Diagnostic Performance of Qualitative EBUS Elastography in Mediastinal Lymph Node Evaluation
Year: 2026
Type: preprint
Study design: Observational Study
Abstract: Background/Purpose: Accurate assessment of mediastinal lymph node malignancy is essential for lung cancer staging. Current methods, such as positron emission tomography/computed tomography (PET-CT) or invasive sampling, have limitations and risks. Qualitative EBUS elastography (QEE) may offer an alternative for real-time assessment of nodal malignancy without requiring expensive quantitative tools or invasive procedures. Methods In this retrospective study, mediastinal and hilar lymph nodes were assessed using QEE features: Izumo stiffness score, intranodal color heterogeneity, and contour irregularity. Lymph node characteristics, PET-CT, and mediastinoscopy findings were recorded. Histopathology served as the reference standard. The diagnostic performance of QEE was evaluated using sensitivity, specificity, positive and negative predictive values, accuracy, and the area under the receiver operating characteristic curve. Results A total of 237 lymph nodes with definitive histopathological diagnoses were included. No malignant node (n = 98) showed an Izumo stiffness score-1 pattern. Malignant nodes more frequently showed score-3 stiffness than benign or granulomatous nodes (79/98 vs 12/107 vs 6/32, p < 0.001).Internal heterogeneity and contour irregularity were also significantly more common in malignant nodes (both p < 0.001). Using score 3 as the cutoff for malignancy, QEE achieved 80.6% sensitivity, 87.1% specificity, 81.4% positive predictive value, 86.4% negative predictive value, 84.4% accuracy, and an AUC of 0.818. PET-CT showed high sensitivity in malignant nodes (88/98, 89.8%) but also frequent false-positive findings in benign (40/107, 37.4%) and granulomatous nodes (25/32, 78.1%). Conclusion QEE has significant potential to improve the characterization of mediastinal lymph nodes and to inform biopsy decisions, particularly when PET-CT specificity is limited.
Source: Research Square
Institutions: Istanbul University, Northwestern University
Language: English
Subfield: Radiology, Nuclear Medicine and Imaging
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W7204809546