Vascular Image Patterns of Lymph Nodes for the Prediction of Metastatic Disease During EBUS-TBNA for Mediastinal Staging of Lung Cancer Takahiro Nakajima,

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Vascular Image Patterns of Lymph Nodes for the Prediction of Metastatic Disease During EBUS-TBNA for Mediastinal Staging of Lung Cancer Takahiro Nakajima, MD, PhD, Takashi Anayama, MD, PhD, Masato Shingyoji, MD, PhD, Hideki Kimura, MD, PhD, Ichiro Yoshino, MD, PhD, Kazuhiro Yasufuku, MD, PhD Journal of Thoracic Oncology Volume 7, Issue 6, Pages 1009-1014 (June 2012) DOI: 10.1097/JTO.0b013e31824cbafa Copyright © 2012 International Association for the Study of Lung Cancer Terms and Conditions

FIGURE 1 EBUS Power/Color Doppler-mode image characteristics of LNs. This figure shows the different EBUS Power/Color Doppler-mode image characteristics used for the classification of LNs. (A), Grade 0: no blood flow or small amounts of flow, (B) Grade I: a few main vessels running toward the center of the LN from the hilum, (C) Grade II: a few punctiforms or rod-shaped flow signals, a few small vessels found as a long strip of a curve, (D) Grade III: rich flow, more than four vessels found with different diameters and twist or helical-flow signal, (E) BA inflow sign: The blood flow from the BA toward the LN that was visualized as blue signals on EBUS Color Doppler-mode image. EBUS, endobronchial ultrasound; LN, lymph node; BA, bronchial artery. Journal of Thoracic Oncology 2012 7, 1009-1014DOI: (10.1097/JTO.0b013e31824cbafa) Copyright © 2012 International Association for the Study of Lung Cancer Terms and Conditions

FIGURE 2 Representative Doppler-mode findings of EBUS images characteristics. (A) Grade 0, (B) Grade I, (C) Grade II, (D) Grade III, and (E) BA inflow sign. EBUS, endobronchial ultrasound; BA, bronchial artery. Journal of Thoracic Oncology 2012 7, 1009-1014DOI: (10.1097/JTO.0b013e31824cbafa) Copyright © 2012 International Association for the Study of Lung Cancer Terms and Conditions

FIGURE 3 EBUS Doppler-mode image classification and final diagnosis. The actual results of comparison between EBUS Doppler-mode image classification and final diagnosis. When LNs had been categorized as Grade 0 or I, and negative for BA inflow sign, they tended to be benign. Conversely, when LNs had been categorized as Grade II or III, and positive for BA inflow sign, they tended to be malignant, vice versa. EBUS, endobronchial ultrasound; LN, lymph node; BA, bronchial artery. Journal of Thoracic Oncology 2012 7, 1009-1014DOI: (10.1097/JTO.0b013e31824cbafa) Copyright © 2012 International Association for the Study of Lung Cancer Terms and Conditions

FIGURE 4 Overview of EBUS Doppler-mode image findings and final diagnosis. Forty-nine of 58 LNs (87.5%) were metastatic when both categories were determined as “metastatic,” and 50 out of 57 LNs (84.7%) were nonmetastatic when both categories were determined as “benign,” vice versa. (49 lymph nodes: Doppler positive, final positive; nine lymph nodes: Doppler positive, final negative; 50 lymph nodes: Doppler negative, final negative; and seven lymph nodes: Doppler negative, final positive). EBUS, endobronchial ultrasound; LN, lymph node. Journal of Thoracic Oncology 2012 7, 1009-1014DOI: (10.1097/JTO.0b013e31824cbafa) Copyright © 2012 International Association for the Study of Lung Cancer Terms and Conditions