ISSN : 1301-5680
e-ISSN : 2149-8156
Turkish Journal of Thoracic and Cardiovascular Surgery     
A promising tool for T-staging of lung cancer: Is convex probe endobronchial ultrasound superior to computed tomography in detecting invasion of mediastinal and hilar vessels?
İbrahim Onur Alıcı1, Seher Susam2, Melike Yüksel Yavuz1, Eda Bayramiç1, Filiz Güldaval1, Ceyda Anar1, Ahmet Üçvet3, Melih Büyükşirin1
1Department of Chest Disease, SBÜ İzmir Dr. Suat Seren Chest Diseases and Thoracic Surgery Health Application and Research Center, Izmir, Turkey
2Department of Radiology, SBÜ İzmir Dr. Suat Seren Chest Diseases and Thoracic Surgery Health Application and Research Center, Izmir, Turkey
3Department of Thoracic Surgery, SBÜ İzmir Dr. Suat Seren Chest Diseases and Thoracic Surgery Health Application and Research Center, Izmir, Turkey
DOI : 10.5606/tgkdc.dergisi.2019.16987
Background: In the present study, we aimed to compare performance of convex probe endobronchial ultrasound and computed tomography in detecting vascular invasion of mediastinal and hilar lesions.

Methods: Medical data of a total of 55 patients (47 males, 8 females; mean age 59.6±7.7 years; range, 29 to 76 years) who underwent convex probe endobronchial ultrasound for diagnosis and staging of lung cancer in a tertiary care hospital between May 2016 and December 2017 were retrospectively analyzed. The presence of vascular invasion was determined according to two main criteria: visualization of the tumor tissue within the vessel lumen and loss of vessel-tumor hyperechoic interface. All available contrast enhanced computed tomography images were retrospectively re-evaluated by a blinded radiologist. The intra-rater agreement between convex probe endobronchial ultrasound and computed tomography was analyzed. The sensitivity, specificity, positive and negative predictive values, and accuracy of both modalities were calculated.

Results: A total of 65 vessel-tumor interface areas of 55 patients were analyzed. Almost all mediastinal and hilar vascular structures including pulmonary arteries and veins, aorta, superior vena cava and its branches, and left atrium with pulmonary veno-atrial junctions could be easily assessed by convex probe endobronchial ultrasound. The intra-agreement of both modalities in detecting vascular invasion was k=0.268 (p=0.028). In nine patients with a surgical confirmation, the sensitivity, specificity, positive and negative predictive values, and accuracy values were 100%, 33.3%, 75.0%, 100%, and 77.7%, respectively for convex probe endobronchial ultrasound and 66.6%, 33.3%, 66.6%, 33.3%, and 55.5%, respectively for computed tomography.

Conclusion: Convex probe endobronchial ultrasound can be used to detect vascular invasion alone or in conjunction with contrast-enhanced computed tomography. Hence, a T4 lesion would be better differentiated from T3 in clinical staging of lung cancer.

Keywords : Computed tomography, convex probe endobronchial ultrasound, invasion, lung cancer
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