期刊
RESPIRATION
卷 100, 期 11, 页码 1088-1096出版社
KARGER
DOI: 10.1159/000516505
关键词
Lung cancer staging; Nonsmall-cell lung cancer; Observer variability; Lymph node staging; Endoscopic ultrasound; Esophageal ultrasound; Bronchoscopy; Cancer; Endobronchial ultrasound; Endobronchial ultrasound-transbronchial needle aspiration
资金
- Astra Zeneca Oncology Netherlands
- Pentax Medical Europe
The study found that the short axis size of lymph nodes is an objective measure for predicting malignancy risk, with high accuracy for nodes >= 8mm in size. Observer disagreement in scoring small and large lymph nodes suggests subjective features are difficult to use for stratification. Future research should focus on integrating other quantitative values for improving predictions.
Background: Endoscopic ultrasound routinely guides lymph node evaluation for the staging of a known or suspected lung cancer. Characteristics seen on B-mode imaging might help the observer decide on the lymph nodes of risk. The influence of nodal size on the predictivity of these characteristics and the agreement with which operators can combine these for malignancy risk prediction is to be determined. Objectives: We evaluated (1) if prospectively scored individual B-mode ultrasound features predict malignancy when further divided by size and (2) assessed if observers were able to reproducibly agree on still lymph node image malignancy risk. Methods: Lymph nodes as visualized by EBUS were prospectively scored for B-mode characteristics. Still B-mode images were furthermore collected. After collection, a repeated scoring of a subset of lymph nodes was retrospectively performed (n = 11 observers). Results: Analysis of 490 lymph nodes revealed the short axis size is an objective measure for stratifying risk of malignancy (ROC area under the curve 0.78). With >= 8-mm size, 210/237 malignant lymph nodes were correctly identified (89% sensitivity, 46% specificity, 61% PPV, and 81% NPV). Secondary addition of B-mode features in Conclusions: Lymph nodes of >= 8-mm size and preferably even smaller should be aspirated regardless of other B-mode features. Observer disagreement in scoring both small and large lymph nodes suggests it is infeasible to include subjective features for stratification. Future research should focus on (integrating) other (semi)quantitative values for improving prediction.
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