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Diagnosis of Peripheral Lung Cancer with Three Echoic Features via Endobronchial Ultrasound

Department of Thoracic Medicine, Chang Gung Memorial Hospital, Chang Gung University, School of Medicine, Taipei, Taiwan

q8828{at}ms11.hinet.net

Abstract

BackgroundEndobronchial ultrasonography (EBUS) is useful in localizing peripheral lung lesions. Previous reports have revealed that several characteristic echoic patterns correlate well with the histopathological findings of benign and malignant lesions. Therefore, EBUS may be also useful in differential diagnosis of malignant lesions of the lung.

ObjectiveTo assess the feasibility of EBUS in differential diagnosis between malignant and benign lesions by three characteristic echoic features indicating malignancy, namely continuous margin, absence of linear discrete air bronchogram and heterogeneous echogenecity.

MethodEBUS images from 224 patients who received bronchoscopy for peripheral lung lesion were analyzed. The sensitivity and specificity for each echoic feature or in combination in diagnosing malignancy or benignity were determined.

Result: Continuous margin, absence of linear discrete air bronchogram and heterogeneous echogenicity are three echoic features indicating malignancy. Echoic feature with absence of linear discrete air bronchogram has the highest sensitivity in diagnosis of malignancy (91.9%), but the lowest specificity (62.4%). By contrast, echoic feature with well defined margin has the highest specificity (93.1%), but the lowest sensitivity (27.6%). The sensitivity and specificity for heterogeneous echogenicity are intermediate (65.0% and 90.1%, respectively). The negative predictive value for malignancy of a lesion with none of these three echoic features is 93.7%. The positive predictive value for malignancy of a lesion with any two of the three echoic features is 89.2%.

ConclusionThese results indicate that EBUS is useful as an adjunct in lung cancer diagnosis, especially when peripheral lung lesions are not visible in traditional bronchoscopy.(This study was registered at ClinicalTrials.gov. Registration number: NCT00415337)

Key Words: EBUS • lung cancer • air bronchogram • heterogenous • continuous margin