Scoring model of convex probe endobronchial ultrasound multimodal imaging in differentiating benign and malignant lung lesions

Abstract

Background: Convex probe endobronchial ultrasound images can reflect the morphology, blood flow status and stiffness of the lesions. Endobronchial ultrasound multimodal imaging has great value for the diagnosis of intrathoracic lymph nodes. This study aimed to analyze the application of endobronchial ultrasound multimodal imaging on lung lesions.

Methods: Patients undergoing endobronchial ultrasound-guided transbronchial needle aspiration in Shanghai Chest Hospital from July 2018 to December 2019 were retrospectively enrolled. Nine grayscale features (long and short axes, margin, shape, lobulation sign, echogenicity, necrosis, liquefaction, calcification, and air-bronchogram), blood flow volume and elastography five-score method were analyzed to explore the best diagnostic method. The gold standard for diagnosing lesions depends on the histological and cytopathological findings of endobronchial ultrasound-guided transbronchial needle aspiration, transthoracic biopsy, resected sample of lesions, microbiological examination or clinical follow-up of at least 6 months.

Results: Endobronchial ultrasound multimodal imaging of 97 malignant lung lesions and 19 benign lung lesions from 116 patients were analyzed. There were statistically significant differences in distinct margin, presence of lobulation sign, presence of necrosis, and elastography grading score 4-5 between malignant and benign lung lesions, among which presence of lobulation sign and elastography grading score 4-5 were independent predictors. A diagnostic scoring model was then constructed based on the above four features, and when two or more features were present, the sensitivity, specificity, positive predictive value, negative predictive value and accuracy for malignant lung lesions prediction were 92.78%, 57.89%, 91.84%, 61.11% and 87.07%, respectively.

Conclusions: The combination of endobronchial ultrasound grayscale and elastography has potential value for malignant and benign lung lesions differentiation. The diagnostic scoring model established in this study needs further validation to guide the malignant and benign diagnosis of lung lesions.

Keywords: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA); diagnosis; elastography; grayscale; lung lesions.

Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/jtd-2020-abpd-005). The series “Advance in Bronchoscopy for Peripheral Pulmonary Diseases” was commissioned by the editorial office without any funding or sponsorship. JS served as the unpaid Guest Editor of the series. The authors have no other conflicts of interest to declare.

2020 Journal of Thoracic Disease. All rights reserved.

Figures

Figure 1

Diagram of CP-EBUS grayscale features for pulmonary lesions. CP-EBUS, convex probe endobronchial ultrasound.

Figure 2

ROC curves analysis of long and short axes for lung lesions. The cutoff values of long and short axes were 29.20 and 25.41 mm, respectively. ROC, receiver operating characteristic.

Figure 3

Distribution of diseases by elastography grading score. There were 3 cases of malignant lesions in score 2, including 1 neuroendocrine tumor not otherwise specified, 1 squamous cell carcinoma and 1 adenocarcinoma. The benign lesion was inflammation. The 13 malignant lesions in score 3 were 7 adenocarcinoma, 1 squamous cell carcinoma, 4 small cell carcinoma and 1 NSCLS-NOS. The 9 benign masses in score 4 contained 5 tuberculosis, 3 inflammation and 1 aspergillosis. The 6 malignant tumors in score 5 included 1 typical carcinoid tumor, 1 small cell carcinoma, 2 adenocarcinoma, 1 squamous cell carcinoma and 1 NSCLS-NOS. NSCLS-NOS, non-small cell lung cancer not otherwise specified.