Shafiek Hanaa, Fiorentino Federico, Peralta Alejandro David, Serra Enrique, Esteban Blanca, Martinez Rocío, Noguera Maria Angels, Moyano Pere, Sala Ernest, Sauleda Jaume, Cosío Borja G
Departamento de Medicina Respiratoria, Hospital Universitario Son Espases, Palma de Mallorca, España; Departamento de Enfermedades del Tórax, Facultad de Medicina, Universidad de Alejandría, Alejandría, Egipto.
Departamento de Medicina Respiratoria, Hospital Universitario Son Espases, Palma de Mallorca, España.
Arch Bronconeumol. 2014 Jun;50(6):228-34. doi: 10.1016/j.arbres.2013.12.002. Epub 2014 Feb 8.
To evaluate the utility of different ultrasonographic (US) features in differentiating benign and malignant lymph node (LN) by endobronchial ultrasound (EBUS) and validate a score for real-time clinical application.
208 mediastinal LN acquired from 141 patients were analyzed. Six different US criteria were evaluated (short axis ≥10 mm, shape, margin, echogenicity, and central hilar structure [CHS], and presence of hyperechoic density) by two observers independently. A simplified score was generated where the presence of margin distinction, round shape and short axis ≥10 mm were scored as 1 and heterogeneous echogenicity and absence of CHS were scored as 1.5. The score was evaluated prospectively for real-time clinical application in 65 LN during EBUS procedure in 39 patients undertaken by two experienced operators. These criteria were correlated with the histopathological results and the sensitivity, specificity, positive and negative predictive values (PPV and NPV) were calculated.
Both heterogenicity and absence of CHS had the highest sensitivity and NPV (≥90%) for predicting LN malignancy with acceptable inter-observer agreement (92% and 87% respectively). On real-time application, the sensitivity and specificity of the score >5 were 78% and 86% respectively; only the absence of CHS, round shape and size of LN were significantly associated with malignant LN.
Combination of different US criteria can be useful for prediction of mediastinal LN malignancy and valid for real-time clinical application.
通过支气管内超声（EBUS）评估不同超声特征在鉴别良性和恶性淋巴结（LN）中的效用，并验证一种用于实时临床应用的评分系统。
分析了从141例患者获取的208个纵隔LN。两名观察者独立评估了六种不同的超声标准（短轴≥10 mm、形状、边界、回声性以及中央肺门结构[CHS]和高回声密度的存在情况）。生成了一个简化评分，其中边界清晰、圆形和短轴≥10 mm记为1分，回声不均匀和无CHS记为1.5分。在39例患者的EBUS检查过程中，由两名经验丰富的操作人员对65个LN进行实时临床应用的前瞻性评分评估。将这些标准与组织病理学结果相关联，并计算敏感性、特异性、阳性和阴性预测值（PPV和NPV）。
不均匀性和无CHS在预测LN恶性方面具有最高的敏感性和NPV（≥90%），观察者间一致性可接受（分别为92%和87%）。在实时应用中，评分>5的敏感性和特异性分别为78%和86%；只有无CHS、LN的圆形和大小与恶性LN显著相关。
不同超声标准的组合可用于预测纵隔LN恶性，对实时临床应用有效。
