Clinical Value of Endobronchial Ultrasound Findings for Predicting Nodal Metastasis in Patients with Suspected Lymphadenopathy: A Prospective Study |
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| Authors: | Byung Woo Jhun Sang-Won Um Gee Young Suh Man Pyo Chung Hojoong Kim O Jung Kwon Joungho Han Kyung-Jong Lee |
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| Affiliation: | 1Division of Pulmonary and Critical Care Medicine, Department of Medicine, The Armed Forces Capital Hospital, Seongnam, Korea.;2Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.;3Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. |
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| Abstract: | We evaluated whether sonographic findings can provide additional diagnostic yield in endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA), and can more accurately predict nodal metastasis than chest computed tomography (CT) or positron emission tomography (PET)/CT scans. EBUS-TBNA was performed in 146 prospectively recruited patients with suspected thoracic lymph node involvement on chest CT and PET/CT from June 2012 to January 2013. Diagnostic yields of EBUS finding categories as a prediction model for metastasis were evaluated and compared with findings of chest CT, PET/CT, and EBUS-TBNA. In total, 172 lymph nodes were included in the analysis: of them, 120 were malignant and 52 were benign. The following four EBUS findings were predictive of metastasis: nodal size ≥10 mm, round shape, heterogeneous echogenicity, and absence of central hilar structure. A single EBUS finding did not have sufficient diagnostic yield; however, when the lymph node had any one of the predictive factors on EBUS, the diagnostic yields for metastasis were higher than for chest CT and PET/CT, with a sensitivity of 99.1% and negative predictive value of 83.3%. When any one of predictive factors is observed on EBUS, subsequent TBNA should be considered, which may provide a higher diagnostic yield than chest CT or PET/CT.Graphical Abstract | |
| Keywords: | Endoscopic Ultrasound Needle Aspiration Lymph Nodes Lymphatic Metastasis Prediction |
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