Procedures: Unique Investigations in Interventional Pulmonology |

Validating Spectrum Image Analysis of Lymph Nodes During Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration in Patients With Lung Cancer FREE TO VIEW

Hideki Ujiie, MD; Takahiro Nakajima, MD; Hsin-pei Hu; Kosuke Fujino, MD; Tatsuya Kato, MD; Kazuhiro Yasufuku, MD
Author and Funding Information

Division of Thoracic Surgery, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada

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

Chest. 2016;150(4_S):1045A. doi:10.1016/j.chest.2016.08.1151
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SESSION TITLE: Unique Investigations in Interventional Pulmonology

SESSION TYPE: Original Investigation Slide

PRESENTED ON: Tuesday, October 25, 2016 at 02:45 PM - 04:15 PM

PURPOSE: The purpose of this prospective study (NCT01972386) is to evaluate the clinical benefit of spectrum analysis of ultrasound images of lymph nodes during endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) and its diagnostic value for detecting metastatic nodes in patients with lung cancer.

METHODS: Patients with lung cancer or suspected lung cancer scheduled for EBUS-TBNA for lymph node staging were enrolled for real-time ultrasound spectrums analysis. A linear regression of frequency spectrum and three ultrasonic spectral parameters (midband-fit, slope, and intercept) were analyzed. Mean values for these parameters within lymph nodes were calculated, and the cut-off values of each parameter for distinguishing metastatic versus benign lymph nodes were determined. To assess the relevance of each parameter to pathological results, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy in detecting nodal metastasis were calculated as primary outcomes.

RESULTS: Overall, 246 lymph nodes (78 metastatic, 168 benign) in 84 patients were analyzed. All of the parameters showed a significant difference between metastatic and benign lymph nodes (p<0.001). Metastatic nodes tended to show low midband-fit, high slope, and low intercept. Primary outcomes for each spectral parameter (midband-fit, slope, and intercept) were calculated: sensitivity, 89.7, 56.7, 76.9 %; specificity, 77.4, 83.3, 92.9 %; PPV, 64.8, 61.1, 83.3 %; NPV, 94.2, 80.5, 89.7 %; and diagnostic accuracy, 81.3, 74.8, 87.8 %, respectively. The combination of midband-fit and intercept showed the highest sensitivity and NPV, with sensitivity, 91.0 %; specificity, 75.0 %; PPV, 62.8 %; NPV, 94.7 %; and diagnostic accuracy, 80.1 %.

CONCLUSIONS: Real-time spectrum analysis showed high NPV with sufficient sensitivity in nodal staging. It can be performed reliably and may help improve the diagnostic yield for lymph node staging during EBUS-TBNA. It may reduce unnecessary biopsies and examination time.

CLINICAL IMPLICATIONS: Spectrum analysis may be used as an adjunct imaging modality during EBUS-TBNA to improve the accuracy of lung cancer nodal staging.

DISCLOSURE: The following authors have nothing to disclose: Hideki Ujiie, Takahiro Nakajima, Hsin-pei Hu, Kosuke Fujino, Tatsuya Kato, Kazuhiro Yasufuku

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