The Science Behind NodeAI

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NodeAI’s foundation is built on more than seven years of peer-reviewed research, leading to significant breakthroughs in lung cancer staging, including the development of the Canada Lymph Node Score (CLNS) and advanced AI algorithms for real-time malignancy prediction.

Key Research Milestones:

• Systematic Review (2018):
  • Identified key ultrasonographic features of lymph nodes predictive of malignancy during EBUS-TBNA.
  • Established the need for standardized malignancy scoring criteria.
• Development of the Canada Lymph Node Score (2020):
  • A validated 4-point ultrasonographic scoring system to assess malignancy risk in LNs.
  • CLNS has improved the negative predictive value (NPV) of EBUS to 97%, reducing unnecessary biopsies.
• Triple Normal Lymph Node Concept (2021):
  • Demonstrated that LNs appearing normal on CT, PET, and EBUS (CLNS <2) have a malignancy probability of only 5.7%, supporting targeted over systematic sampling.
• Feasibility and Multi-Center Trials (2022-2023):
  • Validated that targeted sampling (TS) of lymph nodes is non-inferior to systematic sampling, optimizing procedural efficiency.
  • A pan-Canadian trial across multiple sites confirmed the safety and accuracy of targeted sampling strategies.
• AI Algorithm Validation (2022-2024):
  • Development of deep neural network models using a dataset of 2,569 LNs, achieving 96.91% specificity and 0.701 AUC in malignancy prediction.
  • NodeAI’s AI algorithms analyze multiple ultrasound frames in real-time, significantly enhancing diagnostic accuracy over single-frame evaluations.

Key Publications:

• Yogita S. Patel; Anthony A. Gatti; Forough Farrokhyar; Feng Xie; Waël C. Hanna.  Artificial Intelligence Algorithm Can Predict Lymph Node Malignancy from Endobronchial Ultrasound Transbronchial Needle Aspiration Images for Non-Small Cell Lung Cancer - PubMed  Respiration: September, 2024

• Yogita S. Patel, BSca ∙ Anthony A. Gatti, PhDb ∙ Forough Farrokhyar, MPhil, PhDc ∙ Feng Xie, PhDd ∙ Waël C. Hanna, MDCM, MBA.  Clinical utility of artificial intelligence-augmented endobronchial ultrasound elastography in lymph node staging for lung cancer - PubMed . JTCVS Techniques: July, 2024

•  Kerrie A. Sullivan, Forough Farrokhyar, Yogita S Patel, Moishe Liberman, Simon R Turner, Anne V Gonzalez, Rahul Nayak, Kazuhiro Yasufuku, Waël C. Hanna. Preoperative mediastinal staging in early-stage lung cancer: Targeted nodal sampling is not inferior to systematic nodal sampling - PubMed Journal of Thoracic and Cardiovascular Surgery: November 2023 

•  Isabella F. Churchill,Anthony A. Gatti,Danielle A. Hylton, Kerrie A. Sullivan, Yogita S. Patel, Grigorious I. Leontiadis, Forough Farrokhyar, Waël C. Hanna,  An Artificial Intelligence Algorithm to Predict Nodal Metastasis in Lung Cancer - PubMed , The Annals of Thoracic Surgery, August 2021 

•  D. Hylton, Y. Shargall, C. Finley, J. Agzarian, C. Fahim, & W.C. Hanna. (2020). A A novel online education module to teach clinicians how to correctly identify ultrasonographic features of mediastinal lymph nodes during endobronchial ultrasound - PubMed  Can J Surg, 63(1):E62-68. Doi: 10.1503/cjs.000119  

• Danielle A Hylton, Simon Turner, Biniam Kidane, Jonathan Spicer, Feng Xie, Forough Farrokhyar, Kazuhiro Yasufuku, John Agzarian, Waël C Hanna.  The Canada Lymph Node Score for prediction of malignancy in mediastinal lymph nodes during endobronchial ultrasound - PubMed  2019, November 29 

•  Hylton DA, Turner J, Shargall Y, Finley C, Agzarian J, Yasufuku K, Fahim C, Hanna WC.  Ultrasonographic characteristics of lymph nodes as predictors of malignancy during endobronchial ultrasound (EBUS): A systematic review - PubMed 2018 Dec;126:97-105. doi: 10.1016/j.lungcan.2018.10.020. Epub 2018 Oct 30. PMID: 30527199. 

• Hylton DA, Kidane B, Spicer J, Turner S, Churchill I, Sullivan K, Finley CJ, Shargall Y, Agzarian J, Seely AJE, Yasufuku K, Hanna WC; Canadian Association of Thoracic Surgery Research Group.  Endobronchial Ultrasound Staging of Operable Non-small Cell Lung Cancer: Do Triple-Normal Lymph Nodes Require Routine Biopsy? - PubMed Chest. 2021 Jun;159(6):2470-2476. doi: 10.1016/j.chest.2020.12.050. Epub 2021 Jan 9. PMID: 33434503. 

•  He RX, Hylton DA, Bédard ELR, Johnson S, Laing B, Valji A, Hanna WC, Turner SR.  Clinical Validation of the Canada Lymph Node Score for Endobronchial Ultrasound - PubMed  Ann Thorac Surg. 2023 Jun;115(6):1456-1462. doi: 10.1016/j.athoracsur.2021.11.071. Epub 2022 Jan 11. PMID: 35031289. 

• Sullivan KA, Farrokhyar F, Leontiadis GI, Patel YS, Churchill IF, Hylton DA, Xie F, Seely AJE, Spicer J, Kidane B, Turner SR, Yasufuku K, Hanna WC.  Routine systematic sampling versus targeted sampling during endobronchial ultrasound: A randomized feasibility trial - PubMed . J Thorac Cardiovasc Surg. 2022 Jul;164(1):254-261.e1. doi: 10.1016/j.jtcvs.2021.11.062. Epub 2021 Dec 4. PMID: 35031139.