0
Original Research: INTERVENTIONAL PULMONOLOGY |

The Utility of Sonographic Features During Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration for Lymph Node Staging in Patients With Lung Cancer: A Standard Endobronchial Ultrasound Image Classification System

Taiki Fujiwara, MD; Kazuhiro Yasufuku, MD, PhD, FCCP; Takahiro Nakajima, MD, PhD; Masako Chiyo, MD, PhD; Shigetoshi Yoshida, MD, PhD; Makoto Suzuki, MD, PhD; Kiyoshi Shibuya, MD, PhD; Kenzo Hiroshima, MD, PhD; Yukio Nakatani, MD, PhD; Ichiro Yoshino, MD, PhD
Author and Funding Information

From the Department of Thoracic Surgery (Drs Fujiwara, Yasufuku, Nakajima, Chiyo, Yoshida, Suzuki, Shibuya, and Yoshino) and Diagnostic Pathology (Drs Hiroshima and Nakatani), Graduate School of Medicine, Chiba University, Chiba, Japan; and the Division of Thoracic Surgery (Dr Yasufuku), Toronto General Hospital, University Health Network, Toronto, ON, Canada.

Corresponding author: Kazuhiro Yasufuku, MD, PhD, Division of Thoracic Surgery, Toronto General Hospital, University Health Network, 200 Elizabeth S, 9N-957, Toronto, ON, M5G2C4, Canada; e-mail: kazuhiro.yasufuku@uhn.on.ca


Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2010 American College of Chest Physicians


Chest. 2010;138(3):641-647. doi:10.1378/chest.09-2006
Text Size: A A A
Published online

Background:  Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a minimally invasive procedure with a high yield for lymph node staging of lung cancer. The aim of this study was to assess the utility of sonographic features of lymph nodes during EBUS-TBNA for the prediction of metastasis in patients with lung cancer and to establish a standard endobronchial ultrasound (EBUS) image classification system.

Methods:  Digital images of lymph nodes obtained during EBUS-TBNA in patients with lung cancer were categorized according to the following characteristics: (1) size (short axis) less or more than 1 cm, (2) shape (oval or round), (3) margin (indistinct or distinct), (4) echogenicity (homogeneous or heterogeneous), (5) presence or absence of central hilar structure, and (6) presence or absence of coagulation necrosis sign. The sonographic findings were compared with the final pathologic results.

Results:  A total of 1,061 lymph nodes were retrospectively evaluated in 487 patients. The accuracy of predicting metastatic property for each category was as high as 63.8% to 86.0%. A multivariate analysis revealed that round shape, distinct margin, heterogeneous echogenicity, and presence of coagulation necrosis sign were independent predictive factors for metastasis. Two hundred eighty-five of the 664 lymph nodes (42.9%) having at least one metastatic feature of the four categories were pathologically proven metastatic, and 96.0% of lymph nodes (381/397) were proven not metastatic when all four categories were determined as benign.

Conclusions:  Sonographic features of lymph nodes based on the new EBUS imaging classification may be helpful in the prediction of metastatic lymph nodes during EBUS-TBNA.

Figures in this Article

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Figures

Tables

References

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Related Content

Customize your page view by dragging & repositioning the boxes below.

Find Similar Articles
CHEST Journal Articles
PubMed Articles
Guidelines
  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543