Identification of specific EBUS sonographic characteristics for predicting benign mediastinal lymph nodes

Clin Respir J. 2018 Feb;12(2):681-690. doi: 10.1111/crj.12579. Epub 2016 Nov 15.

Abstract

Objective: Reliable differentiation of benign from malignant mediastinal lymphadenopathy is important, especially in countries with a high tuberculosis burden. We hypothesized that specific sonographic features on endobronchial ultrasonography (EBUS) may differentiate benign from malignant nodes. In this study, the sonographic features of non-malignant and malignant nodes were compared.

Methods: This was a retrospective analysis of patients with intrathoracic lymphadenopathy who underwent EBUS-guided transbronchial needle aspiration (TBNA). Sonographic features such as nodal size, margin (distinct or indistinct), echogenicity (heterogeneous or homogeneous), and presence or absence of calcification, a central hilar structure, coagulation necrosis sign, and nodal conglomeration were recorded and compared in the 2 groups.

Results: During the study period, a diagnosis of tuberculosis (n = 71), sarcoidosis (n = 63), and malignancy (n = 36) was made in 170 patients by EBUS-TBNA. A total of 312 lymph node stations were examined. Presence of central hilar structure (15.6% versus 4%, P = .03) and the presence of nodal conglomeration (27.5% versus 8%, P < .01) were significantly higher in benign nodes. Further, logistic regression analysis revealed that the presence of well-defined nodal margins, the presence of central hilar structure, and the presence of conglomeration of lymph nodes were independent predictive factors for the diagnosis of benign mediastinal lymphadenopathy.

Conclusion: Sonographic features of well-defined margins, presence of central hilar structure, and presence of nodal conglomeration in the lymph nodes on EBUS are predictive of benign disease.

Keywords: EBUS; malignancy; nodal characteristics; sarcoidosis; tuberculosis.

MeSH terms

  • Adult
  • Aged
  • Cohort Studies
  • Diagnosis, Differential
  • Endoscopic Ultrasound-Guided Fine Needle Aspiration / methods*
  • Female
  • Humans
  • Immunohistochemistry
  • Lymph Nodes / diagnostic imaging*
  • Lymph Nodes / pathology*
  • Lymphatic Metastasis
  • Male
  • Mediastinal Diseases / diagnostic imaging
  • Mediastinal Diseases / pathology
  • Mediastinal Neoplasms / diagnostic imaging*
  • Mediastinal Neoplasms / pathology*
  • Mediastinum / diagnostic imaging
  • Mediastinum / pathology
  • Middle Aged
  • Predictive Value of Tests
  • Prognosis
  • Retrospective Studies
  • Risk Assessment