title: Vascular image patterns of lymph nodes for the prediction of metastatic disease during EBUS-TBNA for mediastinal staging of lung cancer.
abstract: BACKGROUND
  The aims of this study were to establish and assess the utility of Power/Color Doppler-mode vascular image pattern classification of lymph nodes (LN) during mediastinal staging by endobronchial ultrasound (EBUS) for the prediction of metastasis in patients with lung cancer.
  
  
  METHODS
  One hundred and seventy-three LNs were retrospectively evaluated. The convex probe EBUS was used with the endoscopic ultrasound scanner. The vascular image patterns were graded as follows: Grade 0, no blood flow or small amounts of flow; Grade I, a few main vessels running toward the center of the LN from the hilum; Grade II, a few punctiforms or rod-shaped flow signals or a few small vessels found as a long strip of a curve; and Grade III, rich flow, more than four vessels found with different diameters or twist- or helical -low signal. The blood flow from the bronchial artery (BA) toward the LN was also recorded using Color Doppler imaging as a sign for BA inflow.
  
  
  RESULTS
  When we defined Grade 0 and I as "benign" and Grade II and III as "malignant," the sensitivity, specificity, and diagnostic accuracy rate were 87.7%, 69.6%, and 78.0%, respectively. The accuracy of predicting metastasis solely from a positive BA inflow sign was 80.3%. Of the LNs, 84.5% were shown to be metastatic when they were determined as malignant, and 84.7% were proven nonmetastatic when it was determined as benign.
  
  
  CONCLUSIONS
  Vascular image patterns of LN using Power/Color Doppler mode is helpful in the prediction of metastatic LN during EBUS-TBNA.
authors.affiliation: Division of Thoracic Surgery, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada.
authors.forename: Takahiro
authors.initials: T
authors.lastname: Nakajima
authors.forename: Takashi
authors.initials: T
authors.lastname: Anayama
authors.forename: Masato
authors.initials: M
authors.lastname: Shingyoji
authors.forename: Hideki
authors.initials: H
authors.lastname: Kimura
authors.forename: Ichiro
authors.initials: I
authors.lastname: Yoshino
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Yasufuku
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D044963:Biopsy, Fine-Needle / Q000379:methods*; D001999:Bronchoscopy; D003937:Diagnosis, Differential; D019160:Endosonography; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000098:blood supply / Q000000981:diagnostic imaging / Q000473:pathology*; D008198:Lymph Nodes / Q000000981:diagnostic imaging / Q000473:pathology; D008207:Lymphatic Metastasis; D008297:Male; D008479:Mediastinal Neoplasms / Q000098:blood supply* / Q000175:diagnosis / Q000556:secondary; D008482:Mediastinum / Q000000981:diagnostic imaging / Q000473:pathology; D008875:Middle Aged; D009367:Neoplasm Staging / Q000379:methods*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D018615:Ultrasonography, Doppler, Color / Q000379:methods