The diagnostic utility of ultrasound elastography to differentiate tuberculosis and sarcoidosis during endobronchial ultrasound–guided transbronchial needle aspiration (EBUS-TBNA)
Introduction: Elastography is a non-invasive tool that may allow differentiation between benign and malignant lymph nodes during endobronchial ultrasound–guided transbronchial needle aspiration (EBUS-TBNA). In tuberculosis (TB) endemic areas, clinicoradiological features of mediastinal TB and sarcoi...
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| Format: | Article |
| Language: | English |
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Wolters Kluwer Medknow Publications
2022-01-01
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| Series: | Lung India |
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| Online Access: | http://www.lungindia.com/article.asp?issn=0970-2113;year=2022;volume=39;issue=6;spage=532;epage=536;aulast=Madan |
| _version_ | 1828291188196638720 |
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| author | Manu Madan Saurabh Mittal Pawan Tiwari Vijay Hadda Anant Mohan Randeep Guleria Ravindra M Pandey Karan Madan |
| author_facet | Manu Madan Saurabh Mittal Pawan Tiwari Vijay Hadda Anant Mohan Randeep Guleria Ravindra M Pandey Karan Madan |
| author_sort | Manu Madan |
| collection | DOAJ |
| description | Introduction: Elastography is a non-invasive tool that may allow differentiation between benign and malignant lymph nodes during endobronchial ultrasound–guided transbronchial needle aspiration (EBUS-TBNA). In tuberculosis (TB) endemic areas, clinicoradiological features of mediastinal TB and sarcoidosis often overlap, rendering an accurate diagnosis challenging. There is interest in the identification of modalities to aid in this differentiation. There are currently no published data on the utility of EBUS-elastography in differentiating between TB and sarcoidosis. Methods: Subjects undergoing EBUS-TBNA were prospectively enrolled, and elastography features were observed. Subjects with definitive diagnosis of TB or sarcoidosis were enrolled. The elastography features recorded included the three-colour classification patterns and strain ratio. Results: We enrolled 96 subjects with a definitive diagnosis (53 with TB and 43 with sarcoidosis). Of the 27 patients in whom the lymph nodes were classified as type 1 on endobronchial ultrasound elastography colour pattern, 17 had a diagnosis of TB (62.9%), while 10 were sarcoidosis (37%). For type 2 lymph nodes, 20/45 (44.4%) were TB and 25/45 (55.6%) were sarcoidosis. Type 3 lymph nodes were TB in 16/24 (66.7%) and sarcoidosis in 8/24 (33.3%). In classifying type 1 as 'sarcoidosis' and Type 3 as 'tubercular', the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy were 48.5%, 55.6%, 66.7%, 37%, and 0.51, respectively. The strain ratio (Median [IQR]) was 1.29 (0.37–5.98) in TB and 2.10 (0.83–4.52) in sarcoidosis group (P = 0.48). Conclusion: Ultrasound elastographic lymph node characteristics have a poor diagnostic utility to differentiate between TB and sarcoidosis during EBUS-TBNA. |
| first_indexed | 2024-04-13T10:48:27Z |
| format | Article |
| id | doaj.art-e9fdc5a7a99a467fa7b3828e9592108c |
| institution | Directory Open Access Journal |
| issn | 0970-2113 0974-598X |
| language | English |
| last_indexed | 2024-04-13T10:48:27Z |
| publishDate | 2022-01-01 |
| publisher | Wolters Kluwer Medknow Publications |
| record_format | Article |
| series | Lung India |
| spelling | doaj.art-e9fdc5a7a99a467fa7b3828e9592108c2022-12-22T02:49:44ZengWolters Kluwer Medknow PublicationsLung India0970-21130974-598X2022-01-0139653253610.4103/lungindia.lungindia_214_22The diagnostic utility of ultrasound elastography to differentiate tuberculosis and sarcoidosis during endobronchial ultrasound–guided transbronchial needle aspiration (EBUS-TBNA)Manu MadanSaurabh MittalPawan TiwariVijay HaddaAnant MohanRandeep GuleriaRavindra M PandeyKaran MadanIntroduction: Elastography is a non-invasive tool that may allow differentiation between benign and malignant lymph nodes during endobronchial ultrasound–guided transbronchial needle aspiration (EBUS-TBNA). In tuberculosis (TB) endemic areas, clinicoradiological features of mediastinal TB and sarcoidosis often overlap, rendering an accurate diagnosis challenging. There is interest in the identification of modalities to aid in this differentiation. There are currently no published data on the utility of EBUS-elastography in differentiating between TB and sarcoidosis. Methods: Subjects undergoing EBUS-TBNA were prospectively enrolled, and elastography features were observed. Subjects with definitive diagnosis of TB or sarcoidosis were enrolled. The elastography features recorded included the three-colour classification patterns and strain ratio. Results: We enrolled 96 subjects with a definitive diagnosis (53 with TB and 43 with sarcoidosis). Of the 27 patients in whom the lymph nodes were classified as type 1 on endobronchial ultrasound elastography colour pattern, 17 had a diagnosis of TB (62.9%), while 10 were sarcoidosis (37%). For type 2 lymph nodes, 20/45 (44.4%) were TB and 25/45 (55.6%) were sarcoidosis. Type 3 lymph nodes were TB in 16/24 (66.7%) and sarcoidosis in 8/24 (33.3%). In classifying type 1 as 'sarcoidosis' and Type 3 as 'tubercular', the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy were 48.5%, 55.6%, 66.7%, 37%, and 0.51, respectively. The strain ratio (Median [IQR]) was 1.29 (0.37–5.98) in TB and 2.10 (0.83–4.52) in sarcoidosis group (P = 0.48). Conclusion: Ultrasound elastographic lymph node characteristics have a poor diagnostic utility to differentiate between TB and sarcoidosis during EBUS-TBNA.http://www.lungindia.com/article.asp?issn=0970-2113;year=2022;volume=39;issue=6;spage=532;epage=536;aulast=Madanebus-tbnaelastographylymph nodemediastinumsarcoidosistuberculosis |
| spellingShingle | Manu Madan Saurabh Mittal Pawan Tiwari Vijay Hadda Anant Mohan Randeep Guleria Ravindra M Pandey Karan Madan The diagnostic utility of ultrasound elastography to differentiate tuberculosis and sarcoidosis during endobronchial ultrasound–guided transbronchial needle aspiration (EBUS-TBNA) Lung India ebus-tbna elastography lymph node mediastinum sarcoidosis tuberculosis |
| title | The diagnostic utility of ultrasound elastography to differentiate tuberculosis and sarcoidosis during endobronchial ultrasound–guided transbronchial needle aspiration (EBUS-TBNA) |
| title_full | The diagnostic utility of ultrasound elastography to differentiate tuberculosis and sarcoidosis during endobronchial ultrasound–guided transbronchial needle aspiration (EBUS-TBNA) |
| title_fullStr | The diagnostic utility of ultrasound elastography to differentiate tuberculosis and sarcoidosis during endobronchial ultrasound–guided transbronchial needle aspiration (EBUS-TBNA) |
| title_full_unstemmed | The diagnostic utility of ultrasound elastography to differentiate tuberculosis and sarcoidosis during endobronchial ultrasound–guided transbronchial needle aspiration (EBUS-TBNA) |
| title_short | The diagnostic utility of ultrasound elastography to differentiate tuberculosis and sarcoidosis during endobronchial ultrasound–guided transbronchial needle aspiration (EBUS-TBNA) |
| title_sort | diagnostic utility of ultrasound elastography to differentiate tuberculosis and sarcoidosis during endobronchial ultrasound guided transbronchial needle aspiration ebus tbna |
| topic | ebus-tbna elastography lymph node mediastinum sarcoidosis tuberculosis |
| url | http://www.lungindia.com/article.asp?issn=0970-2113;year=2022;volume=39;issue=6;spage=532;epage=536;aulast=Madan |
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