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Lokesh Yagnik
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MA 20 - Recent Advances in Pulmonology/Endoscopy (ID 685)
- Event: WCLC 2017
- Type: Mini Oral
- Track: Pulmonology/Endoscopy
- Presentations: 1
- Moderators:C. Lee, S. Sasada
- Coordinates: 10/18/2017, 14:30 - 16:15, F205 + F206 (Annex Hall)
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MA 20.07 - Endobronchial Ultrasound Elastography: Mediastinal Staging in Non-Small Cell Lung Cancer and Technical Factors (ID 9387)
14:30 - 16:15 | Presenting Author(s): Lokesh Yagnik
- Abstract
- Presentation
Background:
Endobronchial ultrasound (EBUS) transbronchial needle aspiration (TBNA) is the standard of care for diagnosis and mediastinal staging of non-small cell lung cancer (NSCLC). Studies suggest that elastography, an ultrasonic measure of tissue elasticity, may identify malignant lymph nodes (LNs) with sufficient accuracy to guide which LNs need sampling at EBUS and reduce the time and complexity of staging procedures. This study aims to confirm these findings while also describing technical factors that affect elastographic measurements.
Method:
All patients undergoing EBUS TBNA to investigate possible NSCLC were prospectively recruited. Elastographic analysis was performed prior to TBNA of LNs and later correlated with pathology from EBUS TBNA and/or surgical specimens. All LNs were classified qualitatively according to elastographic colour pattern: predominantly blue, predominantly green and mixed. Strain ratios (SR) were calculated to give quantitative measures of elasticity. Measures were compared to PET and sub-group analyses according to LN FDG avidity were performed. Finally the influence of various technical factors (probe pressure, Region of interest selection, and frame average function) were assessed.
Result:
There were 82 LNs from 50 patients who underwent EBUS elastography with the final diagnosis being malignant in 29(35%) and non-malignant in 57(69%). PET was available for 58 LNs. Diagnostic indices relating to elastographic features and effects of various technical factors are shown in Table 1.Table 1 Diagnostic indices for elastographic identification of malignant LNs (A) and Effects of technical factors (B)
A. Variable Sensitivity Specificity PPV NPV Elastography All 88% 47% 42% 90% Elastography PET Positive 90% 64% 66% 90% Elastography PET negative 63% 88% 70% 85% Strain Ratio All Pending Pending Pending Pending Strain Ratio PET positive Pending Pending Pending Pending Strain Ratio PET negative Pending Pending Pending Pending Sonographic features 81% 60% 54% 84% PET All 82% 51% 52% 81% B. Variation in technique Difference p value Probe Pressure - colour map Pending Pending Probe pressure - strain ratio Pending Pending ROI pressure Pending Pending ROI Placement Pending Pending Frame average - colour map Pending Pending
Conclusion:
EBUS elastography can identify malignant LNs with equivalent power to sonography and FDG PET and may have a role in selecting which PET-negative nodes require sampling in staging procedures. It is highly dependent on technique which must be standardised to ensure accuracy of results. Please note: Data acquisition is still underway and planned to continue for a further 2 months. Analysis shall be complete by the time of the conference.
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