Skip to main content

The role of endobronchial ultrasound elastography in the diagnosis of mediastinal lymph nodes



Endobronchial ultrasound (EBUS) has become a powerful tool for the diagnosis of mediastinal and hilar lymph nodes (LNs). Elastography has been introduced recently to provide more accurate data about the lesions seen during EBUS.


The aim of this study was to evaluate the role of elastography during EBUS for the diagnosis of hilar and mediastinal LN.

Patients and methods

We carried out a prospective, cross-sectional study. Patients with hilar/mediastinal LN enlargement on computed tomography examination were included. Convex probe EBUS was performed using conventional B-mode and elastography with transbronchial needle aspiration from the examined LN. All data are presented as mean±SD. Receiver operating characteristic analysis was carried out to find the relative sensitivity and specificity of EBUS elastography and to compare the results with other B-mode findings such as mediastinal LNs.


A total of 147 LNs from 56 patients were examined. Malignancy was found in 111 of them. The strain ratio was found to be more accurate when compared with other findings of B-mode when comparing malignant and benign LNs with a cut-off value of 7.5, giving a sensitivity of 95.5% and a specificity of 91.67%. About 63% of malignant LNs were diagnosed from the first pass with the help of elastography.


Elastography is a very helpful tool for diagnosing mediastinal LNs with a strain ratio above 7.5, having a strong suggestion of malignancy. Elastography can help in directing the needle during EBUS-transbronchial needle aspiration to reach the final diagnosis with the least possible number of passes and avoiding unnecessary punctures (ClinicalTrials. gov Identifier: NCT02724059).


  1. McPhail S, Johnson S, Greenberg D,Peake M, RousB. Stage at diagnosis and early mortality from cancer in England. Br J Cancer 2015; 112: S108–S115.

    Article  Google Scholar 

  2. Silvestri GA, Gonzalez AV, Jantz MA, Margolis ML, Gould MK, Tanoue LT, et al. Methods for staging non-small cell lung cancer: diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence based clinical practice guidelines. Chest 2013; 143 (Suppl):e211S–e250S.

  3. Vaidya PJ, Kate AH, Yasufuku K, Chhajed PN. Endobronchial ultrasound-guided transbronchial needle aspiration in lung cancer diagnosis and staging. Expert Rev Respir Med 2015; 9:45–53.

    Article  CAS  Google Scholar 

  4. He HY, Huang M, Zhu J, Ma H, Lyu XD. Endobronchial ultrasound elastography for diagnosing mediastinal and hilar lymph nodes. Chin Med J 2015; 128:2720–2725.

    Article  Google Scholar 

  5. Fujiwara T, Yasufuku K, Nakajima T, Chiyo M, Yoshida S, Suzuki M, 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; 138:641–647.

    Article  Google Scholar 

  6. Saftoiu A, Vilman P. Endoscopic ultrasound elastography – a new imaging technique for the visualization of tissue elasticity distribution. J Gastrointestin Liver Dis 2006; 15:161–165.

    PubMed  Google Scholar 

  7. Mountain CF, Dresler CM. Regional lymph node classification for lung cancer staging. Chest 1997; 111:1718–1723.

    Article  CAS  Google Scholar 

  8. Rozman A, Malovrh MM, Adamic K, Subic T, Kovac V, Flezar M. Endobronchial ultrasound elastography strain ratio for mediastinal lymph node diagnosis. Radiol Oncol 2015; 49:334–340.

    Article  CAS  Google Scholar 

  9. Nakajima T, Yasufuku K, Saegusa F, Fujiwara T, Sakairi Y, Hiroshima K, et al. Rapid on-site cytologic evaluation during endobronchial ultrasound-guided transbronchial needle aspiration for nodal staging in patients with lung cancer. Ann Thorac Surg 2013; 95:1695–1699.

    Article  Google Scholar 

  10. 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 

Download references

Author information

Authors and Affiliations


Corresponding author

Correspondence to Adel S. Bediwy MD.

Additional information

This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work noncommercially, as long as the author is credited and the new creations are licensed under the identical terms.

Rights and permissions

This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Bediwy, A.S., Hantira, M.S., El Sharawy, D. et al. The role of endobronchial ultrasound elastography in the diagnosis of mediastinal lymph nodes. Egypt J Bronchol 11, 238–243 (2017).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: