title: Differentiating benign from malignant mediastinal lymph nodes visible at EBUS using grey-scale textural analysis.
abstract: OBJECTIVE
  Recent data suggest that grey-scale textural analysis on endobronchial ultrasound (EBUS) imaging can differentiate benign from malignant lymphadenopathy. The objective of studies was to evaluate grey-scale textural analysis and examine its clinical utility.
  
  
  METHODS
  Images from 135 consecutive clinically indicated EBUS procedures were evaluated retrospectively using MATLAB software (MathWorks, Natick, MA, USA). Manual node mapping was performed to obtain a region of interest and grey-scale textural features (range of pixel values and entropy) were analysed. The initial analysis involved 94 subjects and receiver operating characteristic (ROC) curves were generated. The ROC thresholds were then applied on a second cohort (41 subjects) to validate the earlier findings.
  
  
  RESULTS
  A total of 371 images were evaluated. There was no difference in proportions of malignant disease (56% vs 53%, P = 0.66) in the prediction (group 1) and validation (group 2) sets. There was no difference in range of pixel values in group 1 but entropy was significantly higher in the malignant group (5.95 vs 5.77, P = 0.03). Higher entropy was seen in adenocarcinoma versus lymphoma (6.00 vs 5.50, P < 0.05). An ROC curve for entropy gave an area under the curve of 0.58 with 51% sensitivity and 71% specificity for entropy greater than 5.94 for malignancy. In group 2, the entropy threshold phenotyped only 47% of benign cases and 20% of malignant cases correctly.
  
  
  CONCLUSIONS
  These findings suggest that use of EBUS grey-scale textural analysis for differentiation of malignant from benign lymphadenopathy may not be accurate. Further studies are required.
authors.affiliation: Department of Radiology, Southmead Hospital, North Bristol NHS Trust, Bristol, UK.
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: Edey
authors.forename: Adrian
authors.initials: A
authors.lastname: Pollentine
authors.forename: Claire
authors.initials: C
authors.lastname: Doody
authors.forename: Andrew R L
authors.initials: AR
authors.lastname: Medford
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis / Q000556:secondary*; D001999:Bronchoscopy / Q000379:methods*; D019160:Endosonography / Q000379:methods*; D005260:Female; D006801:Humans; D061705:Image-Guided Biopsy / Q000379:methods*; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008297:Male; D008479:Mediastinal Neoplasms / Q000175:diagnosis / Q000556:secondary*; D008875:Middle Aged; D012372:ROC Curve; D012189:Retrospective Studies
keywords: endobronchial ultrasound; grey-scale textural analysis; lymphadenopathy; mediastinal lymph node; mediastinum