Çağlayan Benan, İliaz Sinem, Bulutay Pınar, Armutlu Ayşe, Uzel Işıl, Öztürk Ayşe Bilge
Department of Chest Diseases, Koç University School of Medicine, Istanbul, Turkey.
Department of Pathology, Koç University School of Medicine, Istanbul, Turkey.
Turk Gogus Kalp Damar Cerrahisi Derg. 2020 Jan 23;28(1):158-165. doi: 10.5606/tgkdc.dergisi.2020.18508. eCollection 2020 Jan.
This study aims to investigate the role of endobronchial ultrasonography elastography in predicting malignancy.
Between January 2016 and December 2016, a total of 221 lymph nodes were biopsied using the endobronchial ultrasonography-guided transbronchial needle aspiration from 119 consecutive patients (69 males, 50 females; mean age 63.2±12.4 years; range, 16 to 86 years) were included. Lymph nodes were scored by elastography according to their colors in four categories before the procedure. The strain ratio was calculated based on the region of interest after three measurements.
Of the patients, 93 were diagnosed with a malignancy through endobronchial ultrasonography-guided transbronchial needle aspiration biopsy. The mean lymph node score of benign versus malignant lesions was 2.2±1.0 and 3.2±1, respectively (p<0.001). There was a positive correlation between the lymph node scores and lymph node diameter, strain ratio, ≥3 of lymph node scoring, the sensitivity for malignancy was 79% and specificity was 60%. The mean strain ratio for malignant and benign lymph nodes was 22.2±30.1 and 5.2±1.7, respectively (p<0.001). With a cut-off value of ≥2.47 of strain ratio, the sensitivity for malignancy was 75% and specificity was 65%. The combined use of positron emission tomography and lymph node score or strain ratio yielded 80.4% and 61.2% sensitivity and 80% and 70.3% specificity for malignancy, respectively.
Endobronchial ultrasonography elastography is useful in predicting malignancy of the lymph nodes. When combined with positron emission tomography, specificity and positive predictive value for malignancy increase.
本研究旨在探讨支气管内超声弹性成像在预测恶性肿瘤方面的作用。
2016年1月至2016年12月，共对119例连续患者（男69例，女50例；平均年龄63.2±12.4岁；范围16至86岁）的221个淋巴结进行了支气管内超声引导下经支气管针吸活检。术前根据弹性成像中淋巴结的颜色将其分为四类进行评分。在进行三次测量后，根据感兴趣区域计算应变率。
93例患者通过支气管内超声引导下经支气管针吸活检确诊为恶性肿瘤。良性与恶性病变的平均淋巴结评分为2.2±1.0和3.2±1，分别（p<0.001）。淋巴结评分与淋巴结直径、应变率、淋巴结评分≥3之间存在正相关，对恶性肿瘤的敏感性为79%，特异性为60%。恶性和良性淋巴结的平均应变率分别为22.2±30.1和5.2±1.7，分别（p<0.001）。以应变率≥2.47为临界值，对恶性肿瘤的敏感性为75%，特异性为65%。正电子发射断层扫描与淋巴结评分或应变率联合使用时，对恶性肿瘤的敏感性分别为80.4%和61.2%，特异性分别为80%和70.3%。
支气管内超声弹性成像有助于预测淋巴结的恶性肿瘤。与正电子发射断层扫描联合使用时，对恶性肿瘤的特异性和阳性预测值会增加。
