Quantitative analysis of endobronchial ultrasound elastography in computed tomography-negative mediastinal and hilar lymph nodes
Quantitative analysis of endobronchial ultrasound elastography in computed tomography-negative mediastinal and hilar lymph nodes
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DOI：
10.1111/1759-7714.13579
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发表时间：
2020-07-21
期刊：
影响因子：
2.9
通讯作者：
Yatera, Kazuhiro
中科院分区：
文献类型：
--
作者：
Uchimura, Keigo;Yamasaki, Kei;Yatera, Kazuhiro
背景：在经支气管针吸活检（TBNA）过程中，支气管内超声（EBUS）弹性成像有助于鉴别良恶性淋巴结（LN）。然而，以前的研究没有比较B型超声图像（BSI）和EBUS弹性成像图像（EEI）与放射学正常大小（计算机断层扫描[CT]阴性）LN的最终病理诊断。方法回顾性分析CT阴性淋巴结患者行EBUS-TBNA治疗的临床资料。储存每个LN的BSI和EEI图像并独立评价。通过计算刚度面积比（SAR，蓝色/总面积）评估EEI。使用受试者工作特征曲线计算SAR的截止值。对每个EBUS结果的诊断测试参数进行评价。结果132例患者共149个淋巴结，恶性淋巴结的SAR中位数显著高于良性淋巴结（0.58vs.0.32，P < 0.001）。在SAR临界值为0.41时，弹性成像的敏感性、特异性、阳性预测值、阴性预测值（NPV）和诊断准确率（DAR）分别为88.2%、80.2%、78.9%、89.0%和83.9%。Logistic回归分析显示，弹性成像是恶性肿瘤最强的预测因子（比值比，18.5; 95%置信区间[CI]：6.48-52.6;P < 0.001）。结合使用BSI和EEI可实现最高的净现值（96.6%）。结论EBUS弹性成像预测恶性淋巴结，在CT阴性淋巴结中DAR和NPV较高。当EEIs与BSI组合时，NPV最高。因此，使用EEI和BSI联合评估CT阴性LN可能有助于支气管镜医师更有效地进行EBUS-TBNA。关键点研究的重要发现支气管内超声弹性成像准确预测恶性肿瘤，在放射学正常大小的淋巴结中具有较高的诊断准确率和阴性预测值。B型超声特征的额外使用导致更高的阴性预测值。本研究补充的是，支气管内超声弹性成像可以指导经支气管针吸标本的准确采集，即使是在放射学正常大小的淋巴结中。它还可以很容易地区分良性和恶性淋巴结，从而避免不必要的穿刺。
Background Endobronchial ultrasound (EBUS) elastography assists in the differentiation of benign and malignant lymph nodes (LNs) during transbronchial needle aspiration (TBNA). However, previous studies have not compared B-mode sonographic images (BSIs) and EBUS elastography images (EEIs) with final pathological diagnoses in radiologically normal-sized (computed tomography [CT]-negative) LNs. Methods Consecutive patients with CT-negative LNs, who received EBUS-TBNA, were retrospectively reviewed. Images of BSIs and EEIs of each LN were stored and independently evaluated. EEIs were assessed by calculating the stiffness area ratio (SAR, blue/overall areas). The receiver operating characteristic curve was used to calculate the cutoff value for the SAR. Diagnostic test parameters were evaluated for each EBUS finding. Results A total of 132 patients (149 LNs) were enrolled, and the median SAR of malignant LNs was significantly higher than that of benign LNs (0.58 vs. 0.32,P < 0.001). At the SAR cutoff of 0.41, the sensitivity, specificity, positive predictive value, negative predictive value (NPV), and diagnostic accuracy rate (DAR) of elastography were 88.2%, 80.2%, 78.9%, 89.0%, and 83.9%, respectively. The logistic regression analysis showed that elastography was the strongest predictor of malignancy (odds ratio, 18.5; 95% confidence interval [CI]: 6.48-52.6;P < 0.001). The highest NPV (96.6%) was achieved with a combination of BSIs and EEIs. Conclusions EBUS elastography predicted malignant LNs with a high DAR and NPV in CT-negative LNs. The NPV was highest when EEIs were combined with BSIs. Therefore, the combined evaluation of CT-negative LNs using EEIs and BSIs may help bronchoscopists perform EBUS-TBNA more efficiently. Key pointsSignificant findings of the study Endobronchial ultrasound elastography accurately predicted malignancy with a high diagnostic accuracy rate and negative predictive value in radiologically normal-sized lymph nodes. The additional use of B-mode sonographic features resulted in a higher negative predictive value. What this study adds Endobronchial ultrasound elastography can guide the accurate collection of specimens with transbronchial needle aspiration, even in radiologically normal-sized lymph nodes. It can also readily distinguish benign and malignant lymph nodes, thus avoiding unnecessary punctures.