1 Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Department of Internal Medicine, and.
2 Center for Biostatistics, Ohio State University, Columbus, Ohio.
Ann Am Thorac Soc. 2015 Jun;12(6):914-20. doi: 10.1513/AnnalsATS.201312-430OC.
Multidetector-row chest computed tomography scan is a common initial imaging modality and endobronchial ultrasound is a minimally invasive diagnostic tool used to evaluate enlarged lymph nodes, but comparisons of imaging results are lacking.
To determine the size of thoracic lymph nodes and the strength of agreement between each measurement from coronal plane computed tomography and static endobronchial ultrasound images.
A retrospective review of consecutive patients who underwent endobronchial ultrasound-transbronchial needle aspiration of their lymph nodes because of clinical suspicion of benign or malignant thoracic disease.
One hundred and twenty-four lymph nodes from the mediastinal (74.2%) and hilar (25.8%) stations were measured in 59 patients (mean age, 64.5 yr; 33 males). The mean (standard deviation) short-axis diameter on computed tomography was 14.1 (6.7) mm compared with 12.6 (6.6) mm on endobronchial ultrasound. Benign lymph nodes (n = 42) were larger on computed tomography than on endobronchial ultrasound (14.1 [6.2] vs. 11.5 [6.2] mm). Malignant lymph nodes (n = 35) were larger on endobronchial ultrasound than on computed tomography (17.3 [6.4] vs. 16.2 [6.7] mm). Sixty-five percent of the lymph nodes that were initially interpreted as not enlarged on axial computed tomography images measured greater than 10 mm on each imaging modality (12.5 [5.9] mm on computed tomography and 10.5 [5.6] mm on endobronchial ultrasound) and 24% of the sampled lymph nodes from this group contained malignant cells. Random-effects maximal likelihood linear regression showed a statistically significant difference between endobronchial ultrasound and the computed tomography method for measuring short-axis diameter in all 124 lymph nodes. There was a weak agreement (intraclass correlation, rho: 0.44 [95% confidence interval, 0.31-0.59]) between short-axis diameter measurements from each imaging modality.
Our single-center study shows that there was poor correlation between computed tomography and endobronchial ultrasound for the measurement of mediastinal and hilar lymph nodes. Malignant cells were recovered by ultrasound-guided needle aspiration from a substantial fraction of lymph nodes that were initially interpreted as normal in size. If these findings are confirmed, new criteria may be needed for lymph node measurement on computed tomography that will guide selection of lymph nodes for endobronchial ultrasound-transbronchial needle aspiration.
多排螺旋 CT 胸部扫描是一种常见的初始成像方式，支气管内超声是一种用于评估增大淋巴结的微创诊断工具，但缺乏对成像结果的比较。
确定胸内淋巴结的大小，以及冠状面 CT 与静态支气管内超声图像各测量值之间的一致性。
对因临床怀疑良性或恶性胸内疾病而接受支气管内超声引导经支气管针吸活检的连续患者进行回顾性研究。
59 例患者（平均年龄 64.5 岁；男性 33 例）的纵隔（74.2%）和肺门（25.8%）淋巴结共 124 个。CT 上短轴直径的平均值（标准差）为 14.1（6.7）mm，而支气管内超声上为 12.6（6.6）mm。良性淋巴结（n=42）在 CT 上比在支气管内超声上更大（14.1[6.2] vs. 11.5[6.2]mm）。恶性淋巴结（n=35）在支气管内超声上比在 CT 上更大（17.3[6.4] vs. 16.2[6.7]mm）。在最初的轴位 CT 图像上判断为不增大的 65%的淋巴结在两种成像方式上的测量值均大于 10mm（CT 上为 12.5[5.9]mm，支气管内超声上为 10.5[5.6]mm），并且该组中 24%的采样淋巴结中含有恶性细胞。随机效应最大似然线性回归显示，在所有 124 个淋巴结中，支气管内超声和 CT 方法在测量短轴直径方面存在统计学显著差异。两种成像方式的短轴直径测量值之间存在弱一致性（组内相关系数，rho：0.44[95%置信区间，0.31-0.59]）。
我们的单中心研究表明，CT 和支气管内超声在测量纵隔和肺门淋巴结方面相关性较差。超声引导下的针吸活检从最初判断为正常大小的淋巴结中回收了大量恶性细胞。如果这些发现得到证实，可能需要新的 CT 淋巴结测量标准来指导支气管内超声引导经支气管针吸活检的淋巴结选择。
