Abstract
Aim: The purpose of this study was to assess the ability of contrast-enhanced ultrasonography (CEUS) in the differential diagnosis of cancerous lymph nodes.Methods: Contrast-enhanced ultrasonography was performed in the cervical nodules of included patients, and the diagnoses were confirmed by pathological examination. Contrast-enhanced ultrasonography images and parameters of head and neck lymphomas were compared with those of cancerous lymph nodes. Besides, receiver operating characteristic curve was operated to access the diagnostic value of CEUS.Results: Finally, a total of 63 head and neck lymphomas and 80 cervical cancerous lymph nodes were enrolled in this study. Results showed that the CEUS images of lymphoma were mainly characterized by homogeneous enhancement (71.43%), and approximately half of them were centripetal perfusion (58.73%), whereas most CEUS images of cancerous lymph nodes were inhomogeneous enhancement (82.50%) and centripetal perfusion (92.50%). Quantitative analysis of CEUS parameters indicated that PI (derived peak intensity) and AUC (area under the curve) of lymphomas were both lower than those of cancerous lymph nodes (PI: 8.78 vs. 10.51, AUC: 652.62 vs. 784.09, respectively) (P < 0.05). Receiver operating characteristic analysis showed that the sensitivity of CEUS parameters in the differential diagnosis was significant (80.00%), although the specificity was not high (47.62%). When parameters were combined with the image features, the accuracy of diagnosis was greatly improved (from 0.655 to 0.899).Conclusion: Contrast-enhanced ultrasonography could be a promising tool for the differential diagnosis of head and neck lymphomas and cancerous lymph nodes.
Highlights
Lymphomas, malignant diseases that originate from lymph nodes or lymphoid tissues, are normally divided into Hodgkin and non-Hodgkin lymphoma [1]
Results showed that the contrast-enhanced ultrasonography (CEUS) images of lymphoma were mainly characterized by homogeneous enhancement (71.43%), and approximately half of them were centripetal perfusion (58.73%), whereas most CEUS images of cancerous lymph nodes were inhomogeneous enhancement (82.50%) and centripetal perfusion (92.50%)
Quantitative analysis of CEUS parameters indicated that peak intensity (PI) and area under the curve (AUC) of lymphomas were both lower than those of cancerous lymph nodes (PI: 8.78 vs. 10.51, AUC: 652.62 vs. 784.09, respectively) (P < 0.05)
Summary
Malignant diseases that originate from lymph nodes or lymphoid tissues, are normally divided into Hodgkin and non-Hodgkin lymphoma [1]. The prognosis of lymphoma is poor, which is related to the fact that most patients are already in advanced stage when diagnosed. Most lymphoma patients display no obvious clinical symptoms at early stage, and sometimes cervical lymphadenopathy is the only initial complaint [2]. It is very important to determine the nature of cervical lymphadenopathy for the diagnosis and prognosis of head and neck lymphoma. There are various diseases that may contribute to lymph node enlargement in the neck, including head and neck cancer, infection, tuberculosis, and so on [3]. Early diagnostic methods with high sensitivity to cervical lymphadenopathy are extremely important
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