Wang Yueming, Zhao Zhigang, Zhu Minghui, Zhu Qiang, Yang Zhen, Chen Liangan
School of Medicine, Nankai University, Tianjin, China.
Department of Pulmonary and Critical Care Medicine, Chinese PLA General Hospital, Beijing, China.
Quant Imaging Med Surg. 2023 Jul 1;13(7):4648-4662. doi: 10.21037/qims-23-241. Epub 2023 Jun 5.
Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a first-line approach for diagnosing hilar and mediastinal lymph node metastasis. Endobronchial ultrasound (EBUS) elastography is an imaging technique for describing the elasticity of intrathoracic lesions. However, the reported accuracy of EBUS elastography needs to be improved. In this study, we aimed to explore the diagnostic value of EBUS elastography for differentiating between benign and malignant hilar and mediastinal lymph nodes.
We conducted a single-center, retrospective study enrolling consecutive patients who received EBUS elastography followed by EBUS-TBNA at the Chinese PLA General Hospital from October 2015 to October 2022. The pathological results of EBUS-TBNA confirmed by 6-month follow-up were used as the gold standard. The ultrasound elastography parameters of lymph nodes included strain rate, stiff area ratio, and elasticity score, along with the conventional ultrasound characteristics such as short axis diameter, shape, margin, echogenicity distribution and intensity, and blood flow. The diagnostic performance of these parameters was compared, and conjointly analyzed using multivariate logistic regression. Bootstrapping resampling was applied for internal validation of the regression model.
A total of 83 patients were enrolled with an average age of 57 years, and 66.3% of patients were male. In total, 131 lymph nodes were punctured, among which 79 (60.3%) were malignant. All the conventional ultrasound characteristics were significantly different between benign and malignant lymph nodes. All the ultrasound elastography parameters of malignant lymph nodes were markedly higher than those of benign lymph nodes. Multivariate logistic regression analysis showed that the margin, echogenicity intensity, blood flow, short axis diameter, and stiff area ratio were the main factors affecting the lymph node property. The diagnostic accuracy, sensitivity, and specificity were 91.8% [95% confidence interval (CI): 85.4-96.0%], 94.4% (95% CI: 86.4-98.5%), and 88.0% (95% CI: 75.7-95.5%), respectively. Bootstrap resampling validation showed a concordance index (C-index) of 0.949. The calibration plot indicated good agreement between the predicted and observed results.
EBUS elastography is a promising approach for differentiating between benign and malignant lymph nodes. The combination of conventional EBUS and elastography can improve diagnostic efficacy, provide reliable complementary information, and guide the implementation of EBUS-TBNA more accurately.
支气管内超声引导下经支气管针吸活检术（EBUS-TBNA）是诊断肺门及纵隔淋巴结转移的一线方法。支气管内超声（EBUS）弹性成像技术是一种描述胸内病变弹性的成像技术。然而，报道的EBUS弹性成像的准确性有待提高。在本研究中，我们旨在探讨EBUS弹性成像在鉴别肺门及纵隔淋巴结良恶性方面的诊断价值。
我们进行了一项单中心回顾性研究，纳入了2015年10月至2022年10月在中国人民解放军总医院连续接受EBUS弹性成像检查并随后接受EBUS-TBNA检查的患者。以6个月随访确认的EBUS-TBNA病理结果作为金标准。淋巴结的超声弹性成像参数包括应变率、硬区比和弹性评分，以及常规超声特征，如短轴直径、形状、边界、回声分布及强度和血流情况。比较这些参数的诊断性能，并使用多因素逻辑回归进行联合分析。采用自助重采样对回归模型进行内部验证。
共纳入83例患者，平均年龄57岁，66.3%为男性。总共穿刺了131个淋巴结，其中79个（60.3%）为恶性。良性和恶性淋巴结的所有常规超声特征均有显著差异。恶性淋巴结的所有超声弹性成像参数均明显高于良性淋巴结。多因素逻辑回归分析显示，边界、回声强度、血流、短轴直径和硬区比是影响淋巴结性质的主要因素。诊断准确性、敏感性和特异性分别为91.8%[95%置信区间（CI）：85.4-96.0%]、94.4%（95%CI：86.4-98.5%）和88.0%（95%CI：75.7-95.5%）。自助重采样验证显示一致性指数（C指数）为0.949。校准图表明预测结果与观察结果之间具有良好的一致性。
EBUS弹性成像是鉴别淋巴结良恶性的一种有前景的方法。传统EBUS与弹性成像相结合可提高诊断效能，提供可靠的补充信息，并更准确地指导EBUS-TBNA的实施。
