Benign Cervical Nodes Research Articles

460. THE ADDITIONAL VALUE OF CERVICAL ULTRASOUND IN THE DETECTION OF CERVICAL LYMPH NODE METASTASES IN PATIENTS WITH ESOPHAGEAL CANCER

Abstract Background Esophageal cancer patients with cervical lymph node metastases, staged according to the 8th edition of the American Joint Committee on Cancer (AJCC), are considered to have stage IV disease and are generally not eligible for treatment with curative intent. External cervical ultrasound (US) used to be standard in the diagnostic workup for detection of cervical lymph node metastases in the Netherlands, but is no longer included in the esophageal cancer guideline. This study aimed to assess the additional value of US over 18FDG PET-CT for the detection of cervical lymph node metastases in esophageal cancer patients, to reassure justified removal of cervical US from the guideline. Methods This retrospective cohort study included all esophageal cancer patients referred to or diagnosed in the Amsterdam UMC between January 2014 and January 2021. Radiology and multidisciplinary team meeting reports were reviewed to identify patients with suspected cervical lymph node(s). Primary outcome was detection rate of cervical lymph node metastases on ultrasound and/or 18FDG PET-CT. Golden standard was etiology based on Fine Needle Aspiration (FNA). Results This study included 768 patients, with a median age of 66 years. Patients were predominantly male (75.0%) and the majority had an adenocarcinoma (71.9%). On 18FDG PET-CT, 77 patients had suspected cervical lymph nodes. Of those, 39 proved malignant. Seven malignant lymph nodes were missed on 18FDG PET-CT. 18FDG PET-CT had a positive predictive value (PPV) of 50.6%, a negative predictive value (NPV) of 99.0%, a sensitivity of 84.8% and a specificity of 94.7%. Based on US alone, 134 patients had suspected cervical lymph nodes. Of those, 45 proved malignant. One malignant lymph node was missed on US. US had a PVV of 33.6%, a NPV of 99.8%, a sensitivity of 97.8% and a specificity of 87.7%. In total, suspected cervical lymph nodes were documented in 151 patients (19.7%). FNA was conducted in 134 out of 151 patients. Of those, 46 proved malignant. No major complications after FNA were reported. For 21 patients, this resulted in stage migration and changed policy from curative intent to palliative. Conclusion Standard US increases the number of FNA conducted for benign cervical lymph nodes, as the positive predictive value is low (33.6%). However, it does have an additional value as it identifies 15% of cervical lymph node metastases that were not seen on 18FDG PET-CT.

Evaluating the Elasticity of Metastatic Cervical Lymph Nodes in Head and Neck Squamous Cell Carcinoma Patients Using DWI-based Virtual MR Elastography.

The assessment of metastatic cervical lymph nodes in head and neck squamous cell carcinoma patients is crucial; as such, many studies focusing on non-invasive imaging techniques to evaluate metastatic cervical lymph nodes have been performed. The aim of our study was to assess the usefulness of elasticity values on diffusion weighted imaging (DWI)-based virtual MR elastography in the evaluation of metastatic cervical lymph nodes from head and neck squamous cell carcinoma. Two head and neck radiologists measured the elasticity values of 16 metastatic cervical lymph nodes from head and neck squamous cell carcinoma and 13 benign cervical lymph nodes on DWI-based virtual MR elastography maps. Mean, minimum, maximum, and median elasticity values were evaluated for lymph nodes between the two groups and interobserver agreement in measuring the elasticity was also evaluated. The mean, maximum, and median elasticity values of metastatic cervical lymph nodes were significantly higher than those of benign cervical lymph nodes (P = 0.001, 0.01, and 0.002, respectively). Diagnostic accuracy, sensitivity, and specificity of the mean elasticity were 82.8%, 93.8%, and 69.2%, respectively. Interobserver agreement was excellent for the mean and median elasticity (intraclass correlation coefficients were 0.98 for both). Estimated elasticity values based on DWI-based virtual MR elastography show significant difference between benign and metastatic cervical lymph nodes from head and neck squamous cell carcinoma. While precise modulation of MR sequences and calibration parameters still needs to be established, elasticity values can be useful in differentiating between these lymph nodes.

The Diagnostic Performance of Multiparametric Ultrasound in the Qualitative Assessment of Inconclusive Cervical Lymph Nodes.

Enlarged cervical lymph nodes (CLNs) can result from infection or malignancies, and a definitive diagnosis requires histological examination. Ultrasound (US) remains the first-line imaging modality for detection, and new US techniques may improve characterization. The aim of our study was to investigate whether the qualitative assessment of multiparametric US (mpUS) can improve diagnostic performance in the differentiation of benign and malignant CLNs. 107 CLNs in 105 patients were examined by preoperative mpUS consisting of B-mode US, color-coded duplex sonography (CCDS), shear wave elastography (SWE) and contrast-enhanced US (CEUS). US images were evaluated in consensus by two experienced US operators. Histopathological examination was used as reference standard. SWE and CEUS combined showed the highest overall diagnostic performance (91% sensitivity, 77% specificity, 87% positive predictive value (PPV), 83% negative predictive value (NPV), 90% accuracy, χ2 (1) = 51.485, p < 0.001) compared to B-mode US and CCDS (87% sensitivity, 44% specificity, 73% PPV, 65% NPV, 73% accuracy χ2 (1) = 12.415, p < 0.001). In terms of individual techniques, SWE had higher specificity than B-mode and CCDS (71% sensitivity, 90% specificity, 92% PPV, 64% NPV, 78% accuracy, χ2 (1) = 36.115, p < 0.001), while qualitative CEUS showed the best diagnostic performance of all investigated US techniques (93% sensitivity, 85% specificity, 91% PPV, 87% NPV, 90% accuracy, χ2 (1) = 13.219, p < 0.001). Perfusion patterns, homogeneity, presence of necrosis, and malignancy differed significantly between malignant and benign CLNs (p < 0.001). SWE and CEUS can facilitate the differentiation of inconclusive CLNs when performed to supplement B-mode US and CCDS. MpUS may thus aid the decision between surgery and a watch-and-scan strategy in enlarged CLNs.

The additive diagnostic role of diffusion-weighted magnetic resonance and chemical shift imaging (CSI) in differentiation between malignant and benign cervical lymph nodes

BackgroundImaging with conventional MRI plays a pivotal role in differentiation between benign and malignant nodes, which is crucial for choice of therapeutic plan. The purpose of this study was to evaluate the role of diffusion-weighted imaging DWI MRI and chemical shift imaging (CSI) (in and out of phase) in differentiation between malignant and benign cervical lymph nodes.Patients and methodsWe prospectively reviewed MR images of 31 patients presented to ENT department by cervical adenopathy. Imaging parameters documented included: morphology, ADC values and in-phase to out-of-phase (Ip/Op) ratios and signal drop in out-of-phase images.ResultsADC values of the benign and malignant nodes were 1.06 ± 0.25 and 0.85 ± 0.24, respectively. A statistically significant difference was found between the two groups (p = 0.041). An ADC value of 0.9 × 10−3 mm2/s was concluded to be the best cutoff value for differentiating benign from malignant LNs. The mean values of in/out-of-phase ratios of benign and malignant lymph nodes were 0.75 ± 0.16 and 0.96 ± 0.06, respectively. A statistically significant difference was found between the two groups (p = 0.001). The mean in/out-of-phase ratio of the benign nodes was significantly lower than that of the malignant nodes.ConclusionsCSI can differentiate between malignant and benign lymph nodes with a cutoff value of in/out-phase ratio of 0.9. Also, adding the diffusion-ADC map can prefer the same value with a cutoff value of 0.9 × 10−3 cm2/s. Adding CSI sequence to conventional MRI in examining the nodal status in patients with head and neck primary can enhance diagnostic accuracy of the examination.

Diagnostic Value of Shear Wave Elastography in Differentiation between Benign from Malignant Cervical Lymph Nodes

Background: This study aims to evaluate the role of Shear Wave Elastography (SWE) in the differentiation of malignant from benign cervical lymph nodes and compare its accuracy with conventional ultrasound.&#x0D; Methods: Seventy-one lymph nodes (malignant=52, benign=19) were investigated by both conventional sonography and SWE. Shear Wave Velocity (SWV) and color map were obtained for each lymph node before tissue sampling. R statistical software (x64, v3.6.1) was used for statistical analysis.&#x0D; Results: Among all the conventional and elastography features, color map grading and shear wave velocity (SWV) had the most correlation with malignancy, even in normal-sized nodes. SWV was significantly correlated with the pathology (rpb=0.62, p&lt;0.00). The best cutoff-value for SWV was 2.71 m/s (sensitivity: 82.7%, specificity:84.2%, AUC=0.92). The best predicting model by multivariate analysis was obtained by a combination of SWV and color map grading (sensitivity=92.3%, specificity=94.7%).&#x0D; Conclusion: SWE is a valuable method for the differentiation of malignant from benign lymph nodes. It would help to find the proper lymph node for biopsy.

Association of Cervical Lymph Node Metastasis and Perineural Invasion in Patients with Oral Cavity Squamous Cell Carcinoma

Background: Cervical lymph node metastasis (CLNM) is one of the key prognostic factors in oral squamous cell carcinoma and positive perineural invasion (PNI) is a predictor of cervical lymph node metastasis, recurrence, and decline-free survival. This study determines perineural invasion association with cervical lymph node metastasis in oral cavity squamous cell carcinoma (OCSCC). Method: We analyzed the laboratory data collected from the surgical pathology files of a tertiary care hospital in Karachi. This retrospective study included all diagnosed cases of OCSCC that underwent cervical lymph node dissection during the 10-year period from June 2008 to March 2019. The cases were characterized according to age, gender, perineural invasion, and lymph node metastasis. The data was analyzed using SPSS and Chi-Square test was used to find the association between the cervical lymph node metastatic and PNI status. Results: A total of 527 diagnosed cases of OCSCC with cervical neck dissection were found. It is evident from our study that OCSCC with neck dissection specimens is frequently seen in males, mostly belonging to the middle adult age group followed by young adults. Of the 527 cases, 165 showed PNI (31.3%), and 20% of the PNI cases were positive for cervical lymph node metastasis, while 40% showed benign cervical lymph nodes with negative PNI. Conclusion: This study highlights the single parameter of PNI and its association with cervical lymph node metastasis and showed a significant relationship between perineural invasion and cervical lymph node metastatic status (p &lt; .001).

Evaluation of cervical lymph nodes using multispectral optoacoustic tomography: a proof-of-concept study

ObjectivesExamination of lymph nodes is one of the most common indications for imaging in the head and neck region. The purpose of this study is to evaluate whether multispectral optoacoustic tomography can be used to observe chromophore differences between benign and malignant neck lymph nodes.Materials and methodsProof-of-concept ex vivo study of resected cervical lymph nodes from 11 patients. The examination of lymph nodes included imaging with hybrid ultrasound and multispectral tomography system followed by spectral unmixing to separate signals from the endogenous chromophores water, lipid, hemoglobin and oxygenated hemoglobin; calculation of semi-quantitative parameters (total hemoglobin and relative oxygenation of hemoglobin). Comparison of the results from the hybrid measurement with the histopathological results.ResultsMost patients suffered from squamous cell carcinoma (n = 7), also metastasis from salivary gland adenocarcinoma and papillary thyroid carcinoma, were included. The comparison between benign cervical lymph nodes and metastases showed significant differences for the absorbers water, lipid, hemoglobin and oxygenated hemoglobin and total hemoglobin.ConclusionsOur ex vivo study suggests that multispectral optoacoustic tomography can be used to detect differences between reactive lymph nodes and metastases. The measurement of endogenous chromophores can be used for this purpose. The examinations are non-invasively and thus potentially improve diagnostic prediction. However, potential influences from the ex vivo setting must be considered.

Analysis of bleeding after ultrasound-guided needle biopsy of benign cervical lymph nodes

AimSummarized the incidence of bleeding after ultrasound-guided coarse needle biopsy (US-CNB) of benign cervical lymph nodes.MethodsWe retrospectively examined the clinical and follow-up records of 590 patients with benign cervical lymph node disease who underwent US-CNB at our hospital during February 2015–July 2022 and were confirmed to have the disease by CNB and surgical pathology. The number of cases, types of diseases, and degree of bleeding of all patients with bleeding after US-CNB were statistically analyzed.ResultsOf the 590 patients, bleeding was noted in 44 cases(7.46%), and the infectious lymph node bleeding rate was 9.48%. Infectious lymph nodes were more likely to bleed than noninfectious lymph nodes after CNB, ,x2 = 8.771; P = 0.003, Lymph nodes with pus were more likely to bleed than solid lymph nodes after CNB, x2 = 4.414; P = 0.036,.ConclusionThe bleeding of all patients after CNB was minor bleeding. Infected lymph nodes bleed more frequently than noninfected lymph nodes. Lymph nodes with mobility and a large pus cavity, are more likely to bleed after CNB.

Diagnostic Accuracy of Multislice CT Scan in the Detection of Cervical Lymph Node Metastasis in Head and Neck Cancers

Objectives: To determine the diagnostic accuracy of multislice CT scan in the detection of cervical lymph node metastasis in head and neck cancers, taking histopathology as gold standard. Study design: Descriptive, cross-sectional study. Settings: Department of Radiology, Jinnah Hospital, Lahore Study duration: 8th January 2018 to 7th July 2018 Materials &amp; Methods: Total 95patients with squamous cell carcinoma of head and neck, 15-55 years of age of both genders were selected. All the patients with prior radiation to head and neck, already proven histopathology, CRF and claustrophobic patients were excluded. Multislice computed tomography of neck was performed on Toshiba Aquilion Multislice CT scanner before and after intravenous contrast administration. Each multislice CT scan findings were looked for malignant cervical lymph nodes. Multislice CT scan findings were compared with histopathology findings. Results: Mean age was 43.21 ± 8.16 years. Out of these 95 patients, 54 (56.84%) were males and 41 (43.16%) were females with ratio of 1.3:1.All the patients were subjected to CT of neck and found that 48 were True Positive and 04 were False Positive. Among 43, CT negative patients, 04 (False Negative) had malignant cervical nodes on histopathology whereas 39 (True Negative) had benign cervical nodes on histopathology (p=0.0001). Overall sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of multislice CT scan in the detection of cervical lymph node metastasis in head and neck cancers, taking histopathology as gold standard was 92.31%, 90.70%, 92.31%, 90.70% and 91.58% respectively. Conclusion: This study concluded that multislice CT scan is a highly sensitive and accurate non-invasive modality for detecting cervical lymph node metastasis in head and neck cancers. Keywords: Head and Neck Cancers, Cervical Lymph Node Metastasis, Computed Tomography.

Quantitative Multiparametric Ultrasound (mpUS) in the Assessment of Inconclusive Cervical Lymph Nodes.

Simple SummaryPersisting cervical lymphadenopathy should be further evaluated to distinguish benign infectious enlargements from malignant diseases such as cancer of the upper airway tract, with head and neck squamous cell carcinoma or lymphatic diseases being the most common ones. Ultrasound (US) remains the primary imaging modality for assessment of cervical lymph nodes (CLN) due to their superficial localization. We aimed to investigate whether US examination and classification of CLN can be improved by adding multiparametric applications to the established B-mode–US technique by evaluating tissue stiffness and micro-vascularization. Our results show that tissue stiffness was significantly higher in malignant CLN, even in subgroups without B-mode criteria indicating malignancy. Shear wave elastography is an easy, fast and noninvasive tool available on most US devices today. This may help to detect malignant CLN with higher accuracy and help patients in cancer aftercare to detect recurrent CLN metastasis and to consecutively assess necessary treatment faster.Background: Enlarged cervical lymph nodes (CLN) are preferably examined by ultrasound (US) by using criteria such as size and echogenicity to assess benign and suspicious CLN, which should be histologically evaluated. This study aims to assess the differentiation of malign and benign CLN by using multiparametric US applications (mpUS). Methods: 101 patients received a standardized US protocol prior to surgical intervention using B-mode–US, shear-wave elastography (SWE) and contrast-enhanced ultrasound (CEUS). SWE was assessed by 2D real-time SWE conducting a minimum of five measurements, CEUS parameters were assessed with post-processing perfusion software. Histopathological confirmation served as the gold standard. Results: B-mode–US and SWE analysis of 104 CLN (36 benign, 68 malignant) showed a significant difference between benign and malignant lesions, presenting a larger long axis and higher tissue stiffness (both p < 0.001). Moreover, tissue stiffness assessed by SWE was significantly higher in CLN with regular B-mode–US criteria (Solbiati Index > 2 and short-axis < 1 cm, p < 0.001). No perfusion parameter on CEUS showed a significant differentiation between benign and malignant CLN. Discussion: As the only multiparametric parameter, SWE showed higher tissue stiffness in malignant CLN, also in subgroups with regular B-mode criteria. This fast and easy application may be a promising noninvasive tool to US examination to ameliorate the sonographic differentiation of inconclusive CLN.

Value of Contrast-Enhanced Ultrasound for Evaluation of Cervical Lymph Node Metastasis in Papillary Thyroid Carcinoma.

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 (LNs) in patients with papillary thyroid carcinoma (PTC). Two hundred and one cervical LNs (157 metastatic from PTC and 44 benign) were evaluated using conventional ultrasonography (US) and CEUS before biopsy or surgery. Histopathology was used as the gold standard. We evaluated the size, long axis/short axis ratio (L/S), fatty hilum, hyper-echogenicity, calcification, cystic change, peripheral vascularity and CEUS parameters for each lymph nodule. The CEUS parameters included enhancement type, homogeneity, perfusion type, ring enhancement, peak intensity (PI) index and area under the curve (AUC) index. Univariate analysis demonstrated that compared with benign LNs, malignant LNs more frequently had L/S < 2, absence of a fatty hilum, presence of hyper-echogenicity, presence of calcification, peripheral vascularity, hyper-enhancement, heterogeneous enhancement, centripetal perfusion, ring enhancement, PI index > 1 and AUC index > 1 on preoperative US and CEUS. Binary logistic regression analysis demonstrated that hyper-enhancement, centripetal perfusion, and ring enhancement are independent CEUS characteristics related to malignant LNs for their differentiation from benign LNs (all p < 0.05). Our study indicated that preoperative CEUS characteristics may serve as a useful tool to identify malignant cervical LNs from benign cervical LNs.

Role of Sonoelastography for Differentiating Benign and Malignant Cervical Lymph Nodes: A Cross-sectional Study

Introduction: Cervical nodes form one of the major groups of Lymph Nodes (LN) that are frequently involved in inflammatory and neoplastic diseases. Metastasis causes the most apparent change in consistency of the node among the various nodal pathologies. Ultrasound elastography provides an estimate of tissue consistency by measuring the degree of distortion under the application of an external force. Aim: To estimate the diagnostic accuracy of sonoelastography in the differentiation of malignant and benign cervical LN with fine needle aspiration cytology/biopsy considered as a gold standard. Materials and Methods: A cross-sectional study was carried out from March 2020 to January 2021 in a tertiary care hospital in south India, a total of 50 patients with cervical lymphadenopathy underwent ultrasonography followed by elastography of superficial neck LN using high frequency linear transducer by freehand technique. The ultrasound characteristics of selected LN were determined and colour elastogram pattern was assessed using colour mapping elastography. The chi-square test was performed. Sensitivity, specificity, positive (PPV) and negative predictive values (NPV) were obtained. The results were then compared to the fine needle aspiration cytology. Results: A total of 50 subjects(median age of 40.5±18.71 years ; 19 (38%) males and 31 (62%) females). The grayscale and colour Doppler features of cervical LN which helped predict malignancy were short axis ≥8 mm, S:L axis ratio ≥0.5, absence of normal central fatty hilum, abnormal echogenicity, lobulated border, presence of calcification and peripheral/mixed vascularity. With reference to the above variables of cervical LN characterisation on grayscale, colour doppler ultrasound and sonoelastography findings, elastography pattern was the most promising variable to differentiate malignant from benign cervical LN with 95.2% sensitivity, 75.0% specificity, 95.2% PPV, 75.0% NPV and 92.0% accuracy. Conclusion: Sonoelastography is useful in the assessment of elastic properties of cervical LN with short examination time required, real-time display, immediate interpretation and limited cost. Sonoelastography had higher diagnostic accuracy than gray scale and doppler ultrasound in differentiating benign from malignant cervical LN. Sonoelastography is an effective supplement to conventional gray scale and colour doppler ultrasound and that the combination is clinically recommended for a more accurate diagnosis of metastatic LN.

Head-to-Head Comparison of Neck 18F-FDG PET/MR and PET/CT in the Diagnosis of Differentiated Thyroid Carcinoma Patients after Comprehensive Treatment.

Simple SummaryThe most advanced positron emission tomography–magnetic resonance (PET/MR) combines the high soft tissue contrast of MRI with the high functional/metabolic sensitivity of PET and has the potential to achieve the highest level of diagnostic performance for refractory malignancies in differentiated thyroid cancer (DTC) patients. The utility of PET/MR in the postoperative follow-up of DTC patients has been relatively ambiguous. This retrospective study compared 18F-fluorodeoxyglucose neck PET/MR with PET/CT head-to-head, in order to evaluate the diagnostic efficacy of PET/MR in assessment malignancy in DTC patients after comprehensive treatment. We determined that PET/MR presented better detection rates, image conspicuity, and sensitivity than PET/CT in recurrent DTC lesions and cervical lymph node metastases. The addition of neck PET/MR scan after whole-body PET/CT may provide more favorable diagnostic information.We explored the clinical value of 18F-FDG PET/MR in a head-to-head comparison with PET/CT in loco-regional recurrent and metastatic cervical lymph nodes of differentiated thyroid carcinoma (DTC) patients after comprehensive treatment. 18F-FDG PET/CT and neck PET/MR scans that were performed in DTC patients with suspected recurrence or cervical lymph node metastasis after comprehensive treatment were retrospectively analyzed. Detection rates, diagnostic efficacy, image conspicuity, and measured parameters were compared between 18F-FDG PET/CT and PET/MR. The gold standard was histopathological diagnosis or clinical and imaging follow-up results for more than 6 months. Among the 37 patients enrolled, no suspicious signs of tumor were found in 10 patients, 24 patients had lymph node metastasis, and 3 patients had both recurrence and lymph node metastases. A total of 130 lesions were analyzed, including 3 malignant and 6 benign thyroid nodules, as well as 74 malignant and 47 benign cervical lymph nodes. Compared with PET/CT, PET/MR presented better detection rates (91.5% vs. 80.8%), image conspicuity (2.74 ± 0.60 vs. 1.9 ± 0.50, p < 0.001, especially in complex level II), and sensitivity (80.5% vs. 61.0%). SUVmax differed in benign and malignant lymph nodes in both imaging modalities (p < 0.05). For the same lesion, the SUVmax, SUVmean, and diameters measured by PET/MR and PET/CT were consistent and had significant correlation. In conclusion, compared with 18F-FDG PET/CT, PET/MR was more accurate in determining recurrent and metastatic lesions, both from a patient-based and from a lesion-based perspective. Adding local PET/MR after whole-body PET/CT may be recommended to provide more precise diagnostic information and scope of surgical resection without additional ionizing radiation. Further scaling-up prospective studies and economic benefit analysis are expected.

Nodal-based radiomics analysis for identifying cervical lymph node metastasis at levels I and II in patients with oral squamous cell carcinoma using contrast-enhanced computed tomography.

Discriminating metastatic from benign cervical lymph nodes (LNs) in oral squamous cell carcinoma (OSCC) patients using pretreatment computed tomography (CT) has been controversial. This study aimed to investigate whether CT-based texture analysis with machine learning can accurately identify cervical lymph node metastasis in OSCC patients. Twenty-three patients (with 201 cervical LNs [150 benign, 51 metastatic] at levels I-V) who underwent preoperative contrast-enhanced CT and subsequent cervical neck dissection were enrolled. Histopathologically proven LNs were randomly divided into the training cohort (70%; n = 141, at levels I-V) and validation cohort (30%; n = 60, at level I/II). Twenty-five texture features and the nodal size of targeted LNs were analyzed on the CT scans. The nodal-based sensitivities, specificities, diagnostic accuracy rates, and the area under the curves (AUCs) of the receiver operating characteristic curves of combined features using a support vector machine (SVM) at levels I/II, I, and II were evaluated and compared with two radiologists and a dentist (readers). In the validation cohort, the AUCs (0.820 at level I/II, 0.820 at level I, and 0.930 at level II, respectively) of the radiomics approach were superior to three readers (0.798-0.816, 0.773-0.798, and 0.825-0.865, respectively). The best models were more specific at levels I/II and I and accurate at each level than each of the readers (p < .05). Machine learning-based analysis with contrast-enhanced CT can be used to noninvasively differentiate between benign and metastatic cervical LNs in OSCC patients. • The best algorithm in the validation cohort can noninvasively differentiate between benign and metastatic cervical LNs at levels I/II, I, and II. • The AUCs of the model at each level were superior to those of multireaders. • Significant differences in the specificities at level I/II and I and diagnostic accuracy rates at each level between the model and multireaders were found.

Role of Contrast-Enhanced Ultrasound (CEUS) in the Diagnosis of Cervical Lymph Node Metastasis in Nasopharyngeal Carcinoma (NPC) Patients.

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.

Differentiation Between Malignant and Benign Lymph Nodes: Role of Superb Microvascular Imaging in the Evaluation of Cervical Lymph Nodes.

This study aimed to assess the value of Superb Microvascular Imaging (SMI; Canon Medical Systems, Otawara, Japan) for distinguishing between benign and malignant cervical lymph nodes (LNs) and to compare SMI with power Doppler ultrasound (PDUS). Power Doppler ultrasound and SMI examinations were performed for patients' cervical LNs. The distribution of feeding vessels, number, and appearance of internal vessels were analyzed by 2 readers, and the results of PDUS and SMI were compared. Interobserver agreement was assessed. A subgroup analysis was performed to assess differences in vascular patterns between metastasis and tuberculous lymphadenitis and between Kikuchi disease and lymphoma. The diagnostic performance for distinguishing between benign and malignant LNs was calculated. In total, 147 patients with 147 cervical LNs (85 benign and 62 malignant) were assessed. Interobserver agreement was moderate to strong for SMI. There were significant differences in the vascular patterns between benign and malignant LNs on SMI (distribution, number, and appearance, all P < .001), but not on PDUS. In the subgroup analysis, SMI showed a significant difference in the vascular patterns observed between metastasis and tuberculous lymphadenitis (distribution, P = .012; number, P = .014; and appearance, P = .005). Superb Microvascular Imaging detected significantly greater numbers of vessels in lymphoma than in Kikuchi disease (P = .012). The sensitivity of SMI was significantly greater than that of PDUS in distinguishing malignant from benign LNs (86.9% versus 54.1%; P < .001). Superb Microvascular Imaging yields more detailed information about nodal vessels than does PDUS by enabling visualization of small nodal vessels. Superb Microvascular Imaging is useful and feasible for differentiating between malignant and benign cervical LNs.

The Diagnostic Value of Diffusion-Weighted Imaging in Differentiating Metastatic Lymph Nodes of Head and Neck Squamous Cell Carcinoma: A Systematic Review and Meta-Analysis.

Accurate lymph node staging is crucial for proper treatment planning for metastasis in patients with head and neck squamous cell carcinoma. Our aim was to evaluate the diagnostic performance of DWI for differentiating metastatic cervical lymph nodes from benign cervical lymph nodes in patients with head and neck squamous cell carcinoma and to identify optimal cutoff values for ADC. A computerized literature search was performed to identify relevant original articles in Ovid MEDLINE and EMBASE. Studies evaluating the diagnostic performance of DWI for differentiating metastatic cervical lymph nodes from benign cervical lymph nodes were selected. Diagnostic meta-analysis was conducted with a bivariate random-effects model, and a hierarchical summary receiver operating characteristic curve was obtained. Meta-regression was also performed. Nine studies with 337 patients were included. In all studies, ADC values derived from metastatic lymph nodes were significantly lower than ADC values derived from benign lymph nodes. The median ADC cutoff value was 0.965 × 10-3 mm2/s. The pooled sensitivity and specificity for the diagnostic performance of DWI in differentiating metastatic lymph nodes from benign lymph nodes were 90% (95% CI, 84%-94%) and 88% (95% CI, 80%-93%), respectively. In the meta-regression, sensitivity was significantly higher in the studies using a 3-mm slice thickness (93% [95% CI, 88%-98%]) than in studies using a slice thickness of >3 mm (86% [95% CI, 77%-95%], P < .01). A small number of studies were included in our meta-analysis. DWI demonstrated high diagnostic performance for differentiating metastatic lymph nodes from benign lymph nodes in patients with head and neck squamous cell carcinoma, and the median ADC cutoff value was 0.965 × 10-3 mm2/s. A 3-mm DWI slice thickness can provide a slight improvement in sensitivity.

The value of quantitative shear wave elastography in differentiating the cervical lymph nodes in patients with thyroid nodules.

This study aimed at evaluating the diagnostic performance of quantitative shear wave elastography (SWE) in differentiating metastatic cervical lymph nodes from benign nodes in patients with thyroid nodules. One hundred and forty-one cervical lymph nodes from 39 patients with thyroid nodules that were diagnosed as papillary thyroid cancer had been imaged with SWE. The shear elasticity modulus, which indicates the stiffness of the lymph nodes, was measured in terms of maximum shear elasticity modulus (maxSM), minimum shear elasticity modulus (minSM), mean shear elasticity modulus (meanSM), and standard deviation (SD) of the shear elasticity modulus. All the patients underwent thyroid surgery, 50 of the suspicious lymph nodes were resected, and 91 lymph nodes were followed up for 6months. The maxSM value, minSM value, meanSM value, and SD value of the metastatic lymph nodes were significantly higher than those of the benign nodes. The area under the curve of the maxSM value, minSM value, meanSM value, and SD value were 0.918, 0.606, 0.865, and 0.915, respectively. SWE can differentiate metastasis from benign cervical lymph nodes in patients with thyroid nodules, and the maxSM, meanSM, and SD may be valuable quantitative indicators for characterizing cervical lymph nodes.

Lymphocytic Thyroiditis is Associated with Increased Number of Benign Cervical Nodes and Fewer Central Neck Compartment Metastatic Lymph Nodes in Patients with Differentiated Thyroid Cancer

Whether or not autoimmune thyroid disease influences the progression of differentiated thyroid cancer (DTC) remains controversial. Findings of previous studies are influenced by lead time bias and/or procedure bias selection. These biases can be reduced by studying a single-institution patient population that underwent a similar extent of surgical resection. From a cohort of 660 patients with DTC who underwent thyroidectomy, we retrospectively studied 357 patients who underwent total thyroidectomy and central compartment node dissection (CCND) for DTC between 2003 and 2013. Forty-one percent (140/345) of study patients had lymphocytic thyroiditis (LT), and 30% (91/301) had serum positive for thyroglobulin antibody (TgAb). LT was reported in 78% of the TgAb-positive cases. Sixty percent (213/357) of cases had metastatic thyroid carcinoma in 1 or more neck lymph nodes (55% [198/357] central compartment, and 22% [77/356] lateral compartment). Patients with LT had fewer metastatic cervical lymph nodes than those with no LT (2.7 ± 4.7 vs 3.5 ± 4.8, respectively, P = .0285). Patients with positive TgAb and thyroiditis had a larger number of benign cervical lymph nodes removed than those with negative TgAb or no LT. No significant difference was observed in age, tumor size, multifocality, extrathyroidal extension, vascular invasion, or frequency of cervical lymph node metastasis between TgAb-negative and -positive cases or between cases with and without LT. Lymphocytic thyroiditis is associated with fewer central neck compartment metastatic lymph nodes and a larger number of excised reactive benign cervical lymph nodes. Whether this association indicates a protective role of thyroid autoimmunity in lymph node spreading remains unclear. CCND = central compartment node dissection DTC = differentiated thyroid cancer HT = Hashimoto thyroiditis LT = lymphocytic thyroiditis TgAb = thyroglobulin antibody TPO = thyroid peroxidase.

LYMPHOCYTIC THYROIDITIS IS ASSOCIATED WITH INCREASED NUMBER OF BENIGN CERVICAL NODES AND FEWER CENTRAL NECK COMPARTMENT METASTATIC LYMPH NODES IN PATIENTS WITH DIFFERENTIATED THYROID CANCER

Objective: Whether or not autoimmune thyroid disease influences the progression of differentiated thyroid cancer (DTC) remains controversial. Findings of previous studies are influenced by lead time bias and/or procedure bias selection. These biases can be reduced by studying a single-institution patient population that underwent a similar extent of surgical resection. Methods: From a cohort of 660 patients with DTC who underwent thyroidectomy, we retrospectively studied 357 patients who underwent total thyroidectomy and central compartment node dissection (CCND) for DTC between 2003 and 2013. Results: Forty-one percent (140/345) of study patients had lymphocytic thyroiditis (LT), and 30% (91/301) had serum positive for thyroglobulin antibody (TgAb). LT was reported in 78% of the TgAb-positive cases. Sixty percent (213/357) of cases had metastatic thyroid carcinoma in 1 or more neck lymph nodes (55% [198/357] central compartment, and 22% [77/356] lateral compartment). Patients with LT had fewer metastatic cervical lymph nodes than those with no LT (2.7 ± 4.7 vs 3.5 ± 4.8, respectively, P = .0285). Patients with positive TgAb and thyroiditis had a larger number of benign cervical lymph nodes removed than those with negative TgAb or no LT. No significant difference was observed in age, tumor size, multifocality, extrathyroidal extension, vascular invasion, or frequency of cervical lymph node metastasis between TgAb-negative and -positive cases or between cases with and without LT. Conclusion: Lymphocytic thyroiditis is associated with fewer central neck compartment metastatic lymph nodes and a larger number of excised reactive benign cervical lymph nodes. Whether this association indicates a protective role of thyroid autoimmunity in lymph node spreading remains unclear. Abbreviations: CCND = central compartment node dissection DTC = differentiated thyroid cancer HT = Hashimoto thyroiditis LT = lymphocytic thyroiditis TgAb = thyroglobulin antibody TPO = thyroid peroxidase