Chest
Volume 132, Issue 3, September 2007, Pages 922-929
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ORIGINAL RESEARCH
INTERVENTIONAL PULMONOLOGY
Diagnosis of Peripheral Lung Cancer With Three Echoic Features Via Endobronchial Ultrasound

https://doi.org/10.1378/chest.06-3106Get rights and content

Background

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

Objective

To assess the feasibility of EBUS in the differential diagnosis between malignant and benign lesions by the following three characteristic echoic features indicating malignancy: continuous margin; absence of a linear-discrete air bronchogram; and heterogeneous echogenicity.

Method

EBUS images from 224 patients who undergone bronchoscopy for a 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. The absence of linear-discrete air bronchogram has the highest sensitivity in the diagnosis of malignancy (91.9%), but the lowest specificity (62.4%). By contrast, a 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 the 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%.

Conclusion

These results indicate that EBUS is useful as an adjunct in lung cancer diagnosis, especially when peripheral lung lesions are not visible in traditional bronchoscopy.

Section snippets

Study Subjects

The subjects in this study were patients who underwent bronchoscopy and EBUS to assess peripheral lung lesions in Chang Gung Memorial Hospital, Taipei, Taiwan, from June 2004 to July 2005. A total of 1,963 patients received bronchoscopic examinations for various indications during this period. Informed consent was obtained from all the subjects, and this study was approved by the hospital internal review boards. Among the 1,963 patients, 489 underwent EBUS for evaluation because no peripheral

Hisotopathologic Diagnosis of Lesions

Table 1 summarizes the histopathologic data of 224 patients with peripheral lung lesions. Among these 224 patients, 123 had malignant lesions, and 101 had benign lesions. The histopathologic diagnoses for malignant lesions were adenocarcinoma (n = 85), squamous cell carcinoma (n = 38), and small cell carcinoma (n = 14). The diseases found in benign lesions included tuberculosis (n = 23), pneumonia (n = 25), necrotizing pneumonitis (n = 16), anthracotic deposition (n = 11), organizing pneumonia

Discussion

The results of this study indicate that with three simplified image features, including the presence of a continuous margin, the absence of a linear-discrete air bronchogram, and heterogeneous echogenicity of internal structure, EBUS may provide a useful tool for differentiating benign lesions from malignant peripheral lung lesions. The presence of any single EBUS feature yields a positive value for malignancy of 74%. The likelihood of malignancy rises to 89% when the lesion exhibits any two

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    The authors have reported to the ACCP that no significant conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

    These two authors contributed equally to the work on this project as first authors

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