TY - JOUR
T1 - Accuracy and Reproducibility of Endoscopic Ultrasound B-Mode Features for Observer-Based Lymph Nodal Malignancy Prediction
AU - Verhoeven, Roel L.J.
AU - Leoncini, Fausto
AU - Slotman, Jorik
AU - De Korte, Chris
AU - Trisolini, Rocco
AU - Van Der Heijden, Erik H.F.M.
PY - 2021
Y1 - 2021
N2 - Background: Endoscopic ultrasound routinely guides lymph node evaluation for the staging of a known or suspected lung cancer. Characteristics seen on B-mode imaging might help the observer decide on the lymph nodes of risk. The influence of nodal size on the predictivity of these characteristics and the agreement with which operators can combine these for malignancy risk prediction is to be determined. Objectives: We evaluated (1) if prospectively scored individual B-mode ultrasound features predict malignancy when further divided by size and (2) assessed if observers were able to reproducibly agree on still lymph node image malignancy risk. Methods: Lymph nodes as visualized by EBUS were prospectively scored for B-mode characteristics. Still B-mode images were furthermore collected. After collection, a repeated scoring of a subset of lymph nodes was retrospectively performed (n = 11 observers). Results: Analysis of 490 lymph nodes revealed the short axis size is an objective measure for stratifying risk of malignancy (ROC area under the curve 0.78). With >= 8-mm size, 210/237 malignant lymph nodes were correctly identified (89% sensitivity, 46% specificity, 61% PPV, and 81% NPV). Secondary addition of B-mode features in Conclusions: Lymph nodes of >= 8-mm size and preferably even smaller should be aspirated regardless of other B-mode features. Observer disagreement in scoring both small and large lymph nodes suggests it is infeasible to include subjective features for stratification. Future research should focus on (integrating) other (semi)quantitative values for improving prediction.
AB - Background: Endoscopic ultrasound routinely guides lymph node evaluation for the staging of a known or suspected lung cancer. Characteristics seen on B-mode imaging might help the observer decide on the lymph nodes of risk. The influence of nodal size on the predictivity of these characteristics and the agreement with which operators can combine these for malignancy risk prediction is to be determined. Objectives: We evaluated (1) if prospectively scored individual B-mode ultrasound features predict malignancy when further divided by size and (2) assessed if observers were able to reproducibly agree on still lymph node image malignancy risk. Methods: Lymph nodes as visualized by EBUS were prospectively scored for B-mode characteristics. Still B-mode images were furthermore collected. After collection, a repeated scoring of a subset of lymph nodes was retrospectively performed (n = 11 observers). Results: Analysis of 490 lymph nodes revealed the short axis size is an objective measure for stratifying risk of malignancy (ROC area under the curve 0.78). With >= 8-mm size, 210/237 malignant lymph nodes were correctly identified (89% sensitivity, 46% specificity, 61% PPV, and 81% NPV). Secondary addition of B-mode features in Conclusions: Lymph nodes of >= 8-mm size and preferably even smaller should be aspirated regardless of other B-mode features. Observer disagreement in scoring both small and large lymph nodes suggests it is infeasible to include subjective features for stratification. Future research should focus on (integrating) other (semi)quantitative values for improving prediction.
KW - Bronchoscopy
KW - Cancer
KW - Endobronchial ultrasound
KW - Endobronchial ultrasound-transbronchial needle aspiration
KW - Endoscopic ultrasound
KW - Esophageal ultrasound
KW - Lung cancer staging
KW - Lymph node staging
KW - Nonsmall-cell lung cancer
KW - Observer variability
KW - Bronchoscopy
KW - Cancer
KW - Endobronchial ultrasound
KW - Endobronchial ultrasound-transbronchial needle aspiration
KW - Endoscopic ultrasound
KW - Esophageal ultrasound
KW - Lung cancer staging
KW - Lymph node staging
KW - Nonsmall-cell lung cancer
KW - Observer variability
UR - http://hdl.handle.net/10807/222149
U2 - 10.1159/000516505
DO - 10.1159/000516505
M3 - Article
SN - 0025-7931
VL - 100
SP - 1088
EP - 1096
JO - Respiration
JF - Respiration
ER -