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The Egyptian Journal of Bronchology
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Qualitative role of endobronchial elastography with endobronchial ultrasound in differentiating malignant and benign lesions: a retrospective single-center study from India

Egyptian Journal of Bronchology volume 13, pages 630–635 (2019)Cite this article

Abstract

Background

Endobronchial ultrasound (EBUS) is useful in guiding needle biopsy of mediastinal lesions. Sonoelastography in latest generation machines have enabled mapping the elasticity of the lymph nodes (LNs) leading to potentially better guidance in taking samples.

Aim

We aim to assess the practical usefulness of elastography in assessing mediastinal lymphadenopathy by comparing the patterns seen on EBUS elastography with the final pathological diagnosis from EBUS-guided transbronchial needle aspiration.

Patients and methods

The EBUS scope (convex) was intubated via the oral route, and images were generated to evaluate the patterns produced during elastography according to color distribution: type 1 was taken as predominantly nonblue (yellow, red, and green); type 2 was less than 50% blue color, part nonblue (yellow, red, and green); type 3 predominant blue. Elastography patterns were subsequently compared with the eventual pathological results.

Results

In the study period, 105 LNs in 80 patients were studied, 79 were found to be of benign nature while 26 patients were diagnosed as malignancy. Type 1 LNs were of benign pathology in 42/46 (91.30%) cases and malignant in 4/ 46 (8.70%) cases; for type 2 LNs, 24/30 (80%) cases were benign and 6/30 (20%) cases were malignant. Type 3 nodes were found to be of benign nature in 13/29 (44.82%) cases and malignant in 16 (55.14%) cases. On classifying type 1 group and type 2 group as ‘benign’ and type 3 group as malignant in nature, the sensitivity, specificity, negative predictive value, positive predictive value, and diagnostic accuracy rates were found to be 83.54, 61.54, 86.84, 55.17, and 78.10%.

Conclusions

The addition of elastography while performing EBUS of mediastinal lymphadenopathy is a technique that may be helpful in selecting sites for EBUS-guided transbronchial needle aspiration; however, more studies are needed to access its practical usefulness.

References

  1. Seides BJ, Egan JP, French KD, Kovitz KL, Desai NR. Fiducial marker placement for stereotactic body radiation therapy via convex probe endobronchial ultrasound: a case series and review of literature. J Thorac Dis 2018; 10:1972–1983.

    Article  Google Scholar 

  2. Sircar M, Bhatia A, Gupta R, Kaur R. Bronchoscopic decompression of mediastinal lymph node abscess using endobronchial ultrasound. J Pulm Respir Med 2016; 6:315.

    Article  Google Scholar 

  3. Joshi S, Gupta R, Bhatia A, Ali SJ. The sonoelastographic characters of noncomplicated bronchogenic cyst: an evaluation using CP-EBUS. J Assoc Chest Physicians 2018; 6:41–43.

    Article  Google Scholar 

  4. Izumo T, Sasada S, Chavez C, Matsumoto Y, Tsuchida T. Endobronchial ultrasound elastography in the diagnosis of mediastinal and hilar lymph nodes. Jpn J Clin Oncol 2014; 44:956–962.

    Article  Google Scholar 

  5. Emerson K. Diseases of the breast. In: Thorn WW, ed. Principals of internal medicine. 7 th ed. New York: McGraw-Hill 1974. 582–587

    Google Scholar 

  6. Bhargava S, Bhargava SK, Sharma S, Prakash M. Elastography: a new imaging technique and its application. JIMSA 2013; 26:25–30.

    Google Scholar 

  7. Li P, Zheng W, Zhao L. Convex probe endobronchial ultrasound: applications beyond conventional indications. J Thorac Dis 2015; 7: E289–E297.

    PubMed  PubMed Central  Google Scholar 

  8. Barr RG. U S elastography: applications in tumors. In: Luna A, ed. Functional imaging in oncology. Berlin Heidelberg: Springer-Verlag 2014. 459–488

    Chapter  Google Scholar 

  9. Dietrich CF. Elastography applications. Endo Heute 2011; 24:177–212.

    Article  Google Scholar 

  10. Rana SS, Vilmann P. Endoscopic ultrasound features of chronic pancreatitis: a pictorial review. Endosc Ultrasound 2015; 4:10–14.

    Article  Google Scholar 

  11. Garra BS, Cespedes EI, Ophir J, Spratt SR, Zuurbier RA, Magnant CM, Pennanen MF. Elastography of breast lesions: initial clinical results. Radiology 1997; 202:79–86.

    Article  CAS  Google Scholar 

  12. Lyshchik A, Higashi T, Asato R, et al. Thyroid gland tumor diagnosis at US elastography. Radiology 2005; 237:202–211.

    Article  Google Scholar 

  13. König K, Scheipers U, Pesavento A, et al. Initial experiences with real-time elastography guided biopsies of the prostate. J Urol 2005; 174:115–117.

    Article  Google Scholar 

  14. Foucher J, Chanteloup E, Vergniol J, et al. Diagnosis of cirrhosis by transient elastography (FibroScan): a prospective study. Gut 2006; 55:403–408.

    Article  CAS  Google Scholar 

  15. Trosini-Désert V, Jeny F, Taillade L, Vignot S, Zribi H, Capron F, Similowski T. Bronchial endoscopic ultrasound elastography: preliminary feasibility data. Eur Respir J 2013; 41:477–479.

    Article  Google Scholar 

  16. Nakajima T, Inage T, Sata Y, et al. Elastography for predicting and localizing nodal metastases during endobronchial ultrasound. Respiration 2015; 90:499–506.

    Article  Google Scholar 

  17. He H, Lu X, Ma H, Zhu J, Huang M. Value of endobronchial ultrasound elastography in the diagnosis of mediastinal and hilar lymph node metastasis in lung cancer. Zhong Nan Da Xue Xue Bao Yi Xue Ban 2016; 41:30–36.

    PubMed  Google Scholar 

  18. Xu W, Shi J, Zeng X, Li X, Xie WF, Guo J, Lin Y. EUS elastography for the differentiation of benign and malignant lymph nodes: a meta-analysis. Gastrointest Endosc 2011; 74: 1001–1009.

    Article  Google Scholar 

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Authors and Affiliations

  1. Max Super Specialty Hospital, Vaishali, Ghaziabad, Uttar Pradesh, India

    Rajesh Gupta, Sharad Joshi,  Ankit Bhatia MD, Nitesh Tayal & Praveen Pandey

Authors
  1. Rajesh Gupta
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  2. Sharad Joshi
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  3. Ankit Bhatia MD
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  4. Nitesh Tayal
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  5. Praveen Pandey
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Corresponding author

Correspondence to Ankit Bhatia MD.

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Gupta, R., Joshi, S., Bhatia, A. et al. Qualitative role of endobronchial elastography with endobronchial ultrasound in differentiating malignant and benign lesions: a retrospective single-center study from India. Egypt J Bronchol 13, 630–635 (2019). https://doi.org/10.4103/ejb.ejb_49_19

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