mode imaging might help the observer decide on the lymph nodes of risk. The influence of nodal size on the predictivity of these characteristics and the agreement with which operators can combine these for malignancy risk prediction is to be determined. We evaluated (1) if prospectively scored individual B-mode ultrasound features predict malignancy when further divided by size and (2) assessed if observers were able to reproducibly agree on still lymph node image malignancy risk. Lymph nodes as visualized by EBUS were prospectively scored for B-mode characteristics. Still B-mode images were furthermore collected. After collection, a repeated scoring of a subset of lymph nodes was retrospectively performed (n = 11 observers). Analysis of 490 lymph nodes revealed the short axis size is an objective measure for stratifying risk of malignancy (ROC area under the curve 0.78). With ≥8-mm size, 210/237 malignant lymph nodes were correctly identified (89% sensitivity, 46% specificity, 61% PPV, and 81% NPV). Secondary addition of B-mode features in <8-mm nodes had limited value. Retrospective analysis of intra- and interobserver scoring furthermore revealed significant disagreement. Lymph nodes of ≥8-mm size and preferably even smaller should be aspirated regardless of other B-mode features. Observer disagreement in scoring both small and large lymph nodes suggests it is infeasible to include subjective features for stratification. Future research should focus on (integrating) other (semi)quantitative values for improving prediction.
Sections du résumé
BACKGROUND
BACKGROUND
Endoscopic ultrasound routinely guides lymph node evaluation for the staging of a known or suspected lung cancer. Characteristics seen on B-mode imaging might help the observer decide on the lymph nodes of risk. The influence of nodal size on the predictivity of these characteristics and the agreement with which operators can combine these for malignancy risk prediction is to be determined.
OBJECTIVES
OBJECTIVE
We evaluated (1) if prospectively scored individual B-mode ultrasound features predict malignancy when further divided by size and (2) assessed if observers were able to reproducibly agree on still lymph node image malignancy risk.
METHODS
METHODS
Lymph nodes as visualized by EBUS were prospectively scored for B-mode characteristics. Still B-mode images were furthermore collected. After collection, a repeated scoring of a subset of lymph nodes was retrospectively performed (n = 11 observers).
RESULTS
RESULTS
Analysis of 490 lymph nodes revealed the short axis size is an objective measure for stratifying risk of malignancy (ROC area under the curve 0.78). With ≥8-mm size, 210/237 malignant lymph nodes were correctly identified (89% sensitivity, 46% specificity, 61% PPV, and 81% NPV). Secondary addition of B-mode features in <8-mm nodes had limited value. Retrospective analysis of intra- and interobserver scoring furthermore revealed significant disagreement.
CONCLUSIONS
CONCLUSIONS
Lymph nodes of ≥8-mm size and preferably even smaller should be aspirated regardless of other B-mode features. Observer disagreement in scoring both small and large lymph nodes suggests it is infeasible to include subjective features for stratification. Future research should focus on (integrating) other (semi)quantitative values for improving prediction.
Identifiants
pubmed: 34167125
pii: 000516505
doi: 10.1159/000516505
pmc: PMC8686713
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1088-1096Informations de copyright
© 2021 The Author(s). Published by S. Karger AG, Basel.
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