Usefulness Of Endobronchial Ultrasonographic Appearances And Features For The Evaluation Ofhilar And Mediastinal Lymphadenopathy

Background and objective：EBUS is the fibre optic bronchoscope which is equipped with ultrasoundscanning electronic convex array probe, and the real-time endobrochial ultrasound–guided transbronchial needle aspiration can help to get the pathological diagnosis.The technique is simple, minimally invasive，accuracy and safety. A meta-analysis hasshowed that in1299cases of patients, the sensitivity of EBUS-TBNA staging of lungcancer was93%, specificity was100%, only0.15%(2patients) of the patients hadcomplications. In recent years, EBUS-TBNA has been proved practically indiagnosing the sarcoidosis, lymph node tuberculosis, lymph node reactive hyperplasiaand malignant lymphadenopathy. But rarely notice the clinical performance ofultrasonographicfeatures in different diseases.Previous studies has showed that[6,7], ultrasonographic features of the hilar andmediastinal lymphadenopathy differ in some diseases. In2010, Fujiwara[6]hadreported an analysis about1061pieces of hilar and mediastinallymphadenopathyultrasonographic features made by the EBUS. A multivariateanalysis revealed that round shape, distinct margin, heterogeneous echogenicity, andpresence of coagulation necrosis sign were independent predictive factors formetastasis. Imai[7]also found that homogeneous low echogenicity and the presence ofa germinal center structure were observed in sarcoidosis more frequently than in lungcancer. But also the color doppler ultrasound is differ in different lymph diseases.Japanese scholars Nakajima examined173case of hilar and mediastinallymphadenopathy with color doppler ultrasound under the Ultrasound bronchoscope, finding that the Internal distribution of blood flow of lymph may make contributionsto determine the benign and malignant lymphadenopathy. Ultrasound elastographygradually applied in clinical.Saftoiu had use the EUS elastography to examin78lymphadenopathy and the sensitivity, specificity, and accuracy of the analysis were85.4%,91.9%,88.5%,respectively. Owing to the studies of the hilar and mediastinallymphadenopathy’ sonographic features that under the EBUS, we try to investigatethe vaule of the different ultrasound sonographic features in the hilar and mediastinallymphadenopathy for the clinical.Part Ⅰ The utility of endobronchial grey-scaleultrasonographic features in assessment of hilar andmediastinalmalignant nodulesBackground and ObjectiveLung cancer has become the world’s tallest hair malignancies[1], lymphatic metastasisis one of the most common lung diffusion path, the decision to determine the choiceof surgical approach and treatment programs. Lung airway ultrasound guided needlelocalization and tumor lesions have important applications[2], also made use of theairways characterized by predictable nature of ultrasonographic outer peripheral lunglesions[3]. This study analyzes the hilar and mediastinal lymphadenopathy grayscaleultrasonographic features of benign and malignant contact with its screenedultrasonographic features of malignant lymphadenopathy and evaluate its clinicaldiagnostic value.MethodsRetrospective analysis on November1,2012to November31,2013in our hospitalbronchoscope center and under the Endobronchial ultrasound-guided transbronchialneedle aspiration for diagnosis of lymph node390, divided into malignant and benign group of lymph node, analyzes the ultrasonographic features of lymph node. Theultrasonographic features included: the length of short axis、shape、margin、echogenicity、homogenicity、coagulation necrosis、 calcification、coalesced intomasses、posterior acoustic enhancement.Results: The nine ultrasonographic features of malignant lymphadenopathy diagnosisaccuracy were61.03%,75.38%,75.64%,75.38%,65.90%,68.08%,51.80%,55.13%and67.44%. Binary classification multiariable logistic regression analysis showedthat round, distinct margin and heterogeneous, hypoechoic, posterior acousticenhancement5ultrasonographic features in judging malignant lymphadenopathy.Conclusion: Analysis of the hilar and mediastinal lymph node gray scaleultrasonographic features have predictive value for malignant lymphadenopathy,including round, distinct margin and heterogeneous, hypoechoic, posterior acousticenhancement in predicting malignant lymphadenopathy. Part Ⅱ Grayscale ultrasonographic featuresidentification of hilar and mediastinal lymphadenopathy insarcoidosis and tuberculosis valueBackground and ObjectiveThe clinical diagnosis of sarcoidosis rely mainly on pathological examination, butlymph node tuberculosis and sarcoidosis belong granulomatous diseases, therefore,the diagnosis of both diseases often require mutual authentication between the disease.Because of high resolution ultrasound airway (less than1mm), the microstructure canairway wall and in the vicinity of the organization help understand the situation insidethe trachea, bronchus wall, the wall structure of airway tissue. Investigate grayscale sonographic identification of hilar and mediastinal lymphadenopathy in sarcoidosisand tuberculosis value.MethodsRetrospective analysis on November1,2012to November31,2013in our hospitalbronchoscope center and under the endobronchial ultrasound-guided transbronchialneedle aspiration for diagnosis of390lymphadenopathy, divided into malignant andbenign group of lymph node, analyzes the ultrasonographic features of lymph node.The ultrasonographic features included: the length of short axis、shape、margin、echogenicity、homogenicity、coagulation necrosis、calcification、coalesced intomasses、posterior acoustic enhancement.ResultsThis study had29patients a total of63mediastinal lymph nodes, including28sarcoidosis and35pieces of lymph node tuberculosis.Hilar and mediastinallymphadenopathy in sarcoidosis and tuberculosis ultrasonographic features asshape、margin、homogenicity、coagulation necrosis、 calcification、coalesced intomasses、posterior acoustic enhancement. statistically significant (P <0.05), while inthe length of short axis (P=0.701) and echogenicity、(P=0.107) with no significantdifference.ConclusionGray scale ultrasonographic features help differentiate hilar and mediastinallymphadenopathy and lymph node sarcoidosis Part Ⅲ The value of color doppler flow imaging indiagnosising hilar and mediastinal lymphadenopathy Background and ObjectiveAt present, color doppler flow imaging has become one of the important meansof the qualitative diagnosis of benign and malignant lymphadenopathy. EBUS withcolor doppler flow imaging (CDFI) function used for identify the lesion of vascular,avoid needle puncture into the blood vessels. At the same time, the CDFI can also beon the blood supply of the lesions, and the distribution of blood flow were observed.This study was to explore the ultrasonic color doppler flow imaging in diagnosing thevalue of the lung or mediastinal enlarged lymphadenopathy.MethodsAfter the injection of bladders, EBUS can be close to the target lymphadenopathy.And using the color doppler ultrasound to get the images of the blood flowdistribution. Then switching the grey ultrasound， to get the pathology byEBUS-TBNA. The Blood flow distribution of Color Doppler ultrasound can bedivided into level0-3. Level0,1are the negative lymphadenopathy, and level2,3arethe positive ones.ResultsThere are71lymph node color doppler flow imaging from53patients in this study.There are8(11.26%) of71lymph node in level0,21(29.58%) in level1,24(33.80%)in level2,18(25.35%) in level3. And the malignant lymphadenopathy’groupdiagnosised by color doppler ultrasound have11negative lymphadenopathy and36lymphadenopathy. In benign lymphadenopathy’ group, there are18negativelymphadenopathy and6positive ones. Color doppler flow distribution betweendifferent classification groups constitute relatively benign and malignant with astatistically significant difference (P=0.00). Color doppler ultrasound’s sensitivity,specificity, accuracy, positive and negative predictive in diagnosising malignantlymphadenopathy are the following:85.71%(36/42),62.07%(18/29),76.06%(54/71),76.60%(36/47),75.00%(18/24). ConclusionThe color doppler ultrasound by EBUS can help to diagnosis hilar and mediastinallymphadenopathy, and it simple operation and evaluation,and the technical sensitivity,specificity and accuracy rate are high. Part Ⅳ The value of the endobronchial ultrasoundelastography in the differentiation of benign or malignanthilar and mediastinal lymphadenopathyObjective:Ultrasound elasticity is used in the ultrasonic diagnosis based on the developmentof a dynamic imaging technology. The technology organization under the action ofexternal force produced by deformation size reflects the elasticity coefficient of theorganization. In general, the tissue elasticity coefficient is large, the strain caused bythe relatively small, the deformation small, high hardness; Conversely, the elasticitycoefficient of tissue strain caused by the relatively large, the deformation is large, thehardness of small. At present, in the mammary gland, thyroid gland, neck lymph nodeidentification of benign and malignant lesions such as nature has a good applicationprospect. This study will explore the endobronchoscope real-time ultrasoundelastography in differentiating lung door mediastinal lymphadenopathy in the benignand malignant diagnosisMethods: After the injection of bladders, EBUS can be close to the targetlymphadenopathy, and using the ultrasound elastography to get the images. Thenswitching the grey ultrasound to get the pathology by EBUS-TBNA. The images ofultrasound elastography can be divided into level1～4. Level1,2are the negative lymphadenopathy, and level3,4are the positive ones.Results: Malignant lymphadenopathy mean elasticity score was (3.35±0.88) points,benign lymph average elasticity score was (2.17±0.65) points, ultrasoundelastography score in benign and malignant lymphadenopathy with a statisticallysignificant difference (P=0.000). Endobronchial ultrasound elastography’ ssensitivity, specificity and accuracy in diagnosising malignant lymphadenopathy arethe following:70.83%(17/24),84.21%(16/19),76.74%(33/43).Conclusions: The real-time endobronchial ultrasound elastography can reflect theelasticity of the hilar and mediastinal lymphadenopathy.This technique has highsensitivity, specificity and accuracy, which helps to diagnosis the hilar andmediastinal lymphadenopathy is benign or malignant.