Department of Pulmonology, Radboudumc, Nijmegen, The Netherlands.
Medical Ultrasound Imaging Center (MUSIC), Department of Radiology, Radboudumc, Nijmegen, The Netherlands.
Respiration. 2020;99(6):484-492. doi: 10.1159/000507592. Epub 2020 Jun 3.
Systematic assessment of lymph node status by endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is indicated in (suspected) lung cancer. Sampling is herein guided by nodal size and FDG-PET characteristics. Ultrasound strain elastography (SE) might further improve risk stratification. By imaging tissue deformation over time, SE computes relative tissue strain. In several tissues, a lower strain (deformation) has been associated with a higher likelihood of malignancy.
To assess if EBUS-SE can independently help predict malignancy, and when combined with size and FDG uptake information.
This multicenter (n = 5 centers) prospective trial included patients with suspected or proven lung cancer using a standardized measurement protocol. Cytopathology combined with surgery or follow-up imaging (>6 months) were used as reference standard.
Between June 2016 and July 2018, 327 patients and 525 lymph nodes were included (mean size 12.3 mm, malignancy prevalence 0.48). EBUS-SE had an overall AUC of 0.77. A mean strain <115 (range 0-255) showed 90% sensitivity, 43% specificity, 60% positive predictive value, and 82% negative predictive value. Combining EBUS-SE (<115) with size (<8 mm) and FDG-PET information into a risk stratification algorithm increased the accuracy. Combining size and SE showed that the 48% a priori chance of malignancy changed to 11 and 70% in double negative or positive nodes, respectively. In the subset where FDG-PET was available (n = 370), triple negative and positive nodes went from a 42% a priori chance of malignancy to 9 and 73%, respectively.
EBUS-SE can help predict lymph node malignancy and may be useful for risk stratification when combined with size and PET information.
支气管内超声引导经支气管针吸活检术（EBUS-TBNA）系统评估淋巴结状态适用于（疑似）肺癌。在此，采样由淋巴结大小和 FDG-PET 特征指导。超声应变弹性成像（SE）可能进一步改善风险分层。通过随时间成像组织变形，SE 计算相对组织应变。在几种组织中，较低的应变（变形）与更高的恶性肿瘤可能性相关。
评估 EBUS-SE 是否可以独立帮助预测恶性肿瘤，以及与大小和 FDG 摄取信息相结合时的情况。
这项多中心（n = 5 个中心）前瞻性试验纳入了使用标准化测量方案疑似或确诊肺癌的患者。细胞学检查结合手术或随访影像学（>6 个月）作为参考标准。
2016 年 6 月至 2018 年 7 月，纳入 327 例患者和 525 个淋巴结（平均大小 12.3 毫米，恶性肿瘤患病率 0.48）。EBUS-SE 的总体 AUC 为 0.77。平均应变<115（范围 0-255）的敏感度为 90%，特异性为 43%，阳性预测值为 60%，阴性预测值为 82%。将 EBUS-SE（<115）与大小（<8 毫米）和 FDG-PET 信息相结合到风险分层算法中，提高了准确性。将大小和 SE 结合起来表明，48%的先验恶性肿瘤机会分别变为双阴性或阳性淋巴结中的 11%和 70%。在可获得 FDG-PET 的亚组（n = 370）中，三重阴性和阳性淋巴结的恶性肿瘤先验机会分别从 42%变为 9%和 73%。
EBUS-SE 可帮助预测淋巴结恶性肿瘤，并在与大小和 PET 信息结合时可用于风险分层。
