S. Goyal*a (Dr), U. Parakhb (Dr), B. Bhalhotrab (Prof), N. Jainb (Dr)

a Artemis Hospitals, Gurugram, INDIA ; b Sir Ganga Ram Hospital, New Delhi, INDIA

* shivanshu.goyal@gmail.com

Backgound:

Sonographic features of mediastinal nodes on convex probe endobronchial ultrasound (CP-EBUS) can be used for prediction of various pathologies. Studies to define benign vs. malignant; further sub grouping benign pathologies at a tuberculous endemic country are very few. Our work utilizes large sample size to assess utility of CP-EBUS patterns to aid the operator to predict, sample the most suspicious node and correlate with final diagnosis.

Methods:

Four hundred sixty nine patients (n=469) who underwent CP-EBUS over a period of 24 months at a tertiary care medical center were retrospectively studied. Lymph nodal EBUS patterns such as size, shape, margins, echogenicity, central hilar structure (CHS) and central necrosis sign (CNS) were recorded, compared and correlated with final diagnosis.

Results:

Out of total cases (n=469); malignancy confirmed in (n=68), 44 came out inconclusive and rest turned out benign (n=357) specifically sarcoidosis (n=129), tuberculosis (n=183), reactive (n=36) and others (n=9). Round shape had high senstivity and absence of CHS has a high positive predictive value for malignant nodes (p<0.04). Presence of CNS had low accuracy for prediction of malignancy among Indian population in contrast to other studies. Tuberculosis showed significant presence of CNS (34.9% vs. 2.3%; p<0.001) and heterogenous echotexture (62.3% vs. 17.8%; p<0.01) in contrast to sarcoidosis.

Conclusion:

Presence of central hilar structure was suggestive of benign disease specifically reactive nodes. Central necrosis and heterogeneity were found highly specific for tuberculosis over sarcoidosis. EBUS patterns to suggest malignancy have low specificity in a tuberculous endemic country but are useful to predict benign pathology and further sub grouping of benign diseases.

Disclosure of funding source(s): none