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INTRODUCTION: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is frequently used as an important initial investigation for diagnosing and staging for both suspected malignant and benign mediastinal lesions for the last 10 years.
AIM: We aimed to analyze the correlation between probability of malignity by EBUS-TBNA and m...
Citations
... Transbronchial needle aspiration, accompanied by endobronchial ultrasonography (EBUS-TBNA), has been an important method frequently used both in the diagnosis and staging of mediastinal lesions with suspected malignancy and in the initial investigation of the diagnosis of benign lesions. [1] In cancer patients with mediastinal lymphadenopathies (LAPs), the samples of lymph nodes (LNs) are required to be obtained before deciding the treatment. EBUS-TBNA has been recommended in the cases of mediastinal lymphadenopathy under the international guidelines [2,3] and become the standard diagnostic procedure. ...
... However, given the cut off value as nine for SUVmax, while the specificity was seen high (79.1%), the sensitivity rate was found low (54.39%). [1] There are a limited number of comprehensive studies evaluating the cytological, radiological and clinical features of LNs found positive in 18F-FDG PET/CT. In the study in which the experiences of a large cancer center obtained from 577 LNs were evaluated, 263 (46%) patients were compared with those having PET-CT positivity and malignant cytology, and 314 (54%) patients were compared with those having PET-CT positivity and cytology-benign LNs groups. ...
Introduction:
Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a simple, reliable, minimally invasive and effective procedure. However, a surgical technique may be required, if the results are negative. Therefore, there is a need for new studies to increase the diagnostic value of EBUS-TBNA and provide additional information to guide the biopsy in performing the procedure. Here, we aimed to investigate the diagnostic value of EBUS-TBNA and 18-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) in diagnosis of hilar and/or mediastinal lymph nodes (LNs). It was also aimed to determine the contributions of real-time ultrasonography (USG) images of LNs to distinguishing between the malignant and benign LNs during EBUS-TBNA, and in the diagnosis of anthracotic LNs.
Material and method:
In the retrospective study including 545 patients, 1068 LNs were sampled by EBUS-TBNA between January 2015 and February 2020. EBUS-TBNA, 18-FDG PET/CT and images of USG were investigated in the diagnosis of mediastinal and/or hilar malignant, anthracotic and other benign LNs.
Results:
The sensitivity, specificity, positive predictive value and negative predictive value of EBUS-TBNA were found as 79.5, 98.1, 89.5, and 91.7%, respectively. Mean maximum standardized uptake value (SUVmax) values of 18F-FDG PET/CT were 6.31±4.3 in anthracotic LNs and 5.07 ± 2.53 in reactive LNs. Also, mean SUVmax of malignant LNs was 11.02 ± 7.30 and significantly higher than that of benign LNs. In differentiation of malignant-benign tumors, considering the cut off value of 18F-FDG PET/CT SUVmax as 2.72, the sensitivity and specificity was 99.3 and 11.7%, but given the cut off value as 6.48, the sensitivity, specificity, positive predictive value and negative predictive value was found as 76.5, 64, 20.49, and 78.38% for benign LNs, respectively. Compared LNs as to internal structure and contour features, malignant LNs had most often irregular contours and heterogeneous density. Anthracotic, reactive and other benign LNs were most frequently observed as regular contours and homogeneous density. The difference between malignant and benign LNs was significant.
Conclusion:
EBUS can contribute to the differential diagnosis of malignant, anthracotic and other benign LNs. Such contributions can guide clinician bronchoscopists during EBUS-TBNA. The triple modality of EBUS-TBNA, 18FDG PET/CT, and USG may increase the diagnostic value in hilar and mediastinal lymphadenopathies.
