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

Xinxin Zhi; Lei Wang; Junxiang Chen; Xiaoxuan Zheng; Ying Li; Jiayuan Sun

doi:10.21037/jtd-2020-abpd-005

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

J Thorac Dis. 2020 Dec;12(12):7645-7655. doi: 10.21037/jtd-2020-abpd-005.

Authors

Xinxin Zhi^{1

2

3}, Lei Wang⁴, Junxiang Chen^{1

2

3}, Xiaoxuan Zheng^{1

2

3}, Ying Li^{1

2

3}, Jiayuan Sun^{1

2

3}

Affiliations

¹ Department of Respiratory Endoscopy, Shanghai Jiao Tong University, Shanghai, China.
² Department of Respiratory and Critical Care Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China.
³ Shanghai Engineering Research Center of Respiratory Endoscopy, Shanghai, China.
⁴ Department of Ultrasound, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China.

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.