Analysis of the Internal Structure of Peripheral Pulmonary Lesions Using Endobronchial Ultrasonography: Results

Analysis of the Internal Structure of Peripheral Pulmonary Lesions Using Endobronchial Ultrasonography: ResultsCorrelation Between EBUS Images and the Histopathology
The data from the 69 patients in whom preoperative EBUS images could be correlated with the histopathologic findings of surgical specimens were available for analysis (Table 1).
Of the 18 cases of well-differentiated adenocarcinoma, EBUS showed the preservation of blood vessels within the lesion in 7 (Fig 2). The lesions in these cases had homogeneous internal echoes overall, but some hyperechoic dots (ie, < 1 mm in size) also were observed, which reflected the presence of residual air in the invaded alveoli. The distribution of the hyperechoic dots was irregular, and the margins of the lesions also were irregular comments zyrtec tablets. Blood vessels could be seen coursing through the lesion (Fig 2). One of these blood vessels had a diameter of 0.68 mm when measured histopathologically.
In eight other cases of well-differentiated adenocarcinoma, no blood vessels were visualized. These lesions also presented an irregular distribution of hyperechoic dots or arcs around the probe and had poorly defined borders.
In 25 of the 26 cases of moderately differentiated adenocarcinoma and in 6 of 7 cases of squamous cell carcinoma, the EBUS images showed the obstruction of blood vessels within the lesion, the obstruction of bronchi, heterogeneous internal echoes, and irregular margins (Fig 3). In one case of moderately differentiated adenocarcinoma, numerous very small hyperechoic echoes were observed within the lesion, the distribution of which was identical to that of the multiple calcifications observed histopathologically. In two cases of squamous cell carcinoma, numerous echo-free areas of various sizes were noted, and their distribution corresponded to areas of necrosis (Fig 4).
In one other case of squamous cell carcinoma, a circular hyperechoic line around the probe corresponded to the bronchial wall, revealing the growth and outward compression of the adventitia of the bronchus. In six cases of poorly differentiated adenocarcinoma, EBUS revealed few patent blood vessels or bronchi, heterogeneous internal echoes, and irregular margins.
Fig2
Figure 2. A representative case of well-differentiated adenocarcinoma. This image, which shows a typical case of well-differentiated adenocarcinoma, has homogeneous internal echoes overall. Blood vessels coursing through the lesion are visible. The blood vessel (arrow) has a diameter of 0.68 mm when measured histopathologically.
Fig3
Figure 3. A representative case of moderately differentiated adenocarcinoma. This EBUS image revealed the obstruction of blood vessels within the lesion, the obstruction of bronchi, heterogeneous internal echoes, and irregular margins.
Fig4
Figure 4. A representative case of squamous cell carcinoma. This EBUS image revealed numerous echo-free areas of various sizes within the lesion, and their distribution corresponded histopathologically to areas of necrosis within the tumor.

Table 1—Comparison of Preoperative EBUS Images to the Histopathologic Findings in the 69 patients

Pathology Patients, No. Size, cm
Adenocarcinoma
WD 18 2.2
MD 26 2.5
PD 6 2.3
SCC 7 2.7
Small cell carcinoma 4 2.5
Carcinoid 3 3.3
Malignant lymphoma 2 3
Metastatic tumor 2 3.5
Inflammatory pseudotumor 1 3.2
Total 69
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