Chest
Original ResearchInterventional PulmonologyThe Utility of Sonographic Features During Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration for Lymph Node Staging in Patients With Lung Cancer: A Standard Endobronchial Ultrasound Image Classification System
Section snippets
Patients
A retrospective chart review was performed in patients who underwent EBUS-TBNA for mediastinal staging of lung cancer at the Department of Thoracic Surgery, Chiba University Hospital, from January 2003 to August 2007. EBUS-TBNA was performed in patients with lung cancer or suspected lung cancer without previous treatment, with radiologically defined mediastinal and/or hilar lymph nodes with a short axis of ≥ 5 mm on enhanced CT imaging or positive on PET scan (defined as standardized uptake
Patients
The characteristics of the 487 patients who were enrolled and evaluated in this study are summarized in Table 1. There were 372 men and 115 women, and the average age was 68.0 years. The histologic types of lung cancers were adenocarcinoma in 244, squamous cell carcinoma in 144, small cell carcinoma in 32, large cell carcinoma in 19, and other cancers in 48. A total of 1,061 lymph nodes were analyzed, and the proportion of each station is summarized in Table 2. Radiologically suspected nodes
Discussion
Since our first successful EBUS-TBNA in 2002, we have performed > 1,000 EBUS-TBNA procedures without any complications at our department. For mediastinal staging in lung cancer, all the mediastinal lymph nodes and hilar lymph nodes accessible by CP-EBUS are visualized in a systematic way and evaluated. As reported previously, CP-EBUS is capable of detecting even small-sized lymph nodes not visible on CT imaging and lymph nodes as small as 3 mm in the short axis can be punctured under real-time
Conclusions
In conclusion, by careful examination of the sonographic features of lymph nodes during EBUS-TBNA, we may speculate on the presence of metastatic lymph nodes even in patients with lung cancer. The four sonographically obtained morphologic features, including round shape, distinct margin, heterogeneous echogenicity, and presence of coagulation necrosis sign, are independent predictive factors for nodal metastasis. When at least one such feature is observed during the EBUS procedure, subsequent
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