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Endobronchial Ultrasound (EBUS) Scoring System of Schmid-Bindert et al for Predicting Metastatic Cancer to Mediastinal Lymph Nodes

Description

Schmid-Bindert et al reported a scoring system based on findings observed during endobronchial ultrasound (EBUS) of mediastinal lymph nodes. These findings can help to distinguish lymph nodes that are high risk for metastatic cancer from those that are low risk. The authors are from University Medical Center Mannheim, Heidelberg University and Tongji University in Shanghai.


Patient selection: EBUS (endobronchial ultrasound) in a patient with non-small cell lung cancer

 

Parameters:

(1) shape

(2) margin

(3) echogenicity

(4) central hilar structure (CHS; visible as a linear structure with high echogenicity in the center of the lymph node)

(5) diameter of short axis in cm

(6) grade of blood flow on color power Doppler index (CPDI)

 

CPDI Blood Flow

Grade (Wang et al)

none

0

small amount

1

medium flow; one main vessel; few small vessels as a long strip of a curve

2

rich flow

3

 

 

Parameter

Finding

Points

shape

not round

0

 

round (ratio of 2 perpendicular diameters < 1.5)

1

margin

not distinct

0

 

distinct (sharp white line)

1

echogenicity

homogeneous

0

 

heterogeneous

1

central hilar structure

present

0

 

absent

1

diameter of short axis

<= 1 cm

0

 

> 1 cm

1

grade of blood flow on CPDI

grade 0 or 1

0

 

grade 2 or 3

1

 

total score =

= SUM (points for all 6 parameters)

 

Interpretation:

• minimum score: 0

• maximum score: 6

• The presence of heterogeneity had the best positive predictive value for malignancy.

• The presence of a central hilar structure had the best positive predictive value for benignity (stated as absence of CHS had highest negative predictive value for malignancy).

• A score >= 3 indicates a high risk for malignancy.

 

Performance:

• The area under the ROC curve was 0.79.


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