Roel Lambertus Johannes Verhoeven1,2, Rocco Trisolini3,4, Fausto Leoncini4,5, Piero Candoli6, Michela Bezzi5, Alessandro Messi7, Mark Krasnik8, Chris L de Korte2, Jouke T Annema9, Erik H F M van der Heijden10. 1. Department of Pulmonology, Radboudumc, Nijmegen, The Netherlands. 2. Medical Ultrasound Imaging Center (MUSIC), Department of Radiology, Radboudumc, Nijmegen, The Netherlands. 3. Interventional Pulmonology Unit, Policlinico S. Orsola, Bologna, Italy. 4. Interventional Pulmonology Unit, Dipartimento di Scienza, Mediche e Chirurgiche, Fondazione Policlinico A. Gemelli, Rome, Italy. 5. Department of Pulmonology, Azienda Ospedaliera Universitaria di Careggi, Firenze, Italy. 6. Pulmonology Unit, Santa Croce Hospital, Fano, Italy. 7. Department of Pulmonology, Ospedale Santa Maria Bianca, Modena, Italy. 8. Department of Pulmonology, Rigshopitalet, Copenhagen, Denmark. 9. Department of Respiratory Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands. 10. Department of Pulmonology, Radboudumc, Nijmegen, The Netherlands, erik.vanderheijden@radboudumc.nl.
Abstract
BACKGROUND: 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. OBJECTIVES: To assess if EBUS-SE can independently help predict malignancy, and when combined with size and FDG uptake information. METHODS: 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. RESULTS: 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. CONCLUSIONS: EBUS-SE can help predict lymph node malignancy and may be useful for risk stratification when combined with size and PET information.
BACKGROUND: 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. OBJECTIVES: To assess if EBUS-SE can independently help predict malignancy, and when combined with size and FDG uptake information. METHODS: 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. RESULTS: 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. CONCLUSIONS: EBUS-SE can help predict lymph node malignancy and may be useful for risk stratification when combined with size and PET information.
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