J Korean Med Sci.  2014 Dec;29(12):1632-1638. 10.3346/jkms.2014.29.12.1632.

Clinical Value of Endobronchial Ultrasound Findings for Predicting Nodal Metastasis in Patients with Suspected Lymphadenopathy: A Prospective Study

• Jhun BW
• Um SW
• Suh GY
• Chung MP
• Kim H
• Kwon OJ
• Han J
• Lee KJ

• KMID: 2069951
• DOI: http://doi.org/10.3346/jkms.2014.29.12.1632

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 > or =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.

Keyword

Endoscopic Ultrasound; Needle Aspiration; Lymph Nodes, Lymphatic Metastasis; Prediction

MeSH Terms

Aged
Bronchi
Endoscopic Ultrasound-Guided Fine Needle Aspiration/*methods
Endosonography/*methods
Female
Humans
Lymph Nodes/*pathology/ultrasonography
Lymphatic Diseases/*pathology/ultrasonography
Lymphatic Metastasis
Male
Middle Aged
Prospective Studies
Reproducibility of Results
Sensitivity and Specificity
Thoracic Neoplasms/*pathology/*secondary/ultrasonography

Figure

• 

  Fig. 1 The results for lymph nodes sampled by EBUS-TBNA; LN, lymph node; EBUS-TBNA, endobronchial ultrasound-guided transbronchial needle aspiration; PET/CT, positron emission tomography/computed tomography.

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