ISSN : 1301-5680
e-ISSN : 2149-8156
TURKISH JOURNAL OF
THORACIC AND
CARDIOVASCULAR SURGERY
Turkish Journal of Thoracic and Cardiovascular Surgery     
A valuable endobronchial ultrasound scoring system predicting malignant lymph nodes
Nurcan Guler1, Kemal Can Tertemiz1, Duygu Gurel2
1Department of Respiratory Diseases, Dokuz Eylül University Faculty of Medicine, Izmir, Türkiye
2Department of Pathology, Dokuz Eylül University Faculty of Medicine, Izmir, Türkiye
DOI : 10.5606/tgkdc.dergisi.2023.23568
Background: This study aims to determine the sonographic criteria of lymph nodes to predict malignancy with endobronchial ultrasound.

Methods: A total of 1,987 lymph nodes of 967 patients (666 males, 301 females; mean age: 62.1±11.9 years; range, 21 to 90 years) between May 2016 and July 2020 were retrospectively analyzed. The endobronchial ultrasound images of lymph nodes were evaluated according to the following criteria: size (short axis >1 cm), shape (round or oval), margin (distinct or indistinct), coagulation necrosis sign (present or absent), central hilar structure (present or absent) and echogenicity (homogeneous or heterogeneous). A scoring system was developed for predicting malignancy.

Results: A total of 765 (38.5%) of the lymph nodes were malignant. In the univariate analysis, size >1 cm, round shape, distinct margin, absence of central hilar structure, presence of coagulation necrosis sign, and heterogeneity were significant predictors of malignancy (p<0.001 for all). In the multivariate analysis, the main independent predictors were heterogeneity and presence of coagulation necrosis sign (odds ratio=5.9, 95% confidence interval: 4.2-8.2 vs. odds ratio=3.1 95% confidence interval: 2.2-4.5, respectively). A cut-off value for endobronchial ultrasound score of ?4 increased the malignancy risk 30 times with a sensitivity of 84.7%, and specificity of 84.5%.

Conclusion: Our study results show that endobronchial ultrasound scoring system with six criteria has a high sensitivity and specificity for predicting malignant lymph nodes.

Keywords : Endobronchial ultrasound, lymph node, malignancy, score
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