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The Canada Lymph Node Score for prediction of malignancy in mediastinal lymph nodes during endobronchial ultrasound.

Published on Jun 1, 2020in The Journal of Thoracic and Cardiovascular Surgery5.261
· DOI :10.1016/J.JTCVS.2019.10.205
Danielle A. Hylton2
Estimated H-index: 2
(McMaster University),
Simon R. Turner6
Estimated H-index: 6
(U of A: University of Alberta)
+ 6 AuthorsWaël C. Hanna7
Estimated H-index: 7
(St. Joseph's Healthcare Hamilton)
Abstract
Abstract Objective (s) : During endobronchial ultrasound (EBUS) staging, ultrasonographic features can be used to predict mediastinal lymph node (LN) malignancy. We sought to develop the Canada Lymph Node Score (CLNS) a tool capable of predicting LN metastasis at the time of EBUS. Methods Patients undergoing EBUS staging for lung and esophageal cancer were prospectively enrolled. Features were identified in real-time by an endoscopist and video-recorded. Videos were sent to raters. Pathological specimens from biopsies/surgical resections were used as the gold-standard reference test. Logistic regression, receiver operator characteristic curve, and Gwet’s AC1 analyses were used to test the performance, discrimination, and inter-rater reliability, respectively. Results In total, 300 LNs from 140 patients were analyzed by 12 endoscopists (raters) across 7 Canadian centres. Beta-coefficients from a multivariate regression model were used to create a 4-point score: short-axis diameter, margins, central hilar structure, and necrosis. The model showed good discriminatory power (c-statistic= 0.72 ± 0.04, 95%CI: 0.64-0.80; bias-corrected c-statistic: 0.66, 95%CI: 0.55-0.76). LNs scoring 3/4 or 4/4 had odds ratios of 15.17 (p Conclusions The CLNS is a 4-point score demonstrating excellent performance in identifying malignant LNs during EBUS. A cut-off of ≥ 3 may inform decision-making regarding biopsy, repeat biopsy, or mediastinoscopy if the initial results are inconclusive.
  • References (19)
  • Citations (3)
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References19
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#1Danielle A. HyltonH-Index: 2
#2Yaron ShargallH-Index: 13
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Background: Ultrasonographic features can be used to predict mediastinal lymph node malignancy during endobronchial ultrasonography. Despite the validity of using these features for this purpose, the features are not being widely used in clinical practice. This may be attributable to the absence of educational programs that teach clinicians how to identify the features. To address this knowledge gap, we developed an online educational module to teach clinicians how to correctly interpret ultraso...
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#1Patricia Akissue de Camargo Teixeira (USP: University of São Paulo)H-Index: 1
#2Luciano Fernandes Chala (USP: University of São Paulo)H-Index: 8
Last. Nestor de Barros (USP: University of São Paulo)H-Index: 13
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Abstract The purpose of this study was to build a mathematical model to predict the probability of axillary lymph node metastasis based on the ultrasonographic features of axillary lymph nodes and the tumor characteristics. We included 74 patients (75 axillae) with invasive breast cancer who underwent axillary ultrasonography ipsilateral to the tumor and fine-needle aspiration of one selected lymph node. Lymph node pathology results from sentinel lymph node biopsy or surgical dissection were cor...
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#1Daniel J. Boffa (Yale University)H-Index: 25
#2Felix G. Fernandez (Emory University)H-Index: 22
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Background The role of surgical resection in patients with clinical stage IIIA–N2 positive (cIIIA-N2) lung cancer is controversial, partly because of the variability in short- and long-term outcomes. The objective of this study was to characterize the management of cIIIA-N2 lung cancer in The Society of Thoracic Surgeons General Thoracic Surgery Database (STS-GTSD). Methods The STS-GTSD was queried for patients who underwent operations for cIIIA-N2 lung cancer between 2002 and 2012. A subset of ...
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#2Hongjun Lyu (Xi'an Jiaotong University)H-Index: 1
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Introduction There are several papers on the sonographic features of mediastinal lymph nodes affected by several diseases, but none gives the importance and clinical utility of the features. Objective In order to find out which lymph node should be sampled in a particular nodal station during endobronchial ultrasound, we investigated the diagnostic performances of certain sonographic features and proposed an algorithmic approach. Methods We retrospectively analyzed 1051 lymph nodes and randomly ...
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Clinical prediction models are developed to calculate estimates of the probability of the presence/occurrence or future course of a particular prognostic or diagnostic outcome from multiple clinical or non-clinical parameters. Radiologic imaging techniques are being developed for accurate detection and early diagnosis of disease, which will eventually affect patient outcomes. Hence, results obtained by radiological means, especially diagnostic imaging, are frequently incorporated into a clinical...
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#1Matthew Evison (University of Manchester)H-Index: 9
#2Julie Morris (University of Manchester)H-Index: 51
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Background Over the last 10 years, endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has become established as the first-line nodal staging procedure of choice for lung cancer patients. However, the pathway for patients following a negative EBUS-TBNA has not been clearly defined. The primary aim of this study was to develop and validate a risk stratification model to categorize lymph nodes deemed negative by EBUS-TBNA into "low-risk" and "high-risk" groups, where "risk...
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#1Ahmed H. El-Sherief (Cleveland Clinic)H-Index: 8
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Abstract Objective To evaluate the utility of different ultrasonographic (US) features in differentiating benign and malignant lymph node (LN) by endobronchial ultrasound (EBUS) and validate a score for real-time clinical application. Methods A total of 208 mediastinal LNs acquired from 141 patients were analyzed. Six different US criteria were evaluated (short axis ≥10 mm, shape, margin, echogenicity, central hilar structure [CHS], and presence of hyperechoic density) by two observers independe...
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