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Original Research: Pulmonary Procedures |

Noninvasive Tissue Characterization of Lung Tumors Using Integrated Backscatter Intravascular Ultrasound: An Ex Vivo Comparative Study With Pathological Diagnosis

Fumitaka Ito, MD; Masanori Kawasaki, MD, PhD; Yasushi Ohno, MD, PhD; Sayaka Toyoshi, MD; Megumi Morishita, MD; Daizo Kaito, MD; Komei Yanase, MD; Norihiko Funaguchi, MD, PhD; Masahiro Asano, MD; Junki Endo, MD, PhD; Hidenori Mori, MD, PhD; Kazuhiro Kobayashi, MD; Kazuhiko Nishigaki, MD, PhD; Tatsuhiko Miyazaki, MD, PhD; Genzou Takemura, MD, PhD; Shinya Minatoguchi, MD, PhD
Author and Funding Information

FUNDING/SUPPORT: This study was funded, in part, by a Grant-in-Aid for Exploratory Research (No. 18659237; 2006) from the Ministry of Education, Culture, Sports, Science and Technology of Japan.

CORRESPONDENCE TO: Masanori Kawasaki, MD, PhD, Department of Cardiology, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu 501-1194, Japan


Copyright 2016, American College of Chest Physicians. All Rights Reserved.


Chest. 2016;149(5):1276-1284. doi:10.1378/chest.14-3042
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Background  Endobronchial ultrasonography (EBUS) facilitates a lung cancer diagnosis. However, qualitative tissue characterization of lung tumors is difficult using EBUS. Integrated backscatter (IBS) is an ultrasound technique that calculates the power of the ultrasound signal to characterize tissue components in coronary arteries. We hypothesized that qualitative diagnosis of lung tumors is possible using the IBS technique. The aim of the present study was to elucidate whether the IBS technique can be used in lung tissue diagnoses.

Methods  Thirty-five consecutive patients who underwent surgery for lung cancer were prospectively enrolled. Surgical specimens of the lung and the tumor tissue were obtained, and the IBS values were measured within 48 h after surgery. Histologic images of lung and tumor tissues were compared with IBS values, and the relative interstitial area according to results of Masson’s trichrome staining were determined by using an imaging processor.

Results  The IBS values in tumor tissue were significantly lower than those in normal lung tissue (–50.9 ± 2.6 dB and –47.6 ± 2.6 dB, respectively; P < .001). The IBS values of adenocarcinomas associated with a good 5-year survival rate were higher than those of non-adenocarcinomas (–48.1 ± 1.6 dB and –52.6 ± 1.4 dB; P < .001). There were significant correlations between the IBS values and the relative interstitial area or micro air area in tumor (r = 0.53 and r = 0.67; P < .01). After combining normal lung tissue and adenocarcinomas with a good prognosis, the sensitivity and specificity for establishing the presence of lung tumors were 84% and 85%.

Conclusions  Qualitative diagnosis of lung tumors was possible, with a sensitivity of 84% and a specificity of 85%, using the ultrasound IBS technique.

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