Endosonographic features predictive of malignancy in mediastinal lymph nodes in patients with lung cancer.
BACKGROUND
EUS is useful in determining mediastinal lymph node (LN) metastases in patients undergoing staging for lung cancer. However, FNA of LNs is often performed only if suspicious features are present. The utility of individual LN features in predicting malignant cytology remains unclear.


OBJECTIVE
To evaluate the utility of EUS-determined LN features for predicting malignant cytology.


METHODS
Prospective observational study.


METHODS
Two U.S. tertiary-care centers.


METHODS
This study involved 425 patients with primary lung cancer who underwent EUS.


METHODS
All mediastinal LNs were described according to size, shape, echogenicity, and margin characteristics. FNA was performed on LNs with any features suggestive of malignancy. EUS-guided FNA cytology was classified as benign or abnormal (suspicious/malignant). The utility of LN features in predicting malignant cytology was determined and further analyzed by logistic regression, and a predictive model was established.


METHODS
Accuracy of individual LN features for predicting malignancy.


RESULTS
EUS detected 836 LNs in 425 patients, and FNA was obtained in 698 patients. On multivariable analysis, only round shape, a short axis of >8.3 mm, and sharp margins were predictive of malignant cytology. According to the predictive model, the calculated probability of having malignancy is less than 4% (95% confidence interval [CI], 0.022-0.064) when none of the LN features are present and 63% (95% CI, 51%-72.2%) when all features were seen.


CONCLUSIONS
No surgical histology as the criterion standard.


CONCLUSIONS
Among patients with lung cancer, EUS features of round shape, sharp margins, and short axis of >8.3 mm are significant predictors of malignancy. The probability of malignancy is low when none of the features are present.
Gill
Kanwar R
KR
Department of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida 32224, USA.
Ghabril
Marwan S
MS
Jamil
Laith H
LH
Hasan
Muhammad K
MK
McNeil
Rebecca B
RB
Woodward
Timothy A
TA
Raimondo
Massimo
M
Hoffman
Brenda J
BJ
Hawes
Robert H
RH
Romagnuolo
Joseph
J
Wallace
Michael B
MB
D044963:Biopsy, Fine-Needle / Q000379:methods; D019160:Endosonography / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000556:secondary*; D008198:Lymph Nodes / Q000000981:diagnostic imaging* / Q000473:pathology; D008207:Lymphatic Metastasis; D008297:Male; D008482:Mediastinum; D009367:Neoplasm Staging / Q000379:methods; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies