https://doi.org/10.4081/monaldi.2023.2662

Endobronchial ultrasound sonographic characteristics of mediastinal lymph node in evaluation of lung cancer

Early Access
Submitted: June 13, 2023
Accepted: August 7, 2023
Published: September 5, 2023
Mediastinal lymphadenopathy, EBUS, Lung Cancer, CECT
Abstract Views: 426
PDF_early view: 236
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Authors

Manoranjan Pattnaik
https://orcid.org/0000-0002-9955-0373
Department of Pulmonary Medicine (Superspeciality-DM), Sriram Chandra Bhanja Medical College and Hospital, Cuttack, India.
Jeetendra Kumar Patra
https://orcid.org/0000-0002-5664-6180
Department of Pulmonary Medicine (Superspeciality-DM), Sriram Chandra Bhanja Medical College and Hospital, Cuttack, India.
Onkar Kumar Jha
onkarjha@hotmail.com
https://orcid.org/0000-0002-1356-701X
Department of Pulmonary Medicine (Superspeciality-DM), Sriram Chandra Bhanja Medical College and Hospital, Cuttack, India.

Endobronchial ultrasound (EBUS) and contrast enhanced computed tomography (CECT) are essential components of lung cancer evaluation. Features of mediastinal lymph nodes on EBUS and CECT can help in predicting metastatic disease. Clinical, radiological and EBUS data of patients with clinico-radiological suspicion of lung cancer and have undergone EBUS with no trans-bronchial needle aspiration (TBNA) or nonyielding EBUS-TBNA were retrospectively collected from medical records. EBUS features of lymph nodes for metastatic disease [Size >1cm, round shape, heterogeneous echo-texture, indistinct margin, coagulation necrosis(CN), absence of central hilar structures (CHS) and grade II-III vascularity] were noted. CECT findings were noted from CECT films and reports to analyse and compare with EBUS findings. Scoring criteria of EBUS sonographic characteristics from previous studies for discriminating benign and malignant lymph-nodes were also assessed for possible prediction. Thirty-one (31) patients [male=18 (58.1%), female=13 (41.9); age (mean±SD) =52.9±15.7 years] with CECT findings suggesting lung cancer were studied. EBUS showed mediastinal lymphadenopathy at 82 lymph node station in 29 patients. Size>1cm, round shape, heterogeneous echo-texture, distinct margin, CN, absence of CHS and grade II-III vascularity at 33 (40%), 28 (34%), 31 (38%), 55 (67%), 3 (4%), 77 (94%) and 6 (7.3%) lymph nodes, respectively. Malignant or benign status assigned to lymph nodes using different scoring criteria were highly discordant. Compared to EBUS, CECT revealed abnormal mediastinal lymph nodes (LN) in significantly less number of patients [21( 67.7%) vs 29 (93.5%), p=0.01] involving less number of lymph node stations (LNS) [(37 vs 82, p<0.001]. Lymphadenopathy frequency at different LNS on EBUS and CECT showed a weak positive but significant correlation (r=0.356; p=0.0426). EBUS characteristics and related scores have limited accuracy in differentiating benign and malignant nodes. CECT underestimates lymph-adenopathy in comparison to EBUS. Larger prospective study of EBUS features with cyto/histo-pathology correlation may elicit its clinical significance and help to create a better and composite scoring criteria.

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Scopus
Google Scholar
Europe PMC
Detterbeck FC, Lewis SZ, Diekemper R, et al. Executive Summary: Diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest 2013;143:7S-37S. DOI: https://doi.org/10.1378/chest.12-2377
Zhi X, Chen J, Xie F, et al. Diagnostic value of endobronchial ultrasound image features: A specialized review. Endosc Ultrasound 2021;10:3-18. DOI: https://doi.org/10.4103/eus.eus_43_20
Walker CM, Chung JH, Abbott GF, et al. Mediastinal lymph node staging: from noninvasive to surgical. AJR Am J Roentgenol 2012;199:W54-64. DOI: https://doi.org/10.2214/AJR.11.7446
Fujiwara T, Yasufuku K, Nakajima T, et al. The utility of sonographic features during endobronchial ultrasound-guided transbronchial needle aspiration for lymph node staging in patients with lung cancer: a standard endobronchial ultrasound image classification system. Chest 2010;138:641-7. DOI: https://doi.org/10.1378/chest.09-2006
Nakajima T, Anayama T, Shingyoji M, et al. Vascular image patterns of lymph nodes for the prediction of metastatic disease during EBUS-TBNA for mediastinal staging of lung cancer. J Thorac Oncol 2012;7:1009-14. DOI: https://doi.org/10.1097/JTO.0b013e31824cbafa
Ayub II, Mohan A, Madan K, et al. Identification of specific EBUS sonographic characteristics for predicting benign mediastinal lymph nodes. Clin Respir J 2018;12:681-90. DOI: https://doi.org/10.1111/crj.12579
Wang Memoli JS, El-Bayoumi E, Pastis NJ, et al. Using endobronchial ultrasound features to predict lymph node metastasis in patients with lung cancer. Chest 2011;140:1550-16. DOI: https://doi.org/10.1378/chest.11-0252
Shafiek H, Fiorentino F, Peralta AD, et al. Real-time prediction of mediastinal lymph node malignancy by endobronchial ultrasound. Arch Bronconeumol 2014;50:228-34. DOI: https://doi.org/10.1016/j.arbr.2014.05.003
Schmid-Bindert G, Jiang H, Kähler G, et al. Predicting malignancy in mediastinal lymph nodes by endobronchial ultrasound: a new ultrasound scoring system. Respirology 2012;17:1190-8. DOI: https://doi.org/10.1111/j.1440-1843.2012.02223.x
Wahidi MM, Herth F, Yasufuku K, et al. Technical aspects of endobronchial ultrasound-guided transbronchial needle aspiration: CHEST guideline and expert panel report. Chest 2016;149:816-35. DOI: https://doi.org/10.1378/chest.15-1216
Dhooria S, Agarwal R, Aggarwal AN, et al. Differentiating tuberculosis from sarcoidosis by sonographic characteristics of lymph nodes on endobronchial ultrasonography: a study of 165 patients. J Thorac Cardiovasc Surg 2014;148:662-7. DOI: https://doi.org/10.1016/j.jtcvs.2014.01.028
Andersen MB, Harders SW, Ganeshan B, et al. CT texture analysis can help differentiate between malignant and benign lymph nodes in the mediastinum in patients suspected for lung cancer. Acta Radiologica 2016;57:669-76. DOI: https://doi.org/10.1177/0284185115598808
Meyer HJ, Schnarkowski B. Pappisch J, et al. CT texture analysis and node-RADS CT score of mediastinal lymph nodes - diagnostic performance in lung cancer patients. Cancer Imaging 2022;22:75. DOI: https://doi.org/10.1186/s40644-022-00506-x
Schmidt-Hansen M, Baldwin DR, Hasler E, et al. PET-CT for assessing mediastinal lymph node involvement in patients with suspected resectable non-small cell lung cancer. Cochrane Database Syst Rev 2014;2014:CD009519. DOI: https://doi.org/10.1002/14651858.CD009519.pub2
Kumar A, Dutta R, Kannan U, et al. Evaluation of mediastinal lymph nodes using F-FDG PET-CT scan and its histopathologic correlation. Ann Thorac Med 2011;6:11-6. DOI: https://doi.org/10.4103/1817-1737.74270
Hernández Roca M, Pérez Pallarés J, Prieto Merino D, et al. Diagnostic value of elastography and endobronchial ultrasound in the study of hilar and mediastinal lymph nodes. J Bronchology Interv Pulmonol 2019;26:184-92. DOI: https://doi.org/10.1097/LBR.0000000000000550

How to Cite

Pattnaik, Manoranjan, Jeetendra Kumar Patra, and Onkar Kumar Jha. 2023. “Endobronchial Ultrasound Sonographic Characteristics of Mediastinal Lymph Node in Evaluation of Lung Cancer”. Monaldi Archives for Chest Disease, September. https://doi.org/10.4081/monaldi.2023.2662.
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