Diagnosis Of Lymph Node Lesions Research Articles

Comparison of microvascular flow imaging and contrast-enhanced ultrasound for blood flow analysis of cervical lymph node lesions.

To compare the diagnostic value of microvascular flow imaging (MVFI) with that of contrast-enhanced ultrasound (CEUS) for the analysis of blood flow in benign and malignant cervical lymph nodes. As a prospective study, 95 cervical enlarged lymph nodes (43 benign and 52 malignant) were observed in 95 patients using conventional ultrasonography (including gray and Color Doppler Flow Imaging), CEUS, and MVFI. Two researchers evaluated vascular parameters of MVFI (vascular distribution, internal vascular features, vascular index) and CEUS (enhancement mode, enhancement type) and compared the diagnostic effects of MVFI and CEUS.All results were compared with pathological findings. There were significant differences in the vascular distribution and internal vascular features of benign and malignant lymph nodes on MVFI (P < 0.05). The vascular distribution of benign lymph nodes was mainly of the central and avascular types, the internal blood vessels were mostly normal, the vascular distribution of malignant lymph nodes was mainly mixed, the internal vessels were mainly tortuous and displaced. The optimal cut-off value of the benign and malignant lymph node vascular index (VI) was 15.55%, and the area under the receiver operating characteristic curve (AUC) of the VI was 0.876. There were also significant differences in the enhancement mode and types of benign and malignant lymph nodes in CEUS (P < 0.05). The benign lymph nodes showed centrifugal perfusion, and the enhancement types were mostly type I and type II. Most malignant lymph nodes showed centripetal or mixed perfusion, and the enhancement types were usually type III and type IV. The accuracy, sensitivity, and specificity of CEUS in the diagnosis of lymph node lesions were 84.2%, 84.6% and 83.7%, respectively, and the AUC was 0.845. The accuracy, sensitivity, and specificity of MVFI in the diagnosis of lymph node lesions were 85.3%, 84.6%, and 86.0%, respectively, and the AUC was 0.886. Both CEUS and MVFI are valuable in differentiating benign and malignant lesions of lymph nodes and have a similar diagnostic performance; however, MVFI is less invasive and simpler than CEUS. Therefore it is preferred for auxiliary examination of enlarged lymph nodes that are difficult to diagnose by conventional ultrasound.

A stepwise approach to fine needle aspiration cytology of lymph nodes.

The cytological diagnosis of lymph node lesions is extremely challenging because of the diverse diseases that cause lymph node enlargement, including both benign and malignant or metastatic lymphoid lesions. Furthermore, the cytological findings of different lesions often resemble one another. A stepwise diagnostic approach is essential for a comprehensive diagnosis that combines: clinical findings, including age, sex, site, multiplicity, and ultrasonography findings; low-power reactive, metastatic, and lymphoma patterns; high-power population patterns, including two populations of continuous range, small monotonous pattern and large monotonous pattern; and disease-specific diagnostic clues including granulomas and lymphoglandular granules. It is also important to remember the histological features of each diagnostic category that are common in lymph node cytology and to compare them with cytological findings. It is also essential to identify a few categories of diagnostic pitfalls that often resemble lymphomas and easily lead to misdiagnosis, particularly in malignant small round cell tumors, poorly differentiated squamous cell carcinomas, and nasopharyngeal undifferentiated carcinoma. Herein, we review a stepwise approach for fine needle aspiration cytology of lymphoid diseases and suggest a diagnostic algorithm that uses this approach and the Sydney classification system.

Dual-mode ultrasound radiomics and intrinsic imaging phenotypes for diagnosis of lymph node lesions.

BackgroundThe ultrasonic diagnosis of lymph node lesions is usually based on a small number of subjective visual features from a single ultrasonic modality, which limits diagnostic accuracy. Therefore, our study aimed to propose a computerized method for using dual-mode ultrasound radiomics and the intrinsic imaging phenotypes for accurately differentiating benign, lymphomatous, and metastatic lymph nodes.MethodsA total of 543 lymph nodes from 538 patients were examined with both B-mode ultrasonography and elastography. The data set was randomly divided into a training set of 407 nodes and a validation set of 136 nodes. First, we extracted 430 radiomic features from dual-mode images. Then, we combined the least absolute shrinkage and selection operator with the analysis of variance to select several typical features. We retrieved the intrinsic imaging phenotypes by using a hierarchical clustering of all radiomics features, and we integrated the phenotypes with the selected features for the classification of benign, lymphomatous, and metastatic nodes.ResultsThe areas under the receiver operating characteristic curves (AUCs) on the validation set were 0.960 for benign vs. lymphomatous, 0.716 for benign vs. metastatic, 0.933 for lymphomatous vs. metastatic, and 0.856 for benign vs. malignant.ConclusionsThe radiomics features and intrinsic imaging phenotypes derived from the dual-mode ultrasound can capture the distinctions between benign, lymphomatous, and metastatic nodes and are valuable in node differentiation.

Potential of the ImageJ software in the differentiation of various types of canine lymphadenopathies with fine needle aspiration cytology (FNAC)

This study was designed to evaluate the potential of the ImageJ software in the differentiation of various types of lymphadenopathies with fine needle aspiration cytology (FNAC). For this purpose, the samples of enlarged mandibular lymph node were selected from 46 dogs suspected of lymphadenopathy and 10 healthy dogs as a control. The target tissues were obtained from the animals by fine needle aspiration and lymph node removed by surgery. The samples were then prepared for cytological and histological study. Finally, the ImageJ software was used to evaluate the quantitative nuclear morphometric parameters. The data obtained from nuclear parameters (diameter, circularity, area, and perimeter) revealed a significant difference between the control group and the hyperplasia and lymphoma groups. There is also a significant difference between the lymphoma and hyperplasia groups (P < 0.05). These results indicated that cytology is a fast, easy, and cost-effective method for the diagnosis of lymph node lesions and cytomorphologic assessment by image analysis software can increase the diagnostic accuracy.

Estudo de linfonodos por espectroscopia Raman confocal

Among the lymphoid organs there are lymph nodes,, which are considered as lymph filters because they are rich in lymphocytes and other defense cells. Among the factors that contribute to their impairment we note the invasion of its structure by neoplastic cells. Cytology is the gold-standard diagnostic test, and FNA is the technique most used to obtain the material to be analyzed. However, some studies question its use, due to the loss of cellular architecture. Confocal Raman spectroscopy, through its ability to utilize biochemical differences in tissues and cells, has been increasingly prominent in this type of diagnosis. The study aimed to identify the main biochemical characteristics in normal and compromised lymph nodes and cervical lesion using confocal Raman spectroscopy. We analyzed 12 normal and altered lymph node samples from patients with medical indications for a lymphadenectomy by spectroscopy, followed by statistical analysis of the main components (PCA) and linear discriminant analysis (LDA). After the analysis, it was observed that this technique was able to discriminate the tissues with values of specificity, sensitivity and accuracy of up to 83%. Therefore, confocal Raman spectroscopy has been shown to be an important tool in the characterization of lymph nodes, and may help in the diagnosis of lymph node lesions in the future.

Application of ultrasound-guided fine-needle aspiration cytopathology combined with cell block immunohistochemistry in the diagnosis of lymph node lesions in elderly patients

Objective To explore the clinical value of ultrasound-guided fine-needle aspiration(FNA) cytopathology combined with FNA cell block immunohistochemistry in diagnosing lymph node diseases for elderly patients. Methods A total of 55 elderly patients with lymph node lesions who were admitted to our hospital from January 2014 to February 2015 were treated by ultrasound-guided fine-needle aspiration. The obtained samples were sent for cytopathology, and FNA cell block was detected by immunohistochemistry. The diagnostic conclusions and the follow-up results were retrospectively analyzed and compared. Results The success rate of FNA cytology of this group was 96.4% (53/55). Among 53 patients, the results of cytological examination in 43 cases were consistent with the follow-up results. The coincidence rate of clinical diagnosis was 81.1% (43/53). The results of the cytology combined with cell block immunohistochemistry in 50 cases were consistent with the follow-up results. The coincidence rate of clinical diagnosis was 94.3% (50/53). The clinical diagnostic accordance rate of cytology combined with cell block immunohistochemistry was better than that of cytology alone (P<0.05). Conclusions Ultrasound-guided fine-needle aspiration cytopathology combined with FNA cell block immunohistochemistry in diagnosis of lymph node lesions is simple, practical, safe and reliable, which can significantly improve the diagnosis rate. It has a higher clinical application value and promotion prospects, especially for frail elderly patients. Key words: Ultrasonography; Lymph node; Immunohistochemistry

English

BACKGROUND: Lymphadenopathy is a common clinical presentation in HIV/AIDS patients and conventional lymph node biopsy is the standard procedure for the diagnosis of this condition but the procedure incurs a high risk for healthcare providers. OBJECTIVES: The aim of this study was to analyze the cytological patterns of lymph node lesions in HIV/AIDS patients and to compare the results of Fine Needle Aspiration Cytology (FNAC) with conventional lymph node biopsy, along with the correlation of findings with CD4 count. MATERIALS AND METHODS: This study is a prospective comparison of an alternative procedure for the diagnosis of lymph node lesions in HIV/AIDS patients, Fine Needle Aspiration Cytology (FNAC), with the conventional method. The study population comprises 73 HIV/AIDS patients who attended the Department of medicine (ART centre), N.S.C.B Medical College Jabalpur. Aspirates were stained routinely with haematoxylin and eosin, Wrights and Ziehl-Neelsen stains. Special stains were done in selected cases. RESULTS: Cytological diagnosis included reactive (46. 6%), tuberculous (31.5%), non-specific chronic granulomatous (8.2%), suppurative (9.5%), Hodgkins lymphoma (1.4%), Suspicious Non- Hodgkins lymphoma n (1.4%), Smear inadequate (1.4%). Reactive and tuberculous lesions were further categorized. Each lesion was correlated with clinical details and CD4 counts. AFB grading was done on Ziehl-Neelsen stained smears in tuberculous lymphadenitis cases. CONCLUSION: Fine Needle Aspiration Cytology of lymph node is very useful for segregating lymphadenopathy cases in HIV/AIDS patient. FNAC is practical, convenient, safe, and relatively painless. Correlation of lesions with mean CD4 count and AFB grading reflects immunity, stage of disease and disease activity.

Current status of power Doppler and color Doppler sonography in the differential diagnosis of lymph node lesions.

The use of Power Doppler sonography in nodal diseases provides an improvement of early and noninvasive diagnosis of regional metastatic involvement. By using Power Doppler sonography it is possible to characterize lymph nodes as reactively enlarged, metastases, malignant lymphoma, tuberculosis and to study cervical cysts. The high diagnostic accuracy is based on perfusion-characteristics of these lymph nodes. Reactive lymph nodes show increased central perfusion of the hilum, whereas metastases tend to show increased peripheral perfusion. Affected lymph nodes in patients with by malignant lymphoma are highly perfused in the center but also peripheral. Power Doppler sonography is still not able to discriminate small (<8 mm) nonnecrotic metastasis or micrometastases from reactive lymph nodes. The purpose of this paper is to provide a summary of the current status of power Doppler and Doppler sonography in the differential diagnosis of lymph nodes.

Differential diagnosis of lymph node lesions. A semiquantitative approach with power Doppler sonography.

To assess the value of power Doppler for distinguishing reactive from malignant lymph node disease. In a prospective study, 48 untreated patients with palpable cervical lymph node enlargement (n = 211) underwent examination with power Doppler sonography. The perfusion sites were subdivided into three groups: central, peripheral, and hilar perfusion. In addition, the authors qualified the intensity of perfusion using a semiquantitative scale from 0 (no perfusion) to III (high perfusion). Finally, the overall perfused lymph node area was measured and the percentage of perfused nodal area was calculated. Power Doppler sonography showed perfusion in 183 of 211 lymph nodes. Histologic examination revealed 67 reactively enlarged lymph nodes, 72 metastases, and 44 lymphomas. Reactively enlarged lymph nodes showed characteristically intense hilar perfusion (82.1%), whereas nodal metastases exhibited mainly peripherally located flow (84.7%) of grade intensity I to III. Lymph nodes invaded by malignant lymphoma were highly perfused, displaying color signals in the center as well as in the nodal periphery (90.9%). The perfusion patterns of lymph nodes provide useful additional information in the differential diagnosis of cervical lymphadenopathy.