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Predicting malignancy in mediastinal lymph nodes by endobronchial ultrasound: A new ultrasound scoring system

  1. GERALD SCHMID-BINDERT1,
  2. HONGBIN JIANG5,*,
  3. GEORG KÄHLER1,
  4. JOACHIM SAUR2,
  5. THOMAS HENZLER3,
  6. HAO WANG6,
  7. SHENGXIANG REN7,
  8. CAICUN ZHOU7,
  9. LOTHAR R. PILZ4

Article first published online: 25 OCT 2012

DOI: 10.1111/j.1440-1843.2012.02223.x

Issue

Respirology

Respirology

Volume 17, Issue 8, pages 1190–1198, November 2012

Additional Information

How to Cite

SCHMID-BINDERT, G., JIANG, H., KÄHLER, G., SAUR, J., HENZLER, T., WANG, H., REN, S., ZHOU, C. and PILZ, L. R. (2012), Predicting malignancy in mediastinal lymph nodes by endobronchial ultrasound: A new ultrasound scoring system. Respirology, 17: 1190–1198. doi: 10.1111/j.1440-1843.2012.02223.x

Author Information

  1. 1

    Department of Surgery

  2. 2

    1st Department of Medicine

  3. 3

    Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim

  4. 4

    Medical Faculty Mannheim of Heidelberg University, Mannheim, Germany

  5. 5

    Emergency Department

  6. 6

    Department of Surgery

  7. 7

    Department of Medical Oncology, Cancer Institute, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China

*Hongbin Jiang, Emergency Department, Shanghai Pulmonary Hospital, Tongji University School of Medicine, no. 507 Zhengmin Road, Shanghai 200433, China. Email: jiang-r-d@hotmail.com

Publication History

  1. Issue published online: 25 OCT 2012
  2. Article first published online: 25 OCT 2012
  3. Accepted manuscript online: 12 JUL 2012 01:56PM EST
  4. Received 14 December 2011; Invited to revise 26 January 2012, 17 April 2012; revised 20 March 2012, 11 May 2012; accepted 24 May 2012 (Associate Editor: David Feller-Kopman).

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Keywords:

  • endobronchial ultrasound;
  • mediastinal lymph node;
  • non-small-cell lung cancer;
  • sarcoidosis;
  • tuberculosis

ABSTRACT

Background and objective:  Endobronchial ultrasound (EBUS) is now widely used in patients with resectable non-small-cell lung cancer to sample mediastinal lymph nodes (LN) for preoperative staging. The aim of this study was to investigate prospectively the utility of six ultrasound criteria to predict malignancy in mediastinal LN.

Methods:  EBUS was performed in patients with mediastinal lymphadenopathy irrespective of the underlying disease. The following criteria were expected to predict malignancy: short axis >1 cm, heterogeneous pattern, round shape, distinct margin, absence of a central hilar structure and high blood flow in a LN. A sum score prediction model for malignancy was built. If more than two criteria were present, LN was classified as high risk for malignancy. Moreover, interrater variability of two blinded investigators was evaluated.

Results:  Two hundred eighty-one LN in 145 patients were analysed. Forty-four percent of LN were found malignant, 10% revealed sarcoidosis, and 10% revealed tuberculosis. Interobserver agreement was very good. Positive predictive value was best for heterogeneity (73%), with a negative predictive value of more than 80%. The sum score resulted in an odds ratio of 15.5 if more than two criteria were positive (P < 0.00001).

Conclusions:  The assessment of ultrasound criteria during routine EBUS examinations is feasible and reproducible with very good interrater agreement. If less than three of the described criteria are present, a LN has a very low chance of being malignant. The best single criterion to predict malignancy is heterogeneity. The introduction of the sum score of ultrasound criteria could potentially increase diagnostic accuracy.

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