Endoscopic ultrasound assessment and tissue acquisition of mediastinal and abdominal lymph nodes

Table 1 Endoscopic ultrasound B-mode and color-Doppler criteria for the characterization of suspected lymph nodes

	Benign LNs	Malignant LNs
B-mode criteria
Shape	Oval	Round
Border	Irregular shape	Clear-cut, asymmetric
Echogenicity	Hyperechoic	Hypoechoic
Vascular hilum	Present, central	Absent
Echostructure	Heterogeneous	Homogeneous
Color-Doppler criteria
Hilar doppler sign	Present	Absent or displaced
Subcapsular vessels	Absent	Often present
Avascular areas	Absent	Often present
Resistance index	< 0.8	> 0.8

LNs: Lymph nodes.

Table 2 Summary of diagnostic performance of B-mode endoscopic ultrasound, elastography, contrast-enhanced harmonic endoscopic ultrasound and endoscopic ultrasound-guided fine needle aspiration for lymph nodes characterization

	Pooled sensitivity	Pooled specificity	Area under the curve	Ref.
EUS (B-mode + Doppler)	84.7%	84.6%	0.91	Puli et al[88], 2008
EUS-E	88%	85%	0.95	Xu et al[75], 2011
CH-EUS	87.7%	91.8%	0.97	Lisotti et al[14], 2019
Combined EUS-E + CH-EUS1	43.6%	100%	0.92	Lisotti et al[92], 2019
Combined EUS-E “or” CH-EUS2	93.6%	87.5%	0.91	Lisotti et al[92], 2019
EUS-FNA	87%	100%	0.99	Chen et al[86], 2020

¹Both endoscopic ultrasound-elastography (EUS-E) and contrast-enhanced harmonic EUS (CH-EUS) positive for malignancy.

²At least one technique (EUE-E or CH-EUS) positive for malignancy.

EUS: Endoscopic ultrasound; EUS-E: EUS-elastography; CH-EUS: Contrast-enhanced harmonic EUS; EUS-FNA: EUS-guided fine needle aspiration.