Qualitative role of endobronchial elastography with endobronchial ultrasound in differentiating malignant and benign lesions: a retrospective single-center study from India

Background Endobronchial ultrasound (EBUS) is useful in guiding needle biopsy of mediastinal lesions. Sonoelastography in latest generation machines have enabled mapping the elasticity of the lymph nodes (LNs) leading to potentially better guidance in taking samples. Aim We aim to assess the practical usefulness of elastography in assessing mediastinal lymphadenopathy by comparing the patterns seen on EBUS elastography with the final pathological diagnosis from EBUS-guided transbronchial needle aspiration. Patients and methods The EBUS scope (convex) was intubated via the oral route, and images were generated to evaluate the patterns produced during elastography according to color distribution: type 1 was taken as predominantly nonblue (yellow, red, and green); type 2 was less than 50% blue color, part nonblue (yellow, red, and green); type 3 predominant blue. Elastography patterns were subsequently compared with the eventual pathological results. Results In the study period, 105 LNs in 80 patients were studied, 79 were found to be of benign nature while 26 patients were diagnosed as malignancy. Type 1 LNs were of benign pathology in 42/46 (91.30%) cases and malignant in 4/46 (8.70%) cases; for type 2 LNs, 24/30 (80%) cases were benign and 6/30 (20%) cases were malignant. Type 3 nodes were found to be of benign nature in 13/29 (44.82%) cases and malignant in 16 (55.14%) cases. On classifying type 1 group and type 2 group as ‘benign’ and type 3 group as malignant in nature, the sensitivity, specificity, negative predictive value, positive predictive value, and diagnostic accuracy rates were found to be 83.54, 61.54, 86.84, 55.17, and 78.10%. Conclusions The addition of elastography while performing EBUS of mediastinal lymphadenopathy is a technique that may be helpful in selecting sites for EBUS-guided transbronchial needle aspiration; however, more studies are needed to access its practical usefulness.