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Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is widely used for nodal staging in lung cancer patients. Ultrasound elastography (UE) is a new sonographical analysis that translates tissue stiffness into a colour signal. Aim: to assess the value of UE in discriminating malignant from non-malignant mediastinal lymph nodes (LNs). Methods: We evaluated 32 LNs from 28 patients who underwent EBUS-TBNA from Oct 2018 to Feb 2019. EBUS indication, LNs location and UE measurements, such as strain ratio (SR) and blue colour proportion (BCP), were collected. LNs were classified as type 1, mainly non-blue; type 2, partially blue; type 3, mainly blue (stiffest tissues). We compared UE features with TBNA cytological results. Results: 18 patients underwent EBUS-TBNA for cancer staging. 12 LNs were located in group 7, 7 in 4R, 3 in 10R, 3 in 4L, 3 in 11R, 3 in 11L, 1 in 12R. 12 LNs were positive for malignancy, 20 LNs were negative, whose 9 sarcoidotic. BCP and SR were higher in positive LNs (BCP: 0.45 ± 0.19 vs 0.31 ± 0.16, p 0.04; SR: 79.8 ± 69.1 vs 47.4 ± 48.2, not significant). Comparing type 3 group (13 LNs) with the other groups we find that odds ratio for malignance was 6.0 (95% CI: 1.3 – 24.9; p 0.03). Conclusion: Along with CT, PET and EBUS imaging, UE could identify malignant involvement and guide the LNs sampling during EBUS-TBNA. Further studies are needed to validate this technique. |
