title: Real-time prediction of mediastinal lymph node malignancy by endobronchial ultrasound.
abstract: OBJECTIVE
  To evaluate the utility of different ultrasonographic (US) features in differentiating benign and malignant lymph node (LN) by endobronchial ultrasound (EBUS) and validate a score for real-time clinical application.
  
  
  METHODS
  208 mediastinal LN acquired from 141 patients were analyzed. Six different US criteria were evaluated (short axis ≥10 mm, shape, margin, echogenicity, and central hilar structure [CHS], and presence of hyperechoic density) by two observers independently. A simplified score was generated where the presence of margin distinction, round shape and short axis ≥10 mm were scored as 1 and heterogeneous echogenicity and absence of CHS were scored as 1.5. The score was evaluated prospectively for real-time clinical application in 65 LN during EBUS procedure in 39 patients undertaken by two experienced operators. These criteria were correlated with the histopathological results and the sensitivity, specificity, positive and negative predictive values (PPV and NPV) were calculated.
  
  
  RESULTS
  Both heterogenicity and absence of CHS had the highest sensitivity and NPV (≥90%) for predicting LN malignancy with acceptable inter-observer agreement (92% and 87% respectively). On real-time application, the sensitivity and specificity of the score >5 were 78% and 86% respectively; only the absence of CHS, round shape and size of LN were significantly associated with malignant LN.
  
  
  CONCLUSIONS
  Combination of different US criteria can be useful for prediction of mediastinal LN malignancy and valid for real-time clinical application.
authors: Departamento de Medicina Respiratoria, Hospital Universitario Son Espases, Palma de Mallorca, España; Departamento de Enfermedades del Tórax, Facultad de Medicina, Universidad de Alejandría, Alejandría, Egipto.
authors: Hanaa
authors: H
authors: Shafiek
authors: Departamento de Medicina Respiratoria, Hospital Universitario Son Espases, Palma de Mallorca, España.
authors: Federico
authors: F
authors: Fiorentino
authors: Departamento de Medicina Respiratoria, Hospital Universitario Son Espases, Palma de Mallorca, España.
authors: Alejandro David
authors: AD
authors: Peralta
authors: Departamento de Anatomía Patológica, Hospital Universitario Son Espases, Palma de Mallorca, España.
authors: Enrique
authors: E
authors: Serra
authors: Departamento de Anatomía Patológica, Hospital Universitario Son Espases, Palma de Mallorca, España.
authors: Blanca
authors: B
authors: Esteban
authors: Departamento de Medicina Respiratoria, Hospital Universitario Son Espases, Palma de Mallorca, España.
authors: Rocío
authors: R
authors: Martinez
authors: Departamento de Medicina Respiratoria, Hospital Universitario Son Espases, Palma de Mallorca, España.
authors: Maria Angels
authors: MA
authors: Noguera
authors: Departamento de Anestesiología, Hospital Universitario Son Espases, Palma de Mallorca, España.
authors: Pere
authors: P
authors: Moyano
authors: Departamento de Medicina Respiratoria, Hospital Universitario Son Espases, Palma de Mallorca, España; Ciber de Enfermedades Respiratorias (Ciberes), España.
authors: Ernest
authors: E
authors: Sala
authors: Departamento de Medicina Respiratoria, Hospital Universitario Son Espases, Palma de Mallorca, España; Ciber de Enfermedades Respiratorias (Ciberes), España.
authors: Jaume
authors: J
authors: Sauleda
authors: Departamento de Medicina Respiratoria, Hospital Universitario Son Espases, Palma de Mallorca, España; Ciber de Enfermedades Respiratorias (Ciberes), España. Electronic address: borja.cosio@ssib.es.
authors: Borja G
authors: BG
authors: Cosío
mesh_terms: D000368:Aged; D001707:Biopsy, Needle / Q000379:methods; D002289:Carcinoma, Non-Small-Cell Lung / Q000000981:diagnostic imaging / Q000556:secondary*; D003199:Computer Systems; D019160:Endosonography; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D008198:Lymph Nodes / Q000473:pathology; D008207:Lymphatic Metastasis / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging / Q000379:methods*; D015588:Observer Variation; D049268:Positron-Emission Tomography; D011446:Prospective Studies; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed
keywords: Ecografía endobronquial; Endobronchial ultrasound; Estadificación de cáncer de pulmón; Ganglio linfático mediastínico; Lung cancer staging; Mediastinal lymph node