NSCLC: A new way to evaluate hilar and mediastinal lymph nodes

A team of Barcelona-based researchers developed an algorithm that exhibits high accuracy in predicting the dignity of mediastinal and hilar lymph nodes in lung cancer patients [1].

Classically, PET-CT scans and EBUS-TBA (endobronchial ultrasound-guided transbronchial needle aspiration) are used to determine whether lymph nodes of lung cancer patients found in mediastinum or at the hilum are malignant or not [1]. The retrospective investigation, presented by Dr Jaume Bordas-Martínez (Bellvitge Universitary Hospital, Catalonia, Spain), combined the information provided by the 2 techniques with a list of clinical criteria to develop a model to predict malignancy with high probability. Standardised uptake values (SUV) were determined for each of the 358 lymph node samples obtained from 116 consecutive patients.

Data gathered from the EBUS consisted of diameter in short axis, borders, morphology, echogenicity, and whether a vascular hilum was detected. Also obtained were supplementary clinical variables including age, gender, smoking history, diabetes, lung diseases, primary tumour location, and its histology. Two blinded experts separately evaluated every lymph node and reference point.

As a result of the modelling, a lymph node malignancy was predicted with 89% probability (AUC 0.89) before biopsy, using a combination of significant factors: age (P=0.0025), SUV_max (P=0.0001), diameter in the short axis (P=0.0001), and anatomical region (hilar lymph node P=0.0121; subcarinal lymph node P=0.0006). All other variables could be discarded when combining PET-CT and EBUS image features.

1. 
   
   1. Bordas-Martinez J, et al. PA323, ERS 2019, 29 Sept-2 Oct, Madrid, Spain.

Posted on 28 November 201918 March 2021