Supplementary Material for: Predictive Value of Endobronchial Ultrasound Strain Elastography in Mediastinal Lymph Node Staging: The E-Predict Multicenter Study Results

Background: Systematic assessment of lymph node status by endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is indicated in (suspected) lung cancer. Sampling is herein guided by nodal size and FDG-PET characteristics. Ultrasound strain elastography (SE) might further improve risk stratification. By imaging tissue deformation over time, SE computes relative tissue strain. In several tissues, a lower strain (deformation) has been associated with a higher likelihood of malignancy. Objectives: To assess if EBUS-SE can independently help predict malignancy, and when combined with size and FDG uptake information. Methods: This multicenter (n = 5 centers) prospective trial included patients with suspected or proven lung cancer using a standardized measurement protocol. Cytopathology combined with surgery or follow-up imaging (>6 months) were used as reference standard. Results: Between June 2016 and July 2018, 327 patients and 525 lymph nodes were included (mean size 12.3 mm, malignancy prevalence 0.48). EBUS-SE had an overall AUC of 0.77. A mean strain

背景：对（疑似）肺癌患者通过支气管镜超声引导的经支气管穿刺活检（EBUS-TBNA）进行系统性淋巴结状态评估是必要的。本研究所采用的采样方法是基于淋巴结大小和FDG-PET特征。超声应变弹性成像（SE）可能进一步优化风险分层。通过成像组织随时间的变化，SE计算相对组织应变。在多种组织中，较低的应变（变形）与恶性肿瘤的可能性增加相关。目标：评估EBUS-SE是否能够独立预测恶性肿瘤，以及当与大小和FDG摄取信息相结合时。方法：这是一项多中心（5个中心）前瞻性试验，纳入了疑似或确诊为肺癌的患者，并采用标准化测量方案。细胞病理学与手术或随访影像学检查（>6个月）相结合作为参考标准。结果：2016年6月至2018年7月间，共纳入327名患者和525个淋巴结（平均大小12.3毫米，恶性肿瘤发生率为0.48）。EBUS-SE的整体AUC为0.77。平均应变