Zhi Xinxin, Sun Xiaoyan, Chen Junxiang, Wang Lei, Ye Lin, Li Ying, Xie Wenhui, Sun Jiayuan
Department of Respiratory Endoscopy, Shanghai Jiao Tong University, Shanghai, China.
Department of Respiratory and Critical Care Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China.
Front Oncol. 2022 Aug 5;12:908265. doi: 10.3389/fonc.2022.908265. eCollection 2022.
Positron emission tomography-computed tomography (PET/CT) and convex probe endobronchial ultrasound (CP-EBUS) elastography are important diagnostic methods in predicting intrathoracic lymph nodes (LNs) metastasis, but a joint analysis of the two examinations is still lacking. This study aimed to compare the diagnostic efficiency of the two methods and explore whether the combination can improve the diagnostic efficiency in differentiating intrathoracic benign LNs from malignant LNs.
LNs examined by EBUS-guided transbronchial needle aspiration (EBUS-TBNA) and PET/CT from March 2018 to June 2019 in Shanghai Chest Hospital were retrospectively analyzed as the model group. Four PET/CT parameters, namely, maximal standardized uptake value mean standardized uptake value (SUVmean), SUVmean, metabolic tumor volume (MTV), and tumor lesion glycolysis (TLG); four quantitative elastography indicators (stiff area ratio, mean hue value, RGB, and mean gray value); and the elastography grading score of targeted LNs were analyzed. A prediction model was constructed subsequently and the dataset from July to November 2019 was used to validate the diagnostic capability of the model.
A total of 154 LNs from 135 patients and 53 LNs from 47 patients were enrolled in the model and validation groups, respectively. Mean hue value and grading score were independent malignancy predictors of elastography, as well as SUVmax and TLG of PET/CT. In model and validation groups, the combination of PET/CT and elastography demonstrated sensitivity, specificity, positive and negative predictive values, and accuracy for malignant LNs diagnosis of 85.87%, 88.71%, 91.86%, 80.88%, and 87.01%, and 94.44%, 76.47%, 89.47%, 86.67%, and 88.68%, respectively. Moreover, elastography had better diagnostic accuracies than PET/CT in both model and validation groups (85.71% . 79.22%, 86.79% . 75.47%).
EBUS elastography demonstrated better efficiency than PET/CT and the combination of the two methods had the best diagnostic efficacy in differentiating intrathoracic benign from malignant LNs, which may be helpful for clinical application.
正电子发射断层扫描-计算机断层扫描（PET/CT）和凸阵探头支气管内超声（CP-EBUS）弹性成像术是预测胸内淋巴结（LN）转移的重要诊断方法，但目前仍缺乏对这两种检查的联合分析。本研究旨在比较这两种方法的诊断效率，并探讨联合使用是否能提高鉴别胸内良性LN与恶性LN的诊断效率。
回顾性分析2018年3月至2019年6月在上海胸科医院接受EBUS引导下经支气管针吸活检（EBUS-TBNA）及PET/CT检查的LN作为模型组。分析了四个PET/CT参数，即最大标准化摄取值、平均标准化摄取值（SUVmean）、代谢肿瘤体积（MTV）和肿瘤病变糖酵解（TLG）；四个定量弹性成像指标（硬区比、平均色调值、RGB和平均灰度值）；以及目标LN的弹性成像分级评分。随后构建预测模型，并使用2019年7月至11月的数据集验证该模型的诊断能力。
模型组和验证组分别纳入了135例患者的154个LN和47例患者的53个LN。平均色调值和分级评分是弹性成像的独立恶性预测指标，PET/CT的SUVmax和TLG也是。在模型组和验证组中，PET/CT与弹性成像联合诊断恶性LN的敏感性、特异性、阳性和阴性预测值及准确性分别为85.87%、88.71%、91.86%、80.88%和87.01%，以及94.44%、76.47%、89.47%、86.67%和88.68%。此外，在模型组和验证组中，弹性成像的诊断准确性均优于PET/CT（85.71%＞79.22%，86.79%＞75.47%）。
EBUS弹性成像术的效率优于PET/CT，两种方法联合在鉴别胸内良性与恶性LN方面具有最佳诊断效能，可能有助于临床应用。
Zotero 插件
