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Diagnostic Value of Elastography and Endobronchial Ultrasound in the Study of Hilar and Mediastinal Lymph Nodes

Hernández Roca, María MSc*; Pérez Pallarés, Javier MSc; Prieto Merino, David MD; Valdivia Salas, María del Mar MD; García Solano, Jose MD†,‡; Fernández Álvarez, Javier BSc§; Lozano Vicente, Desiree MSc*; Wasniewski, Samantha MSc*; Martínez Díaz, Juan J. MSc; Elías Torregrosa, Cristina BSc*; Santa Cruz Siminiani, Antonio MSc

Journal of Bronchology & Interventional Pulmonology: July 2019 - Volume 26 - Issue 3 - p 184–192
doi: 10.1097/LBR.0000000000000550
Original Investigations
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Background: The aim of this study was to explore elastography features and its ability to distinguish between benign and malignant lymph nodes by comparing the results with an anatomopathologic examination used as gold standard.

Methods: Patients were randomized in 2 groups [endobronchial ultrasound (EBUS) and EBUS-elastography]. Echographic characteristics of the lymph nodes were collected in both categories. In the EBUS-elastography group, elastographic data were also determined.

Results: A total of 100 lymph nodes were evaluated. Group 1 (EBUS) consisted of 57 lymph nodes. Group 2 (EBUS-elastography) included 43 lymph nodes. In group 2, lymph nodes with predominantly blue pattern were associated with a pathologic determination of malignancy, and the probability of presenting malignant infiltration with this color pattern was 86.7% (P=0.00004). Malignant lymph nodes presented less color dispersion (48.8 vs. 94.8, P=0.00013), higher ratio of blue pixels (66% vs. 32.5%, P=0.016), and higher strain ratio (7.1 vs. 2.48, P=0.005). The cut-off points to distinguish between benign and malignant lymph nodes were 4 for strain ratio, 61 for frequency histograms, and 52 for blue pixel ratio. The area under the curve of the ROC curves were 0.75, 0.83, and 0.87, respectively. Group 2 presented a lower number of nondiagnostic samples (2.3% vs. 21%, P=0.001) and a higher rate of malignant results (42% vs. 16%, P=0.005).

Conclusion: EBUS-elastography is feasible during EBUS and may be helpful in predicting malignant lymph node infiltration. It could improve anatomopathologic sample collection and increase diagnostic efficiency.

*Rafael Méndez General University Hospital, Lorca

Santa Lucía General University Hospital, Cartagena

San Antonio Catholic University, Guadalupe

§Morales Meseguer General University Hospital, Murcia

Almansa General Hospital, Almansa, Albacete, Spain

Disclosure: There is no conflict of interest or other disclosures.

Reprints: María Hernández Roca, MSc, Paseo de la Pinada No 29, CP 30110 Murcia, Spain (e-mail: mariahernandezroca@gmail.com).

Received April 27, 2018

Accepted August 29, 2018

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