Danielle A Hylton1, Simon Turner2, Biniam Kidane3, Jonathan Spicer4, Feng Xie1, Forough Farrokhyar1, Kazuhiro Yasufuku5, John Agzarian6, Waël C Hanna7. 1. Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada. 2. Division of Thoracic Surgery, Department of Surgery, University of Alberta, WC Mackenzie Health Sciences Centre, Edmonton, Alberta, Canada. 3. Division of Thoracic Surgery, Department of Surgery, University of Manitoba, Health Sciences Centre, Winnipeg, Manitoba, Canada. 4. Division of Thoracic Surgery and Upper Gastrointestinal Surgery, Department of Surgery, McGill University, Montreal General Hospital, Montreal, Quebec, Canada. 5. Division of Thoracic Surgery, Department of Surgery, University of Toronto, Toronto General Hospital, Toronto, Ontario, Canada. 6. Division of Thoracic Surgery, Department of Surgery, McMaster University, St Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada. 7. Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; Division of Thoracic Surgery, Department of Surgery, McMaster University, St Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada. Electronic address: hannaw@mcmaster.ca.
Abstract
OBJECTIVE(S): During endobronchial ultrasound (EBUS) staging, ultrasonographic features can be used to predict mediastinal lymph node (LN) malignancy. We sought to develop the Canada Lymph Node Score a tool capable of predicting LN metastasis at the time of EBUS. METHODS: Patients undergoing EBUS staging for lung and esophageal cancer were prospectively enrolled. Features were identified in real time by an endoscopist and video-recorded. Videos were sent to raters. Pathologic specimens from biopsies/surgical resections were used as the gold-standard reference test. Logistic regression, receiver operator characteristic curve, and Gwet's AC1 analyses were used to test the performance, discrimination, and inter-rater reliability, respectively. RESULTS: In total, 300 LNs from 140 patients were analyzed by 12 endoscopists (raters) across 7 Canadian centers. Beta-coefficients from a multivariate regression model were used to create a 4-point score: short-axis diameter, margins, central hilar structure, and necrosis. The model showed good discriminatory power (c-statistic = 0.72 ± 0.04, 95% confidence interval [CI], 0.64-0.80; bias-corrected c-statistic: 0.66, 95% CI, 0.55-0.76). LNs scoring 3/4 or 4/4 had odds ratios of 15.17 (P < .0001) and 50.56 (P = .001) for predicting malignancy, respectively. Inter-rater reliability for a score ≥3 was 0.81 ± 0.02 (95% CI, 0.77-0.85). CONCLUSIONS: The Canada Lymph Node Score is a 4-point score demonstrating excellent performance in identifying malignant LNs during EBUS. A cut-off of ≥3 may inform decision-making regarding biopsy, repeat biopsy, or mediastinoscopy if the initial results are inconclusive.
OBJECTIVE(S): During endobronchial ultrasound (EBUS) staging, ultrasonographic features can be used to predict mediastinal lymph node (LN) malignancy. We sought to develop the Canada Lymph Node Score a tool capable of predicting LN metastasis at the time of EBUS. METHODS:Patients undergoing EBUS staging for lung and esophageal cancer were prospectively enrolled. Features were identified in real time by an endoscopist and video-recorded. Videos were sent to raters. Pathologic specimens from biopsies/surgical resections were used as the gold-standard reference test. Logistic regression, receiver operator characteristic curve, and Gwet's AC1 analyses were used to test the performance, discrimination, and inter-rater reliability, respectively. RESULTS: In total, 300 LNs from 140 patients were analyzed by 12 endoscopists (raters) across 7 Canadian centers. Beta-coefficients from a multivariate regression model were used to create a 4-point score: short-axis diameter, margins, central hilar structure, and necrosis. The model showed good discriminatory power (c-statistic = 0.72 ± 0.04, 95% confidence interval [CI], 0.64-0.80; bias-corrected c-statistic: 0.66, 95% CI, 0.55-0.76). LNs scoring 3/4 or 4/4 had odds ratios of 15.17 (P < .0001) and 50.56 (P = .001) for predicting malignancy, respectively. Inter-rater reliability for a score ≥3 was 0.81 ± 0.02 (95% CI, 0.77-0.85). CONCLUSIONS: The Canada Lymph Node Score is a 4-point score demonstrating excellent performance in identifying malignant LNs during EBUS. A cut-off of ≥3 may inform decision-making regarding biopsy, repeat biopsy, or mediastinoscopy if the initial results are inconclusive.
Authors: Filiz Oezkan; Stephan Eisenmann; Kaid Darwiche; Asmae Gassa; David P Carbone; Robert E Merritt; Peter J Kneuertz Journal: J Clin Med Date: 2021-11-30 Impact factor: 4.241
Authors: Seung Hyun Yong; Sang Hoon Lee; Sang-Il Oh; Ji-Soo Keum; Kyung Nam Kim; Moo Suk Park; Yoon Soo Chang; Eun Young Kim Journal: Transl Lung Cancer Res Date: 2022-01
Authors: Roel L J Verhoeven; Fausto Leoncini; Jorik Slotman; Chris de Korte; Rocco Trisolini; Erik H F M van der Heijden Journal: Respiration Date: 2021-06-24 Impact factor: 3.580
Authors: Mario Nosotti; Michele Ferrari; Ilaria Righi; Paolo Mendogni; Francesco Damarco; Margherita Cattaneo; Lorenzo Rosso Journal: Mediastinum Date: 2021-03-25