Endosonographic features predictive of malignancy in mediastinal lymph nodes in patients with lung cancer

Kanwar R. Gill, Marwan Ghabril, Laith H. Jamil, Muhammad K. Hasan, Rebecca B. McNeil, Timothy A. Woodward, Massimo Raimondo, Brenda J. Hoffman, Robert H. Hawes, Joseph Romagnuolo, Michael B. Wallace

Research output: Contribution to journalArticle

26 Citations (Scopus)

Abstract

Background: EUS is useful in determining mediastinal lymph node (LN) metastases in patients undergoing staging for lung cancer. However, FNA of LNs is often performed only if suspicious features are present. The utility of individual LN features in predicting malignant cytology remains unclear. Objective: To evaluate the utility of EUS-determined LN features for predicting malignant cytology. Design: Prospective observational study. Setting: Two U.S. tertiary-care centers. Patients: This study involved 425 patients with primary lung cancer who underwent EUS. Intervention: All mediastinal LNs were described according to size, shape, echogenicity, and margin characteristics. FNA was performed on LNs with any features suggestive of malignancy. EUS-guided FNA cytology was classified as benign or abnormal (suspicious/malignant). The utility of LN features in predicting malignant cytology was determined and further analyzed by logistic regression, and a predictive model was established. Main Outcome Measurements: Accuracy of individual LN features for predicting malignancy. Results: EUS detected 836 LNs in 425 patients, and FNA was obtained in 698 patients. On multivariable analysis, only round shape, a short axis of >8.3 mm, and sharp margins were predictive of malignant cytology. According to the predictive model, the calculated probability of having malignancy is less than 4% (95% confidence interval [CI], 0.022-0.064) when none of the LN features are present and 63% (95% CI, 51%-72.2%) when all features were seen. Limitations: No surgical histology as the criterion standard. Conclusion: Among patients with lung cancer, EUS features of round shape, sharp margins, and short axis of >8.3 mm are significant predictors of malignancy. The probability of malignancy is low when none of the features are present.

Original languageEnglish (US)
Pages (from-to)265-271
Number of pages7
JournalGastrointestinal Endoscopy
Volume72
Issue number2
DOIs
StatePublished - Aug 2010
Externally publishedYes

Fingerprint

Lung Neoplasms
Lymph Nodes
Cell Biology
Neoplasms
Endoscopic Ultrasound-Guided Fine Needle Aspiration
Confidence Intervals
Tertiary Care Centers
Observational Studies
Histology
Logistic Models
Prospective Studies
Neoplasm Metastasis

ASJC Scopus subject areas

  • Gastroenterology
  • Radiology Nuclear Medicine and imaging

Cite this

Endosonographic features predictive of malignancy in mediastinal lymph nodes in patients with lung cancer. / Gill, Kanwar R.; Ghabril, Marwan; Jamil, Laith H.; Hasan, Muhammad K.; McNeil, Rebecca B.; Woodward, Timothy A.; Raimondo, Massimo; Hoffman, Brenda J.; Hawes, Robert H.; Romagnuolo, Joseph; Wallace, Michael B.

In: Gastrointestinal Endoscopy, Vol. 72, No. 2, 08.2010, p. 265-271.

Research output: Contribution to journalArticle

Gill, KR, Ghabril, M, Jamil, LH, Hasan, MK, McNeil, RB, Woodward, TA, Raimondo, M, Hoffman, BJ, Hawes, RH, Romagnuolo, J & Wallace, MB 2010, 'Endosonographic features predictive of malignancy in mediastinal lymph nodes in patients with lung cancer', Gastrointestinal Endoscopy, vol. 72, no. 2, pp. 265-271. https://doi.org/10.1016/j.gie.2010.02.037
Gill, Kanwar R. ; Ghabril, Marwan ; Jamil, Laith H. ; Hasan, Muhammad K. ; McNeil, Rebecca B. ; Woodward, Timothy A. ; Raimondo, Massimo ; Hoffman, Brenda J. ; Hawes, Robert H. ; Romagnuolo, Joseph ; Wallace, Michael B. / Endosonographic features predictive of malignancy in mediastinal lymph nodes in patients with lung cancer. In: Gastrointestinal Endoscopy. 2010 ; Vol. 72, No. 2. pp. 265-271.
@article{2d635127c71847349cf40a335a249ba5,
title = "Endosonographic features predictive of malignancy in mediastinal lymph nodes in patients with lung cancer",
abstract = "Background: EUS is useful in determining mediastinal lymph node (LN) metastases in patients undergoing staging for lung cancer. However, FNA of LNs is often performed only if suspicious features are present. The utility of individual LN features in predicting malignant cytology remains unclear. Objective: To evaluate the utility of EUS-determined LN features for predicting malignant cytology. Design: Prospective observational study. Setting: Two U.S. tertiary-care centers. Patients: This study involved 425 patients with primary lung cancer who underwent EUS. Intervention: All mediastinal LNs were described according to size, shape, echogenicity, and margin characteristics. FNA was performed on LNs with any features suggestive of malignancy. EUS-guided FNA cytology was classified as benign or abnormal (suspicious/malignant). The utility of LN features in predicting malignant cytology was determined and further analyzed by logistic regression, and a predictive model was established. Main Outcome Measurements: Accuracy of individual LN features for predicting malignancy. Results: EUS detected 836 LNs in 425 patients, and FNA was obtained in 698 patients. On multivariable analysis, only round shape, a short axis of >8.3 mm, and sharp margins were predictive of malignant cytology. According to the predictive model, the calculated probability of having malignancy is less than 4{\%} (95{\%} confidence interval [CI], 0.022-0.064) when none of the LN features are present and 63{\%} (95{\%} CI, 51{\%}-72.2{\%}) when all features were seen. Limitations: No surgical histology as the criterion standard. Conclusion: Among patients with lung cancer, EUS features of round shape, sharp margins, and short axis of >8.3 mm are significant predictors of malignancy. The probability of malignancy is low when none of the features are present.",
author = "Gill, {Kanwar R.} and Marwan Ghabril and Jamil, {Laith H.} and Hasan, {Muhammad K.} and McNeil, {Rebecca B.} and Woodward, {Timothy A.} and Massimo Raimondo and Hoffman, {Brenda J.} and Hawes, {Robert H.} and Joseph Romagnuolo and Wallace, {Michael B.}",
year = "2010",
month = "8",
doi = "10.1016/j.gie.2010.02.037",
language = "English (US)",
volume = "72",
pages = "265--271",
journal = "Gastrointestinal Endoscopy",
issn = "0016-5107",
publisher = "Mosby Inc.",
number = "2",

}

TY - JOUR

T1 - Endosonographic features predictive of malignancy in mediastinal lymph nodes in patients with lung cancer

AU - Gill, Kanwar R.

AU - Ghabril, Marwan

AU - Jamil, Laith H.

AU - Hasan, Muhammad K.

AU - McNeil, Rebecca B.

AU - Woodward, Timothy A.

AU - Raimondo, Massimo

AU - Hoffman, Brenda J.

AU - Hawes, Robert H.

AU - Romagnuolo, Joseph

AU - Wallace, Michael B.

PY - 2010/8

Y1 - 2010/8

N2 - Background: EUS is useful in determining mediastinal lymph node (LN) metastases in patients undergoing staging for lung cancer. However, FNA of LNs is often performed only if suspicious features are present. The utility of individual LN features in predicting malignant cytology remains unclear. Objective: To evaluate the utility of EUS-determined LN features for predicting malignant cytology. Design: Prospective observational study. Setting: Two U.S. tertiary-care centers. Patients: This study involved 425 patients with primary lung cancer who underwent EUS. Intervention: All mediastinal LNs were described according to size, shape, echogenicity, and margin characteristics. FNA was performed on LNs with any features suggestive of malignancy. EUS-guided FNA cytology was classified as benign or abnormal (suspicious/malignant). The utility of LN features in predicting malignant cytology was determined and further analyzed by logistic regression, and a predictive model was established. Main Outcome Measurements: Accuracy of individual LN features for predicting malignancy. Results: EUS detected 836 LNs in 425 patients, and FNA was obtained in 698 patients. On multivariable analysis, only round shape, a short axis of >8.3 mm, and sharp margins were predictive of malignant cytology. According to the predictive model, the calculated probability of having malignancy is less than 4% (95% confidence interval [CI], 0.022-0.064) when none of the LN features are present and 63% (95% CI, 51%-72.2%) when all features were seen. Limitations: No surgical histology as the criterion standard. Conclusion: Among patients with lung cancer, EUS features of round shape, sharp margins, and short axis of >8.3 mm are significant predictors of malignancy. The probability of malignancy is low when none of the features are present.

AB - Background: EUS is useful in determining mediastinal lymph node (LN) metastases in patients undergoing staging for lung cancer. However, FNA of LNs is often performed only if suspicious features are present. The utility of individual LN features in predicting malignant cytology remains unclear. Objective: To evaluate the utility of EUS-determined LN features for predicting malignant cytology. Design: Prospective observational study. Setting: Two U.S. tertiary-care centers. Patients: This study involved 425 patients with primary lung cancer who underwent EUS. Intervention: All mediastinal LNs were described according to size, shape, echogenicity, and margin characteristics. FNA was performed on LNs with any features suggestive of malignancy. EUS-guided FNA cytology was classified as benign or abnormal (suspicious/malignant). The utility of LN features in predicting malignant cytology was determined and further analyzed by logistic regression, and a predictive model was established. Main Outcome Measurements: Accuracy of individual LN features for predicting malignancy. Results: EUS detected 836 LNs in 425 patients, and FNA was obtained in 698 patients. On multivariable analysis, only round shape, a short axis of >8.3 mm, and sharp margins were predictive of malignant cytology. According to the predictive model, the calculated probability of having malignancy is less than 4% (95% confidence interval [CI], 0.022-0.064) when none of the LN features are present and 63% (95% CI, 51%-72.2%) when all features were seen. Limitations: No surgical histology as the criterion standard. Conclusion: Among patients with lung cancer, EUS features of round shape, sharp margins, and short axis of >8.3 mm are significant predictors of malignancy. The probability of malignancy is low when none of the features are present.

UR - http://www.scopus.com/inward/record.url?scp=77955711731&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=77955711731&partnerID=8YFLogxK

U2 - 10.1016/j.gie.2010.02.037

DO - 10.1016/j.gie.2010.02.037

M3 - Article

C2 - 20541192

AN - SCOPUS:77955711731

VL - 72

SP - 265

EP - 271

JO - Gastrointestinal Endoscopy

JF - Gastrointestinal Endoscopy

SN - 0016-5107

IS - 2

ER -