The Role of Endobronchial Ultrasound Elastography in Granulomatous and Malignant Lung Diseases

Abstract Abstract Ultrasonographic elastography is an imaging technique that measures tissue elasticity or stiffness. We aim to demonstrate that Endobronchial Ultrasound (EBUS) elastography is superior to traditional EBUS in the early, accurate differentiation of granulomatous and malignant mediastinal lymph nodes. Material and methods In this study, we evaluate the role of Endobronchial Ultrasound elastography in predicting granulomatous and malignant hilar and mediastinal lymph nodes or masses. We also assess its correlation with lymph node morphology, thoracic computed tomography (CT), Positron Emission Tomography - Computed Tomography (PET-CT), pathological tissue diagnosis. Results A total of 83 consecutive patients (56 males) with a mean age of 62.13 ± 11 years (20 to 80 years) who underwent transbronchial needle aspiration biopsy guided by EBUS were included. A total of 177 lymph nodes were evaluated. Among the patients, 88 were diagnosed with malignancy and 71 with sarcoidosis via EBUS-guided TBNA. A significant positive correlation (p < 0.01) was observed between elastography score III and predominantly Stage IV adenocarcinoma diagnosis, lymph node size, border features, presence of necrosis, and elevated FDG uptake. In granulomatous mediastinal lymph nodes diagnosed with histopathological sarcoidosis, a positive correlation was found between elastography scores I and II, while no correlation was established with the disease stage (p > 0.05). Conclusions Our study has demonstrated that EBUS elastography is important in distinguishing granulomatous and malignant lymph nodes and masses, thereby enhancing diagnostic accuracy. It can provide deeper insights into the biological behavior of lymph nodes and may reveal the potential benefits of elastography in future studies, even for lymph nodes measuring 1 cm or smaller.