Combination of 18F-FDG PET/CT and convex probe endobronchial ultrasound elastography for intrathoracic malignant and benign lymph nodes prediction

Xinxin Zhi; Xiaoyan Sun; Junxiang Chen; Lei Wang; Lin Ye; Ying Li; Wenhui Xie; Jiayuan Sun

doi:10.3389/fonc.2022.908265

Combination of ¹⁸F-FDG PET/CT and convex probe endobronchial ultrasound elastography for intrathoracic malignant and benign lymph nodes prediction

Front Oncol. 2022 Aug 5:12:908265. doi: 10.3389/fonc.2022.908265. eCollection 2022.

Authors

Xinxin Zhi^{1

2

3}, Xiaoyan Sun^{4

5}, Junxiang Chen^{1

2

3}, Lei Wang⁶, Lin Ye^{1

2

3}, Ying Li^{1

2

3}, Wenhui Xie⁵, 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 Nuclear Medicine, The Fifth People's Hospital of Shanghai Fu Dan University, Shanghai, China.
⁵ Department of Nuclear Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China.
⁶ Department of Ultrasound, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China.

Abstract

Background: Positron emission tomography-computed tomography (PET/CT) and convex probe endobronchial ultrasound (CP-EBUS) elastography are important diagnostic methods in predicting intrathoracic lymph nodes (LNs) metastasis, but a joint analysis of the two examinations is still lacking. This study aimed to compare the diagnostic efficiency of the two methods and explore whether the combination can improve the diagnostic efficiency in differentiating intrathoracic benign LNs from malignant LNs.

Materials and methods: LNs examined by EBUS-guided transbronchial needle aspiration (EBUS-TBNA) and PET/CT from March 2018 to June 2019 in Shanghai Chest Hospital were retrospectively analyzed as the model group. Four PET/CT parameters, namely, maximal standardized uptake value mean standardized uptake value (SUVmean), SUVmean, metabolic tumor volume (MTV), and tumor lesion glycolysis (TLG); four quantitative elastography indicators (stiff area ratio, mean hue value, RGB, and mean gray value); and the elastography grading score of targeted LNs were analyzed. A prediction model was constructed subsequently and the dataset from July to November 2019 was used to validate the diagnostic capability of the model.

Results: A total of 154 LNs from 135 patients and 53 LNs from 47 patients were enrolled in the model and validation groups, respectively. Mean hue value and grading score were independent malignancy predictors of elastography, as well as SUVmax and TLG of PET/CT. In model and validation groups, the combination of PET/CT and elastography demonstrated sensitivity, specificity, positive and negative predictive values, and accuracy for malignant LNs diagnosis of 85.87%, 88.71%, 91.86%, 80.88%, and 87.01%, and 94.44%, 76.47%, 89.47%, 86.67%, and 88.68%, respectively. Moreover, elastography had better diagnostic accuracies than PET/CT in both model and validation groups (85.71% vs. 79.22%, 86.79% vs. 75.47%).

Conclusion: EBUS elastography demonstrated better efficiency than PET/CT and the combination of the two methods had the best diagnostic efficacy in differentiating intrathoracic benign from malignant LNs, which may be helpful for clinical application.

Keywords: PET/CT; diagnosis; elastography; endobronchial ultrasound; lymph nodes.