A valuable endobronchial ultrasound scoring system predicting malignant lymph nodes

• Published in: Türk göğüs kalp damar cerrahisi dergisi Vol. 31; no. 3; pp. 358 - 366
• Main Authors: Guler, Nurcan, Can Tertemiz, Kemal, Gurel, Duygu
• Format: Journal Article
• Language: English
• Published: Bayçınar Medical Publishing 01-07-2023
• Subjects: Original
• DOI: 10.5606/tgkdc.dergisi.2023.23568
• EISSN: 2149-8156
• ISSN: 1301-5680

Background:
This study aims to determine the sonographic criteria of lymph nodes to predict malignancy with endobronchial ultrasound.
Methods:
A total of 1,987 lymph nodes of 967 patients (666 males, 301 females; mean age: 62.1±11.9 years; range, 21 to 90 years) between May 2016 and July 2020 were retrospectively analyzed. The endobronchial ultrasound images of lymph nodes were evaluated according to the following criteria: size (short axis >1 cm), shape (round or oval), margin (distinct or indistinct), coagulation necrosis sign (present or absent), central hilar structure (present or absent) and echogenicity (homogeneous or heterogeneous). A scoring system was developed for predicting malignancy.
Results:
A total of 765 (38.5%) of the lymph nodes were malignant. In the univariate analysis, size >1 cm, round shape, distinct margin, absence of central hilar structure, presence of coagulation necrosis sign, and heterogeneity were significant predictors of malignancy (p<0.001 for all). In the multivariate analysis, the main independent predictors were heterogeneity and presence of coagulation necrosis sign (odds ratio=5.9, 95% confidence interval: 4.2-8.2
vs.
odds ratio=3.1 95% confidence interval: 2.2-4.5, respectively). A cut-off value for endobronchial ultrasound score of ≥4 increased the malignancy risk 30 times with a sensitivity of 84.7%, and specificity of 84.5%.
Conclusion:
Our study results show that endobronchial ultrasound scoring system with six criteria has a high sensitivity and specificity for predicting malignant lymph nodes.