Sonographic Features of Endobronchial Ultrasonography Predict Intrathoracic Lymph Node Metastasis in Lung Cancer Patients Lei Wang, MD, Weihua Wu, MD,

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Sonographic Features of Endobronchial Ultrasonography Predict Intrathoracic Lymph Node Metastasis in Lung Cancer Patients Lei Wang, MD, Weihua Wu, MD, Yunqian Hu, MD, Jiajun Teng, MD, Runbo Zhong, MD, Baohui Han, MD, PhD, Jiayuan Sun, MD, PhD The Annals of Thoracic Surgery Volume 100, Issue 4, Pages 1203-1209 (October 2015) DOI: 10.1016/j.athoracsur.2015.04.143 Copyright © 2015 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Image characteristics of metastatic and reactive lymph nodes and representative morphologic findings of endobronchial ultrasonography images used for classifying metastatic and reactive lymph nodes: size; long axis greater than 1.67 cm and short axis 1.42 cm or less; shape, oval or round; margin, indistinct (arrow) or distinct; central hilar structure, present or absent; echogenicity, homogeneous or heterogeneous; necrosis sign, present (arrow) or absent; matting, present (arrow) or absent; calcification, present (arrow) or absent; vascular patterns, avascular, hilar, or nonhilar (capsular, central, mixed). The Annals of Thoracic Surgery 2015 100, 1203-1209DOI: (10.1016/j.athoracsur.2015.04.143) Copyright © 2015 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Receiver-operating characteristic curve analysis for short-axis diameter (cm) lymph node. A short-axis diameter threshold of 1.42 cm is the cutoff defined for predicting lymph node metastasis. Solid line indicates sensitivity; broken line indicates specificity. The Annals of Thoracic Surgery 2015 100, 1203-1209DOI: (10.1016/j.athoracsur.2015.04.143) Copyright © 2015 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Receiver-operating characteristic curve analysis for long-axis diameter (cm) lymph node. A long-axis diameter threshold of 1.67 cm is the cutoff defined for predicting lymph node metastasis. Solid line indicates sensitivity; broken line indicates specificity. The Annals of Thoracic Surgery 2015 100, 1203-1209DOI: (10.1016/j.athoracsur.2015.04.143) Copyright © 2015 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 Endobronchial ultrasonography image classification and final confirmation, including pathology and at least 24 months of clinical follow-up, for metastatic lymph nodes (shaded bar) and reactive lymph nodes (open bar). (CHS = central hilar structure; NS = necrosis sign.) The Annals of Thoracic Surgery 2015 100, 1203-1209DOI: (10.1016/j.athoracsur.2015.04.143) Copyright © 2015 The Society of Thoracic Surgeons Terms and Conditions

Fig 5 Endobronchial ultrasonography images for reactive and metastatic nodes. Typical reactive lymph nodes: (A) absence of matting, presence of CHS; (B) hilar vascular pattern perfusion. Typical metastatic lymph nodes: (C) round shape, presence of matting, absence of CHS; (D) nonhilar vascular pattern perfusion. The Annals of Thoracic Surgery 2015 100, 1203-1209DOI: (10.1016/j.athoracsur.2015.04.143) Copyright © 2015 The Society of Thoracic Surgeons Terms and Conditions