Elastography in EBUS- Useful Tool or Useless Gadget in 2024

Since 2014, elastography for endobronchial ultrasound has been studied as a tool to predict malignancy and improve the diagnostic yield. We summarize the data and review the clinical applications of elastography.

Meta-analyses for elastography to predict malignant nodes, showed an area under the curve (AUC) of 0.86 to 0.91. However, multiple limitations of EBUS-E exist, with factors such as fibrotic nodes leading to false positives or necrosis leading to false negatives. Standard B-mode features such as heterogenous echogenicity and absence of central hilar structure have good sensitivity (85%). Adding elastography to EBUS B-mode features increases the diagnostic accuracy compared to either technique used alone.

EBUS-E can offer additional information regarding the likelihood of malignancy and the specific areas within the lymph node to target. However, the high negative and positive predictive values of elastography, do not preclude the need to obtain tissue for a definitive diagnosis and molecular subtyping.