Underestimated value of Hounsfield unit in differentiating benign and malignant lymph nodes via EBUS-TBNA
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Updated: Nov 3, 2026
Systematic Endobronchial Ultrasound - The Six Landmarks Approach
Published on: August 11, 2023
Caner Çınar1, Zeynep Mercancı2, Şehnaz Olgun Yıldızeli2
1Department of Pulmonary and Critical Care Medicine, Marmara University, Istanbul, Turkey. dr.canercinar@gmail.com.
Introduction:
Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is vital for diagnosing mediastinal/hilar lymphadenopathy. This study investigated the diagnostic performance of Hounsfield unit (HU) values and PET-CT SUVmax in differentiating malignant from benign lymph nodes.
Methods:
This retrospective analysis included 168 patients who underwent EBUS-TBNA between 2021 and 2024. Data on demographics, smoking history, HU, PET-CT SUVmax, and EBUS lymph node measurements were collected. Statistical methods included logistic regression and receiver operating characteristic (ROC) analysis to assess diagnostic accuracy.
Results:
Malignant lymph nodes had significantly lower HU values and larger EBUS dimensions (p < 0.05). The PET‒CT SUVmax did not significantly differ (p = 0.607). ROC analysis revealed that HU had the highest predictive accuracy (AUC = 0.678). Logistic regression identified HU as an independent predictor of malignancy.
Conclusion:
CT-based HU measurements have greater diagnostic value than PET-CT SUVmax in predicting malignancy in EBUS-TBNA-biopsied lymph nodes. HU could aid in guiding biopsy decisions and improve diagnostic accuracy.
