A Research Study for Correlating Endobronchial Ultrasound Lymph Node Ultrasonographic Features with Its Results

A Research Study for Correlating Endobronchial Ultrasound Lymph Node Ultrasonographic Features with Its Results

18 July 2022


In ordinary clinical practice, the most frequent causes of mediastinal lymphadenopathy are sarcoidosis, TB, and metastatic primary lung cancer. To treat mediastinal lymphadenopathy, tissue must undergo a histopathological diagnosis. The market for endoscopic ultrasound was worth USD 848.78 million in 2020. By 2028, it is anticipated to reach USD 1.37 billion, indicating a CAGR of 6.17 per cent from 2020 to 2028.


Non-surgical methods for sampling and diagnosing mediastinal lymphadenopathy include endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) and endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA). Endobronchial ultrasonography with a convex probe enables lymph node characterization. It can be possible to differentiate between benign and malignant lymph nodes by looking at their round form, distinct edge, heterogeneous echogenicity, lack of central hilar structure (CHS), and presence of the coagulation necrosis sign (CNS). In the context of background non-diagnostic EBUS, identifying lymph nodal features on EBUS is particularly beneficial in decision-making. This can, in turn, help to narrow down the list of lymph nodes that need to be sampled, especially in settings with limited resources, by identifying the target nodes with the highest pre-test probability. In the current study, we compared the final outcome, whether benign or malignant, with the ultrasonographic characteristics of lymph nodes during EBUS.

Materials & Procedures

Participants’ selection and descriptions

The current investigation was a four-year prospective observational study conducted in a tertiary care facility (2017-2021). Over the age of 18, consecutive patients were enrolled. The institutional review board has given the study their blessing. Before the surgery, informed consent was obtained from each patient.

The study included patients with mediastinal lymphadenopathy and EBUS indications when they visited the department of pulmonary medicine. Severe hypoxemia, irreversible coagulopathy, life-threatening cardiac arrhythmias, a recent myocardial infarction, severe pulmonary hypertension, and uremia were the exclusion criteria.

Study Methodology

A standardized questionnaire was framed to collect information about the patients’ age, sex, clinical history (symptoms, duration, and co-morbidities), and radiography (lymph node stations). Endobronchial ultrasonography was carried out using the EU-ME2 ultrasound and the CP-EBUS Olympus-BF-UC180F EBUS scope (Olympus). For the EBUS-TBNA, a 22-gauge Olympus needle was utilized.

The oral route was used for the insertion of the bronchoscope. The major bronchus, vocal folds, tracheal lumen, carina, and bronchial segments were all visible in the endo-larynx. The sampling protocol followed the customary practice, which starts with the highest lymph node station (N3), then moves on to N2, and finally N1. The characteristics of the lymph nodes were evaluated and noted before the collection process.

Doppler mode was used to locate blood vessels in the lymph nodes and the area surrounding the lymph nodes to prevent the vessels’ puncture. Two pulmonologists evaluated and recorded the EBUS characteristics of each lymph node before the quick on-site evaluation. The lymph nodes were sampled using a 22-gauge Olympus needle. The sampled material was moved to the pathology slides after each pass. A skilled pathologist immediately stained each slide and examined it for lymphocytes, granulomas, and unusual cells. Up to three or four passes of sampling were made at each lymph node station before a pathologist on site confirmed the results. The final pathology report served as the benchmark.


The following lymph node EBUS (ultra-sonographic features) characteristics were examined in the research study. I Shape (round vs. oval vs indistinct vs distinct), (ii) Margin (distinct vs. indistinct vs distinct), (iii) Margin (distinct vs. indistinct vs distinct), (iv) Shape (oval vs. round vs indistinct vs indistinct), (v) Shape (round vs Small axis (iii) 10 mm vs >10 mm; heterogeneous vs homogeneous echogenicity; (iv) central hilar structure (central linear structure with high echogenicity): absent or present; (v) coagulation necrosis (hypoechoic area within the lymph node without blood flow) sign: absent or present; and (vi) small axis. These ultra-sonographic characteristics and the ultimate pathology result were compared.

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