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DOI: 10.1055/s-0040-1704408
COMBINED EUS-ELASTOGRAPHY (EUS-E) AND CONTRAST-ENHANCED HARMONIC EUS (CH-EUS) IMPROVES DIFFERENTIAL DIAGNOSIS BETWEEN BENIGN AND MALIGNANT LYMPH NODES - A PROSPECTIVE STUDY
Publication History
Publication Date:
23 April 2020 (online)
Aims To evaluate the diagnostic performance of contrast-enhanced EUS(CH-EUS) and elastography(EUS-E) combination in the differential diagnosis(DD) between benign and malignant lymph nodes(LN).
Methods Consecutive patients with suspected LNs were prospectively enrolled from 2018. EU-ME2 processor(Olympus) elastography and CH-EUS(MI 0.22)with SonoVue(Bracco) were used. Final diagnosis was obtained with pathology(EUS-tissue acquisition or surgical specimen) or based on clinical follow-up(6-month). Age, gender, LN size, location, shape, echotexture, presence of visible vascular hilum. EUS-E, CH-EUS and their combination(both positive, both negative and at least one positive for malignancy) were evaluated.
Results 110 LNs(76 abdominal, 34 mediastinal) in 84 patients(46 male; age 64.8±13.1) were evaluated; of these, 32(29.1%) were benign, 78(70.9%) malignant (65 solid tumor metastasis; 13 lymphoma). No difference was observed in terms of size. B-mode criteria for malignancy were present in 56(50.9%), a visible vascular hilum was identified in 20(18.2%) cases. 54 cases were EUS-E criteria positive, 27 negative and 29 non-diagnostic; 57 cases were CH-EUS criteria positive, 32 negative and 21 non-diagnostic. Vascular hilum identification showed high specificity (97.4%) for benign LNs. [Table 1] showes EUS-E and CH-EUS diagnostic performance. The concordance of the two techniques(both positive) had 100% specificity for malignancy, despite low sensitivity, while when both techniques were negative, specificity for benign LNs was 98.7%. An optimal sensitivity(93.6%) was observed when at least one technique(EUS-elastography “OR” CH-EUS) was suggestive for malignancy.