Quantitative computed tomography texture analysis: can it improve diagnostic accuracy to differentiate malignant lymph nodes?

This study aimed to assess the accuracy of computed tomography (CT) texture analysis (CTTA) in differentiating benign from malignant mediastinal lymph nodes (LNs) in non-small-cell lung cancer patients. We retrospectively reviewed pathologically confirmed malignant and benign mediastinal LN samples, obtained via endobronchial ultrasound-guided transbronchial needle aspiration, alongside chest CT and 18-fluorodeoxyglucose (FDG) uptake positron emission tomography data. CTTA was performed using the "AVIEW" software by Coreline Soft. Among the 132 LNs from 80 patients analyzed, compactness and normalized standard deviation in CTTA features showed differences between malignant and benign LNs. The ability to distinguish malignant LNs was higher using high standard uptake value on FDG PET/CT and normalized SD on CTTA; however, normalized SD had low sensitivity despite high specificity. Thus, CTTA may aid in distinguishing between benign and malignant LNs, but its diagnostic value was not high, necessitating integrated evaluation with other imaging modalities.