PURPOSE:EBUS provides ultrasonographic images of mediastinal and hilar lymph nodes by B mode and power Doppler mode. Power Doppler is to visualize vessels running in a lymph node. We assessed the usefulness of visualizing internal structures of mediastinal and hilar lymph nodes by B mode and power Doppler mode.
METHODS:Seventy eight mediastinal and hilar lymph nodes diagnosed cytologically or histologically by EBUS-TBNA (sarcoidosis 18 LNs, malignancy 60 LNs: adenocarcinoma 25LNs, squamous cell ca. 13LNs, small cell ca. 22 LNs) were enrolled in this study. In the procedure of EBUS-TBNA, we recorded images with B mode for the whole area of the target lymph node, and intranodal vessels with power Doppler mode using BF-UC260F (7.5 MHz, convex type, Olympus). We assesses internal structures with B mode: 1) Hyperechoic interface echo, 2) Homogenous or heterogenous, and patterns of intra-nodal vessels by power Doppler mode: 1) Longitudinal vessels with straight peripheral branches, 2) Aberrant vessels, 3) Subcapsular vessels.
RESULTS:1) Hyperechoic interface echo: sarcoidosis; 16 positive, 2 negative, malignancy; 4 positive, 56 negative. Sensitivity 89%, specificity 93%, diagnostic accuracy: 92%. 2) Homogenous: sarcoidosis; 18 homo, 0 non-homo (hetero), malignancy; 3 homo, 57 non-homo. Sensitivity 100%, specificity 95%, diagnostic accuracy: 96%. 3) Aberrant vessels: sarcoidosis; 16aberrant, 2 not aberrant, malignancy; 1aberrant, 59 not aberrant. Sensitivity 98%, specificity 89%, diagnostic accuracy: 96%. Subcapsular vessels and Focal absence of perfusion were found just in malignant LNs, and subcapsular vessels were detected in LNs of adenoca. and small cell ca., significantly higher than squamous cell ca..
CONCLUSION:Hyperechoic interface echo, internal echogenecity (homogenous or heterogenous), aberrant vessels, subcapsular vessels, and focal absence of perfusion are useful to differentiate metastatic lymph nodes from lymph nodes of sarcoidosis.
CLINICAL IMPLICATIONS:The images of B mode and power Doppler mode by EBUS are useful to diagnose mediastinal and hilar lymph nodes.
DISCLOSURE:Noriaki Kurimoto, No Financial Disclosure Information; No Product/Research Disclosure Information