PURPOSE: Endobronchial Ultrasonography guided Transbronchial Needle Aspiration (EBUS-TBNA) for mediastinal and hilar lymph nodes has been used in many countries. However internal structures of mediastinal and hilar lymph nodes by the convex bronchoscope were not discussed in detail. We could observe hyperechoic interface echo of the lymph node by B mode and aberrant vessels in the lymph node by power Doppler mode. The aim of this study was to further evaluate the diagnostic yield of hyperechoic interface echo and aberrant vessels for differentiation between sarcoidosis and metastatic lymph nodes.
METHODS: In the procedure of EBUS-TBNA, we recorded images with B mode for the whole area of the target lymph node, and intra-nodal vessels with power Doppler mode. BF-UC260F (7.5 MHz, convex type, Olympus) was used. One hundred thirty four mediastinal and hilar lymph nodes diagnosed cytologically or histologically by EBUS-TBNA were enrolled in this study. Fifty six lymph nodes were diagnosed as sarcoidosis. (group A). Seventy eight lymph nodes were diagnosed as malignant metastasis. (group B).
RESULTS: In group A, hyperechoic interface echo by B mode was observed in 52 of 56 patients. In group B, hyperechoic interface echo by B mode was observed in only four patients. The sensitivity, specificity, and diagnostic accuracy rate were 92.9%, 94.9%, 94.0%, respectively. Aberrant vessels were observed in only two patients by power Doppler mode in group A. In group B, aberrant vessels were observed in 76 of 78 patients. The sensitivity, specificity, and diagnostic accuracy rate were 97.4%, 96.4%, 97.0%, respectively. In group A, no patient had EBUS image without hyperechoic interface echo and with aberrant vessels. In group B, no patient had EBUS image with hyperechoic interface echo and without aberrant vessels.
CONCLUSIONS: In patients with metastatic lymph nodes, no patient had EBUS image with hyperechoic interface echo by B mode and without aberrant vessels by power Doppler mode. Our study showed that hyperechoic interface echo and aberrant vessels results in a high diagnostic yield on patients with mediastinal and/or hilar lymphadenopathy.
CLINICAL IMPLICATIONS: This abstract is funded by none
DISCLOSURE: The following authors have nothing to disclose: Takeo Inoue, Noriaki Kurimoto, Naoki Furuya, Hiroshi Handa, Hirotaka Kida, Hiroki Nishine, Miho Nakamura, Seiichi Nobuyama, Taeko Shirakawa, Masamichi Mineshita, Teruomi Miyazawa
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