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Öğe Automatic Sleep Stage Classification for the Obstructive Sleep Apnea(Trans Tech Publications Ltd, 2023) Ozsen, Seral; Koca, Yasin; Tezel, Gulay Tezel; Solak, Fatma Zehra; Vatansev, Hulya; Kucukturk, SerkanAutomatic sleep scoring systems have been much more attention in the last decades. Whereas a wide variety of studies have been used in this subject area, the accuracies are still under acceptable limits to apply these methods to real-life data. One can find many high-accuracy studies in literature using a standard database but when it comes to using real data reaching such high performance is not straightforward. In this study, five distinct datasets were prepared using 124 persons including 93 unhealthy and 31 healthy persons. These datasets consist of time-, nonlinear-, welch-, discrete wavelet transform- and Hilbert-Huang transform features. By applying k-NN, Decision Trees, ANN, SVM, and Bagged Tree classifiers to these feature sets in various manners by using feature-selection highest classification accuracy was searched. The maximum classification accuracy was detected in the case of the Bagged Tree classifier as 95.06% with the use of 14 features among a total of 136 features. This accuracy is relatively high compared with the literature for a real-data application.Öğe Central involvement of SARS-CoV-2 may aggravate ARDS and hypertension(Hindawi Ltd, 2020) Cure, Erkan; Cumhur Cure, Medine; Vatansev, Hulya[Abstract Not Availabe]Öğe Clinical Evaluation of Acute Pancreatitis Caused by SARS-CoV-2 Virus Infection(Hindawi Ltd, 2021) Vatansev, Hulya; Yildirim, Mehmet Aykut; Kuccukturk, Serkan; Karaselek, Mehmet Ali; Kadiyoran, CengizIntroduction. Coronavirus 2019 disease (COVID-19), caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), has spread to more than 200 countries worldwide. We aimed to present acute pancreatitis (AP) cases caused by SARS-CoV-2 viral infection. Methods. The study was conducted retrospectively between April 2020 and June 2020 in Necmettin Erbakan University Meram, Medical Faculty Hospital, and 150 hospitalized patients diagnosed with COVID-19 were included. The degree of acute pancreatitis was determined according to the Atlanta classification. Organ failures of the patients were evaluated in terms of respiratory, cardiovascular, and nephrology according to the modified Marshall scoring (MMS) system, and CTSI (Balthazar score) and Imrie score were determined. Modified Marshall score >= 2 was considered organ failure. Results. A total of 29 patients were diagnosed with acute pancreatitis. All 29 patients with pancreatitis had respiratory failure during hospitalization. After the diagnosis of pancreatitis, there was no change in respiratory failure. According to the Atlanta classification, 19 patients had mild AP and 10 patients had moderate AP. Patients with acute pancreatitis were scored according to the CTSI (Balthazar score), and there were no patients with >= 6 severe pancreatitis. The CTSI score of 4 patients was 3. In addition, the Imrie score of the patients was determined and 8 patients with Imrie score >= 3 were identified. Conclusion. The rate of pancreatic damage in SARS-CoV-2 infection was found to be 19% (n=29) in our study. In our study, we highlight acute pancreatitis as a complication associated with COVID-19 and the importance of pancreatic evaluation in patients with COVID-19 and abdominal pain is demonstrated.Öğe Comparison of Clinical and Laboratory Findings and Computed Tomography Findings of SARS-CoV-2 Infected Patients Followed-up in a Tertiary University Hospital(Galenos Publ House, 2021) Kurt, Esma Kepenek; Kandemir, Bahar; Erayman, Ibrahim; Vatansev, Hulya; Zamani, Adil; Yosunkaya, Sebnem; Demirbas, SonerIntroduction: The severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infection is a pandemic, a major global health concern. In this study, it was aimed to compare the clinical, laboratory and computed tomography (CT) findings of patients with SARS-CoV-2 infection followed up in our hospital. Materials and Methods: In this study, reverse transcriptase-polymerase chain reaction (RT-PCR) positive patients hospitalized between 01.03.2020-31.05.2020 were retrospectively analyzed. Computed tomography images of the patients were grouped as typical, indeterminate, atypical, and no pneumonia based on the Radiological Society of North America. After recording patient information on SPSS, clinical and laboratory findings of the patients were analyzed by comparing them to CT findings. Results: Among 237 RT-PCR positive patients, 104 (43.9%) were female and 133 (56.1%) were male. The mean age of the patients was 50.46 +/- 17.26 (18-92) years and the mean symptom onset time of the patients was 3.75 +/- 2.72 (median: 3) days. Eighty-seven of the patients (36.7%) had contact stories. Twenty-three (9.7%) patients were healthcare professionals. Of the patients, 49.8% had a comorbid disease. The most common referral complaint was cough with 66.7%. The most common treatment that patients received was hydroxychloroquine (96.2%). Anemia was detected in 61 (25.7%) patients, leukopenia in 104 (43.9%), lymphopenia in 25 (10.5%) and thrombocytopenia in 14 (5.9%). High rates were detected for C-reactive protein (CRP) in 221 (84%) patients, ferritin in 190 (80.2%) patients, D-dimer in 144 (60.8%) patients, fibrinogen in 147 (62%) patients and sedimentation (SED) in 172 (72.6%) patients. Headache was detected higher in patients with typical pneumonia findings in thorax CT (p=0.006). A statistically significant difference wasn't detected between other symptoms and CT findings. Leukocyte and neutrophil counts, SED, CRP, ferritin, D-dimer, fibrinogen, aspartate aminotransferase, and lactate dehydrogenase (p=0.001) levels were observed to be higher in patients with typical pneumonia findings on thorax CT. Conclusion: Some laboratory parameters, especially acute phase reactants, were found to be higher in patients with typical pneumonia on thorax CT compared to patients without pneumonia. In this viral infection, patients should be evaluated together with clinical, laboratory and CT findings.Öğe COVID-19 infection can cause chemotherapy resistance development in patients with breast cancer and tamoxifen may cause susceptibility to COVID-19 infection(Churchill Livingstone, 2020) Vatansev, Hulya; Kadiyoran, Cengiz; Cure, Medine Cumhur; Cure, ErkanBreast cancer is the most common cancer in women and is the second most common cause of death in women. Estrogen plays an important role in breast tumor etiopathogenesis. Tamoxifen and other anti-estrogen drugs are used in breast cancer patients who have a positive estrogen receptor (ER). While angiotensin II plays a key role in breast cancer etiology and causes tamoxifen resistance, angiotensin 1-7 has been reported to may reduce the spread and invasion of breast cancer. During the COVID-19 infection, the virus blocks ACE2, and angiotensin 1-7 production discontinued. Angiotensin III production may increase as angiotensin II destruction is reduced. Thus, aminopeptidase upregulation may occur. Increased aminopeptidase may develop resistance to chemotherapy in breast cancer patients receiving chemotherapy. Estrogen can have a protective effect against COVID-19. Estrogen increase causes ER-a upregulation in T lymphocytes. Thus, estrogen increases the release of interferon I and III from T lymphocytes. Increasing interferon I and III alleviates COVID-19 infection. Tamoxifen treatment causes down-regulation, mutation, or loss in estrogen receptors. In the long-term use of tamoxifen, its effects on estrogen receptors can be permanent. Thus, since estrogen receptors are damaged or downregulated, estrogen may not act by binding to these receptors. Tamoxifen is a P-glycoprotein inhibitor, independent of its effect on estrogen receptors. It suppresses T cell functions and interferon release. We think tamoxifen may increase the COVID-19 risk due to its antiestrogen and P-glycoprotein inhibitory effects.Öğe Early Computed Tomography Findings of Novel Coronavirus Disease 2019 (COVID-19) Pneumonia(Briefland, 2020) Yilmaz, Pinar Diydem; Kadiyoran, Cengiz; Bakdik, Suleyman; Poyraz, Necdet; Vatansev, HulyaBackground: Novel coronavirus disease (COVID-19) pneumonia is caused by severe acute respiratory syndrome coronavirus 2 (SARSCoV-2), which is highly contagious and threatens human health. Chest computed tomography (CT) is an accurate imaging modality for diagnosis and follow-up. Objectives: To investigate early CT features of COVID-19 pneumonia. Methods: Retrospective study. Sixty-three patients with COVID-19 pneumonia (28 men, 35 women; age range, 21 - 85 years; mean, 59 years) confirmed by reverse transcription-polymerase chain reaction (RT-PCR) were enrolled in this retrospective study and CT findings were evaluated. Patients were classified into three groups for estimating COVID-19 pneumonia, according to CT features. Results: Nineteen (30%) patients classified as out of COVID-19 pneumonia had normal CT findings. Twenty-eight (44%) patients, classified as highly suggestive for COVID-19 pneumonia, had typical findings for COVID-19 pneumonia. In highly suggestive for COVID-19 pneumonia group most common CT features were peripheral (64%), multilobar (96%), patchy, and round (54%) ground-glass opacity (GGO) (57%). Air bronchogram (93%), crazy-paving patterns (79%), and vascular thickening (61%) were the mostcommon special findings. We only detected these rare findings such as halo sign, reverse halo sign, lymphadenopathy, pleural and pericardial effusion, pleural thickening, and fibrotic lines in patients with COVID-19 with chronic diseases. Conclusions: The early CT findings are peripheral, multilobar, patchy, and round ground glass opacities accompanied by vascular thickening, crazy-paving pattern, or air bronchogram sign. Rare findings are only seen in the presence of concomitant diseases.Öğe Effects of comprehensive and intensive pulmonary rehabilitation and nutritional support on quality of life and functional status in patients with chronic obstructive pulmonary disease(Sage Publications Ltd, 2020) Korkmaz, Celalettin; Demirbas, Soner; Vatansev, Hulya; Yildirmn, Elif; Teke, Turgut; Zamani, AdilObjective To investigate the effects of pulmonary rehabilitation (PR) and combined nutritional support therapy on quality of life (QoL) and functional status in patients with chronic obstructive pulmonary disease (COPD). Methods This pre-and post-intervention prospective exploratory study involved 64 patients with stable stage three to four COPD. Oral nutritional support and personalized diet were combined with an intense and comprehensive PR program. Baseline and 8-week follow-up scores were compared for the 6-minute walk test (6MWT), incremental shuttle walking test (ISWT), St. George's Respiratory Questionnaire (SGRQ), pulmonary function tests (PFT), PImax-PEmax, arterial blood gas (ABG), respiratory rate (RR), handgrip strength, Borg and modified Medical Research Council dyspnoea scale scores and fat-free mass index. Results Significant improvements were found in functional status (6MWT: 86.72 m, ISWT: 76.24 m), QoL (SGRQ total: 13.86), PFT, ABG, RR, dyspnoea, upper extremity muscle strength and hand-body composition. Conclusion Nutritional support with comprehensive and intensive PR can significantly improve physical performance, QoL, dyspnoea and body composition in COPD. The improvement in QoL was greater than that reported in previous studies. Because two modalities were combined in this study, future randomized controlled studies are needed to confirm the extent and contribution of these modalities to the outcomes.Öğe Effects of COVID-19 Pandemic on Psychological Condition and Disease Severity in Patients with Behcet's Disease(Yerkure Tanitim & Yayincilik Hizmetleri A S, 2020) Kucuk, Adem; Vatansev, Hulya; Gica, Sakir; Demir, Salih; Cure, ErkanObjective: Behcet's disease (BD) is an episodic and chronic multisystemic disease. Many comorbid psychiatric disorders are frequently encountered in BD. In addition, it is reported that individuals with chronic diseases during the epidemic period are at risk for COVID-19 infection. Therefore, these situations may cause anxiety levels to increase and coping strategies to decrease overall psychological conditions in patients with BD. However, individuals with both psychiatric complaints and comorbid inflammatory and chronic diseases such as BD are more prone to this stressful situation than healthy individuals. In the current study, we aimed to determine whether patients with Behcet's Disease (BD) are psychologically more sensitive than healthy individuals and whether disease severity increase with the COVID-19 pandemic. Methods: One hundred and fifty-six patients with BD and 156 healthy volunteers were included in the study. All participants received Perceived COVID-19 Threat Form (PCTF), Suicide-Ideation Scale (SIS), Hospital Anxiety and Depression Scale (HADS), The Ability to Cope with Trauma (PACT), well-being index (PGWB) scales. Results: When the responses of the patient with BD and control groups to the psychiatric evaluation scales were examined; the mean scores of PCTF (p <0.001), SIS (p<0.001), HADS-depression (p<0.001) and HADS-anxiety (p<0.001) in patients with BD were significantly higher than the control group. Mean scores of PGWB (p<0.001) and PACT (p= 0.042) in the patient group were found to be lower. In the relationship analysis, BSAS scores were associated with PCTF scores (r=0.20, p=0.013), and PGWB scores were associated with PACT scores (r=0.53, p=0.001). Conclusion: COVID-19 pandemic affects the mental health of both male and female patients with BD significantly. In patients with BD, while disease severity was associated with the perceived COVID threat, psychological well-being was associated with existing psychiatric complaints and patients' ability to cope with trauma. The findings of our study support that patients with BD may need more psychological support than ever during the COVID-19 pandemic.Öğe Evaluation of coagulation with TEG in patients diagnosed COVID-19(Tubitak Scientific & Technological Research Council Turkey, 2022) Vatansev, Hulya; Karaselek, Mehmet Ali; Yilmaz, Resul; Kuccukturk, Serkan; Topal, Ahmet; Yosunkaya, Sebnem; Kucuk, AdemBackground and aim: A high D-dimer level may indicate the risk of coagulopathy and mortality in COVID-19 patients. Thromboelastography (TEG) is a test that evaluates clot formation and fibrinolysis in real-time, unlike routine coagulation tests. The study aimed to investigate the coagulation process with TEG in patients diagnosed with COVID-19. Materials and Methods: The study was performed at our university hospital, chest diseases outpatient clinic as a cross-section study. A total of 51 patients with 23 high D-dimer levels group (HDG) and 28 low D-dimers group (LDG) were included in the study. TEG analysis was performed at the pretreatment evaluation in these two groups. Results: D-dimer and fibrinogen levels of the HDG were higher than those of the LDG (550 vs. 90 ng/mL, p < 0.001; 521 vs. 269 mg/ dL, p < 0.001, respectively). In TEG analysis, HDG's R and K values were lower than LDG, and HDG's Angle, MA, and CI values were higher than LDG (p = 0.037; p < 0.001; p < 0.001; p < 0.001; p < 0.001, respectively). ROC curve analysis suggested that the optimum TEG parameters cut-off points for thrombosis risk were as below: for K was <_2.1 min, for R was <_6.1 min, for Angle was >62 degrees, MA was 60.4 mm. Conclusion: Our study showed that the risk of thrombosis might increase in COVID-19 patients who are not hospitalized in the intensive care unit. Thrombosis risk should be investigated with TEG analysis and laboratory tests in every patient diagnosed with COVID-19, and treatment should be started for risky patients.Öğe Evaluation of the knowledge level and attitude of physicians towards obstructive sleep apnea syndrome(Bayrakol Medical Publisher, 2021) Sarioglu, Ayse; Ecirli, Samil; Senturk, Hayriye; Pekgor, Selma; Vatansev, Hulya; Bekci, Taha TahirAim: The knowledge level and approach of physicians in Turkey to obstructive sleep apnea syndrome (OSAS) is unknown. The aim of this study is to evaluate the knowledge level and attitudes of physicians from various branches to OSAS. Materials and Methods: In this cross-sectional analytical study, Obstructive Sleep Apnea Knowledge and Attitude (OSAKA) questionnaire was performed in order to measure knowledge levels and attitudes to OSAS. SPSS 22 package program was used for statistical analysis of data, p-value <0.05 was considered significant. Results: Four hundred forty-four physicians (16 from fundamental sciences, 295 from internal branches, 99 from surgical branches and 34 general practitioners) participated in the study. The mean knowledge score was 11.41 +/- 3.05 (0-18). The knowledge score of physicians aged 30 years and younger was significantly higher than those aged 31 years and older (p <0.001). There was a negative correlation between knowledge score and age of doctors (rs=-0.214, p <0.001). The level of knowledge of pulmonologists and ENT specialists was higher compared to physicians of other branches (p <0.05). No significant difference was detected between the knowledge scores of academicians and non-academicians (p> 0.05). There was no correlation between knowledge scores and academic degrees (rs=-0.072, p = 0.188). It was observed that the knowledge level of physicians whose professional experience was 4 years or less was higher than that of those whose professional experience was 5 years or more (p = 0.001). A negative correlation was also detected between knowledge scores and professional experience (rs=-0.193, p <0.001). Discussion: It was determined that physicians' level of knowledge about OSAS was not sufficient and they felt insufficient about the management of OSAS patients. It would be appropriate to raise awareness of OSAS among practicing physicians within the scope of vocational training as well as in medical faculties and institutions providing specialist training.Öğe The Impact of Lung Ultrasound on Coronavirus Disease 2019 Pneumonia Suspected Patients Admitted to Emergency Departments(Lippincott Williams & Wilkins, 2021) Sonmez, Leyla Ozturk; Katipoglu, Burak; Vatansev, Hulya; Kaykisiz, Eylem Kuday; Yuce, Nalan; Szarpak, Lukasz; Evrin, TogayObjective The aim of this study was to identify the sensitivity and specificity of lung ultrasound (LUS) and show its place in diagnosing patients with known coronavirus disease 2019 (COVID-19) pneumonia, according to chest computed tomography and the COVID-19 reporting and data system (CO-RADS). Methods Nineteen patients who admitted to a single university hospital emergency department between March 5, 2020, and April 27, 2020, describing dyspnea were included in the study and underwent LUS by a single emergency specialist. The patient population was divided into 2 groups, COVID-19 positive and negative, and the sensitivity and specificity of LUS according to chest computed tomography were calculated for COVID-19 pneumonia diagnosis. In the subgroup analysis, the patient group was divided into real-time reverse transcription-polymerase chain reaction positive (n = 7) and negative (n = 12), and sensitivity and specificity were calculated according to the CO-RADS. Results According to the CO-RADS, significant differences were detected between the LUS positive and negative groups in terms of COVID-19 pneumonia presence. Only 1 patient was evaluated as CO-RADS 2 in the LUS positive group, and 2 patients were evaluated as CO-RADS 4 in the LUS negative group (P = 0.04). The sensitivity of LUS according to the CO-RADS for COVID-19 pneumonia diagnosis was measured to be 77.78% (95% confidence interval [CI], 39.9%-97.1%), specificity was 90% (95% CI, 55.5%-99.75%), positive predictive value was 87.5% (95% CI, 51.35%-97.8%), and accuracy was 84.21% (95% CI, 60.4%-96.62%; P = 0.004). Conclusions In conclusion, LUS is easily used in the diagnosis of COVID-19 pneumonia because it has bedside application and is fast, easy to apply, reproducible, radiation free, safe for pregnant women, and cheap.Öğe Memory B cells and serum immunoglobulins are associated with disease severity and mortality in patients with COVID-19(Oxford Univ Press, 2022) Colkesen, Fatih; Kepenek Kurt, Esma; Vatansev, Hulya; Korkmaz, Celalettin; Colkesen, Fatma; Yucel, Fatih; Yildiz, ErayPurpose of the study The aim of this study was to investigate the relationship of B cell-mediated immunity with disease severity and mortality in patients with COVID-19. Study design In this retrospective cohort and single-centre study, 208 patients with laboratory-confirmed COVID-19 were recruited. A COVID-19 severity score, ranging from 0 to 10, was used to evaluate associations between various factors. Serum immunoglobulin levels and the number of cells in B lymphocyte subsets were measured and their association with disease severity and mortality in patients with COVID-19 examined. Results The median age of the patients was 50 (35-63) years and 88 (42%) were female. The number of deceased patients was 17. The median COVID-19 severity score was 8 (6-8) in deceased patients and 1 (0-2) in survivors. Deceased patients had significantly lower levels of total B lymphocytes, naive B cells, switched memory B cells, and serum IgA, IgG, IgG(1) and IgG(2) than recovered patients (all p<0.05). In addition, a significant negative correlation was found between the number of these parameters and COVID-19 severity scores. Decrease in the number of total B cells and switched memory B cells as well as lower serum IgA, IgG and IgG(1) levels were independent risk factors for mortality in patients with COVID-19. Conclusion In the present study, the prognosis of patients with COVID-19 was shown to be associated with the B cell subset and serum immunoglobulin levels.Öğe Relationship between obstructive sleep apnea and human leukocyte antigen variants(European Respiratory Soc Journals Ltd, 2020) Zamani, Ayse Gul; Yosunkaya, Sebnem; Zamani, Adil; Vatansev, Hulya; Yildirim, Selman[Abstract Not Availabe]Öğe Relationship between Selective IgA Deficiency and COVID-19 Prognosis(Natl Inst Infectious Diseases, 2022) Colkesen, Fatih; Kandemir, Bahar; Arslan, Sevket; Colkesen, Fatma; Yildiz, Eray; Korkmaz, Celalettin; Vatansev, HulyaThe prevalence and mortality rates of coronavirus disease 2019 (COVID-19) widely vary among populations. Mucosal immunity is the first barrier to the pathogen's entry into the body. Immunoglobulin A (IgA) is the primary antibody responsible for mucosal immunity. We explored the relationship between selective IgA deficiency (SIgAD) and COVID-19 severity. We included 424 patients (203 women) with COVID-19. Eleven patients had SIgAD. Laboratory data of patients with SIgAD and normal IgA levels were compared. The relationship between SIgAD and severe COVID-19 infection was explored using logistic regression analysis. In the univariate logistic regression analysis, the risk of severe COVID-19 disease in patients with SIgAD was approximately 7.7 -fold higher than that in other patients (odds ratio [OR], 7.789; 95% confidence interval [CI], 1.665-36.690, P = 0.008), while it was 4-fold (OR, 4.053; 95% CI, 1.182-13.903, P = 0.026) higher in the multivariate logistic regression analysis. Serum IgA levels were positively correlated with total lymphocyte counts and negatively correlated with C-reactive protein levels, which was a risk factor for severe COVID-19. In patients with SIgAD, the number of severe acute respiratory coronaviruses 2 that pass through mucosal membranes may be increased, leading to complications such as cytokine storm syndrome and acute respiratory distress syndrome.Öğe The Role of NEWS2(Taiwan Soc Emergency Medicine, 2022) Kucukceran, Kadir; Ayranci, Mustafa Kursat; Dundar, Zerrin Defne; Keklik, Muhammed Idris; Vatansev, HulyaBackground: We investigated the parameters of National Early Warning Score 2 (NEWS2) + lactate + D-dimer in predicting the intensive care unit (ICU) admission and in-hospital mortality in patients hospitalized with COVID-19. Methods: Patients, who applied to the emergency department of a tertiary university hospital and were taken to the COVID-19 zone with suspected COVID-19 between March 2020 and June 2020, were retrospectively examined. In this study, 244 patients, who were hospitalized and had positive polymerase chain reaction test results, were included. NEWS2, lactate, and D-dimer levels of the patients were recorded. Patients were grouped by the states of in-hospital mortality and ICU admission. Results: Of 244 patients who were included in the study, 122 (50%) were male, while their mean age was 53.76 +/- 17.36 years. 28 (11.5%) patients were admitted to the ICU, while in-hospital mortality was seen in 14 (5.7%) patients. The levels of D-dimer, NEWS2, NEWS2 + lactate, NEWS2 + D-dimer, NEWS2 + lactate + D-dimer were statistically signifi cantly higher in patients with in-hospital mortality and admitted to ICU (p < 0.05). The area under the curve (AUC) values of D-dimer, lactate, NEWS2, NEWS2 + lactate, NEWS2 + D-dimer, NEWS2 + lactate + D-dimer in predicting ICU admission were as 0.745 (0.658-0.832), 0.589 (0.469-0.710), 0.760 (0.675-0.845), 0.774 (0.690-0.859), 0.776 (0.692-0.860), and 0.778 (0.694-0.862), respectively; while the AUC values of these parameters in predicting in-hospital mortality were found to be as 0.768 (0.671-0.865), 0.695 (0.563-0.827), 0.735 (0.634-0.836), 0.757 (0.647-0.867), 0.752 (0.656-0.848), and 0.764 (0.655-0.873), respectively. Conclusions: Compared to using the NEWS2 value alone, a combination of NEWS2, lactate, and D-dimer was found to be more valuable in predicting in-hospital mortality and ICU admission.Öğe The value of endobronchial ultrasound-guided transbronchial needle aspiration, 18-fluorodeoxyglucose positron emission tomography/computed tomography, and ultrasonography imaging techniques in the diagnosis of mediastinal and/or hilar malignant, anthracotic, and other benign lymph nodes(Lippincott Williams & Wilkins, 2021) Korkmaz, Celalettin; Demirbas, Soner; Vatansev, HulyaIntroduction: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a simple, reliable, minimally invasive and effective procedure. However, a surgical technique may be required, if the results are negative. Therefore, there is a need for new studies to increase the diagnostic value of EBUS-TBNA and provide additional information to guide the biopsy in performing the procedure. Here, we aimed to investigate the diagnostic value of EBUS-TBNA and 18-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) in diagnosis of hilar and/or mediastinal lymph nodes (LNs). It was also aimed to determine the contributions of real-time ultrasonography (USG) images of LNs to distinguishing between the malignant and benign LNs during EBUS-TBNA, and in the diagnosis of anthracotic LNs. Material and Method: In the retrospective study including 545 patients, 1068 LNs were sampled by EBUS-TBNA between January 2015 and February 2020. EBUS-TBNA, 18-FDG PET/CT and images of USG were investigated in the diagnosis of mediastinal and/or hilar malignant, anthracotic and other benign LNs. Results: The sensitivity, specificity, positive predictive value and negative predictive value of EBUS-TBNA were found as 79.5, 98.1, 89.5, and 91.7%, respectively. Mean maximum standardized uptake value (SUVmax) values of 18F-FDG PET/CT were 6.31 +/- 4.3 in anthracotic LNs and 5.07 +/- 2.53 in reactive LNs. Also, mean SUVmax of malignant LNs was 11.02 +/- 7.30 and significantly higher than that of benign LNs. In differentiation of malignant-benign tumors, considering the cut off value of 18F-FDG PET/CT SUVmax as 2.72, the sensitivity and specificity was 99.3 and 11.7%, but given the cut off value as 6.48, the sensitivity, specificity, positive predictive value and negative predictive value was found as 76.5, 64, 20.49, and 78.38% for benign LNs, respectively. Compared LNs as to internal structure and contour features, malignant LNs had most often irregular contours and heterogeneous density. Anthracotic, reactive and other benign LNs were most frequently observed as regular contours and homogeneous density. The difference between malignant and benign LNs was significant. Conclusion: EBUS can contribute to the differential diagnosis of malignant, anthracotic and other benign LNs. Such contributions can guide clinician bronchoscopists during EBUS-TBNA. The triple modality of EBUS-TBNA, 18FDG PET/CT, and USG may increase the diagnostic value in hilar and mediastinal lymphadenopathies.
