Abstract
Objective: The aim of the study was to evaluate the diagnostic value of contrast-enhanced ultrasound (CEUS) in distinguishing between benign and malignant cervical lymph nodes in patients with nasopharyngeal carcinoma (NPC).Material and Methods: A total of 144 NPC patients with enlarged superficial cervical lymph nodes underwent CEUS examination. The comparison of CEUS image characteristics between malignant and benign cervical lymph nodes was performed in this study as well. We analyzed parameters of the time–intensity curve (TIC), which includes time to peak (TP), area under the gamma curve (AUC), and peak intensity (PI). Furthermore, receiver operating characteristic (ROC) curve analysis was also investigated to evaluate the diagnostic value of CEUS.Result: We conducted 144 lymph node examinations in total, where 64 cases were biopsy-proven benign nodules and 80 cases were biopsy-proven metastatic nodules. The vast majority of the benign nodes displayed centrifugal perfusion (96.88%, 62/64) and homogeneous enhancement (93.75%, 60/64), while most of the malignant nodes showed centripetal perfusion (92.50%, 74/80) and inhomogeneous 80.00% (64/80). In addition, quantitative analysis showed that CEUS parameters including PI, TP, and AUC in benign lymph nodes (12.51 ± 2.15, 23.79 ± 11.80, and 1110.33 ± 286.17, respectively) were significantly higher than that in the malignant nodes (10.51 ± 2.98, 16.52 ± 6.95, and 784.09 ± 340.24, respectively). The assistance of the three aforementioned parameters and CEUS image characteristics would result in an acceptable diagnostic value.Conclusion: Our results suggest that imaging perfusion patterns as well as quantitative parameters obtained from CEUS provide valuable information for the evaluation of cervical lymph nodes in NPC patients.
Highlights
Nasopharyngeal carcinoma (NPC) is a highly prevalent head and neck malignancy in southeast Asia, with an incidence rate of 20 to 50 cases per 100,000 males [1]
There was a significant difference in enhancement orders between benign and malignant lymph nodes: most of the metastatic nodes in this study showed a centripetal enhancement order, which can be found in only two benign lymph nodes
This was consistent with a previous point of view that the enhancement degree of the lesion in Contrast-enhanced ultrasound (CEUS) depended on the richness of blood supply, and the high-enhancement ring was considered to be the edge area of tumor that closely adhered to the pseudo-capsule fibrous tissue with high microvascular density [24]
Summary
Nasopharyngeal carcinoma (NPC) is a highly prevalent head and neck malignancy in southeast Asia, with an incidence rate of 20 to 50 cases per 100,000 males [1]. The incidence of cervical lymph node involvement in pathologically diagnosed NPC cases is up to 85%, which is much higher than other head and neck cancers [2]. Evaluation of lymph node metastasis is extremely essential for the N staging and treatment of NPC, as well as for the prognosis of NPC [3, 4]. Fine needle aspiration biopsy is the gold standard for identifying cervical lymph node metastasis in NPC patients. With the help of imaging examination, the nature of lymph nodes can be preliminarily determined, which improves the accuracy of fine needle aspiration biopsy. Evaluation of lymph node metastasis is extremely essential for the N staging and treatment of NPC, as well as for the prognostication of NPC
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
