Malignant Cervical Lymphadenopathy Research Articles

Utility of perioperative ultrasonography and fine-needle aspiration cytology in differentiation between benign and malignant cervical lymphadenopathy: a retrospective cohort study

Background: The preoperative differentiation of benign form malignant cervical lymphadenopathy (CLA) is crucial in determining the need for surgical intervention. This study aims to assess the diagnostic performance of ultrasonography (US), fine-needle aspiration cytology (FNAC), and their combination with the postoperative histopathological diagnoses of CLA. Method: In a retrospective study between April 2021 and May 2023, 214 patients with CLA were assessed with preoperative US and FNAC. The morphological parameters, including tissue margins, vascularity, and fatty hilum echogenicity, were collected and analyzed retrospectively. The diagnostic efficacies of US, FNAC, and their combined use were compared to the postoperative histopathological findings. Result: In the final histopathological examination, 185 cases (86.4%) were found to be benign, while 29 cases (13.6%) were determined to be malignant. The US features of fatty hilum, echogenicity, and vascularity pattern had the highest diagnostic accuracy in characterizing CLA patterns, with values of 88.3%, 85.5%, and 85.0%, respectively. The ROC curve showed a significantly higher AUC value of 0.883 (95% CI: 0.832 to 0.923; P<0.0001) for the combined use of all US parameters with better sensitivity (93.10%) and specificity (68.65%) than individual parameters. The overall sensitivity, specificity, and accuracy of FNAC were 97.3%, 82.8%, and 95.3%, respectively. Additionally, US parameters and FNAC together showed a significantly higher AUC value of 0.924 (95% CI: 0.880 to 0.956; P<0.0001) and achieved a sensitivity of 86.21% and specificity of 88.65%. Conclusions: The combined use of US and FNAC provides high sensitivity, specificity, and diagnostic accuracy in characterizing CLA patterns. In limited-resources settings, this approach is feasible, less invasive, and cost-effective thereby enabling clear management strategies and avoiding additional surgical interventions.

Diffusion-weighted imaging in differentiating benign versus malignant lymphadenopathy

Background: Lymphadenopathy requires differentiation into benign and malignant for appropriate management. The current study was done to find out if diffusion-weighted images and apparent diffusion coefficient (ADC) will be able to differentiate benign from malignant cervical lymphadenopathy. Methods: This cross-sectional study was done in the Department of Radiology at Sri Ramachandra Medical College from April 2016 to August 2018. A total of 54 patients with a history of lymphadenopathy were recruited. Histopathological examination (HPE) and magnetic resonance imaging were done for all patients after a complete history and physical examination. The ADC was correlated with HPE in differentiating benign and malignant lymphadenopathy. Results: Majority (46.30%) were in the age group of 51 years and above. Twenty-eight (51.85%) had benign, whereas 26 (48.15%) had malignant lesions. There was a statistically significant difference between the nature of the lesion in ADC value ([× 10–3 mm2/s] [P < 0.001]). The ADC had good predictive validity in predicting malignancy, as indicated by the area under the curve of 0.904 (95% confidence interval 0.821 to 0.987, P < 0.001). Conclusion: ADC values can be used as a complementary tool in assessing the malignant potential of lymph nodes in various conditions and hence play an essential role in the further course of management.

A COMPARATIVE STUDY BETWEEN B-MODE WITH COLOR DOPPLER SONOGRAPHY AND ELASTOGRAPHY IN DIFFERENTIATING BENIGN AND MALIGNANT CERVICAL LYMPHADENOPATHY

Objectives- The purpose of this study was to determine the usefulness of ultrasound elastography in the evaluation of enlarged cervical lymph nodes in comparison with B-mode and color Doppler sonography. Methods-A total of 230 lymph nodes in 164 consecutive patients referred for sonography of the neck were included. B-mode sonograms were evaluated according to short-axis diameter, long-to-short-axis ratio, hilum, echogenicity, and microcalcication. Five different patterns were dened according to vascularity for color doppler sonography. Elastography patterns of the lymph nodes were categorized to 5 main types. The strain index values were calculated for all lymph nodes. Histopathologic ndings were used as reference standards for the diagnosis of benign and malignant lymph nodes. Results-Of the 230 lymph nodes, 62.6% were diagnosed as benign, and 37.4% were diagnosed as malignant. The sensitivity, specicity, and accuracy of B-mode sonography with color Doppler were 76.7%, 81.9%, and 80.0%, respectively; the values were 82.6%, 56.6%, and 66.9% for strain elastography sonography. The strain index cutoff value for the differentiation of benign and malignant lymph nodes was accepted as 1.7. Conclusions-Combination of B-mode sonographic features and vascular pattern of the lymph nodes is best imaging modality in differentiating between malignant and benign cervical lymphadenopathy. Ultrasound elastography adds no additional value to combined B- mode and color Doppler sonography for differentiation of benign and malignant cervical lymph nodes.

Malignant Cervical Lymphadenopathy among Fine Needle Aspiration Cytology in a Tertiary Care Center in Far Western Nepal: A Descriptive Cross-sectional Study

Introduction Metastatic cervical lymphadenopathy is a diagnostic and therapeutic challenge. The utility of Fine Needle Aspiration Cytology is well established in the diagnosis of metastatic lymph nodes, new-onset, or recurrence. This study aims to find the prevalence of metastatic cervical lymphadenopathy among fine needle aspiration cytology in a tertiary care center in far western Nepal. Materials and Methods This is a descriptive cross-sectional study carried out in Seti Provincial Hospital and Maya Metro Hospital, Dhangadhi, Kailali, Nepal between July 2018 to December 2019. Total 534 cervical lymph node aspirations were performed during this period out of which 48 cases were cytologically proven as malignant lymph nodes. Clinical charts and cytology reports of patients with malignant lymph nodes were reviewed. Results Out of 534 cervical lymph node aspirations performed during the study period, the number of malignant lymph nodes was 48 (8.99%). Among malignant lymph nodes (n=48), primary hematolymphoid malignancy was 14 (29.17%) and metastatic cervical lymphadenopathy was 34 (70.83%). Metastatic squamous cell carcinoma was the most common etiology of metastatic cervical lymphadenopathy followed by nasopharyngeal carcinoma and papillary carcinoma of the thyroid. Conclusion Fine needle aspiration cytology has been proved to be a valuable tool in the initial evaluation of metastatic cervical lymphadenopathy in resource-limited settings. Metastatic squamous cell carcinoma is the most common diagnosis in metastatic cervical lymphadenopathy.

Focused Neck Ultrasound and Lymph Node Sampling by Respiratory Physicians in Suspected Lung Cancer

Background: Malignant cervical lymphadenopathy in the setting of lung cancer represents N3 disease, and neck ultrasound (NUS) with sampling is described in the Royal College of Radiologists ultrasound training curriculum for the non-radiologists. This study reviews the incorporation of NUS +/− biopsy in the routine practice of a lung cancer fast-track clinic in the UK. Methods: We retrospectively assessed 29 months of activity of a lung cancer fast-track clinic. Systematic focused NUS was conducted in suspected thoracic malignancy, sampling nodes with a ≥5-mm short axis, under real-time US using a linear probe (5–12 Mhz). Fine-needle aspirations (FNAs) with or without 18 Ga core biopsies were taken. Results: Between August 2017 and December 2019, of 152 peripheral lymph nodes (LNs)/deposits sampled, 98 (64.5%) were supraclavicular fossa LNs with median [IQR] size 12 [8–18] mm. Core biopsies were performed in 54/98 (55%) patients, while all patients had FNAs. No complications occurred. The representative yield was 90/95 (94.7%) in cases with suspected cancer. No difference was seen between FNA versus core biopsy (p = 0.44). Of the 5 non-diagnostic samples, one was FNA only. The commonest diagnosis was lung cancer in 66/98 (67.3%). PDL-1 was sufficient in 35/36 tested (97.2%). ALK-FISH was successful in 24/25 (96%) cases. EGFR mutation analysis was successful in 28/31 (90.3%) cases. Median time from clinic to initial diagnosis was 7 [5–10] days. Computed tomography (CT) scans reported no significant lymphadenopathy in 18/96 (18.7%) cases, yet 10/18 (55.5%) cases were positive for malignancy. Conclusion: Neck nodal sampling by respiratory physicians was safe, timely, with a high diagnostic yield and suitability for molecular testing. Neck US can provide a timely diagnosis in cases that may be missed by CT alone.

Evaluation of Acoustic Radiation Force Impulse Imaging in Differentiating Benign and Malignant Cervical Lymphadenopathy.

Background:The aim of this study was to assess the diagnostic role of acoustic radiation force impulse imaging (ARFI) in differentiating benign and malignant cervical nodes.Methods:This was a diagnostic accuracy cross-sectional study. All patients who underwent ultrasound-guided fine-needle aspiration cytology (FNAC) of cervical nodes were included. Patients without FNAC/biopsy and patients in whom cervical nodes were cystic or completely necrotic were excluded. FNAC was used as reference investigation to predict the diagnostic accuracy. In all cases, FNAC was carried out after the B-mode, color Doppler and the ARFI imaging. In patients with multiple cervical lymph nodes, the most suspicious node based on grayscale findings was chosen for ARFI. ARFI included Virtual Touch imaging (VTI), area ratio (AR), and shear wave velocity (SWV) for each node, and the results were compared with FNAC/biopsy.Results:The final analysis included 166 patients. Dark VTI elastograms had sensitivity and specificity of 86.2% and 72.1%, respectively, in identifying malignant nodes. Sensitivity and specificity of AR were 71.3% and 82.3%, respectively, for a cutoff of 1.155. Median SWV of benign and malignant nodes was 1.9 [95% confidence interval (CI), 1.56–2.55] m/s and 6.7 (95% CI, 2.87–9.10) m/s, respectively. SWV >2.68 m/s helped in identifying malignant nodes with 81% specificity, 81.6% sensitivity, and 81.3% accuracy. ARFI was found to be inaccurate in tuberculous and lymphomatous nodes.Conclusion:Malignant nodes had significantly darker elastograms, higher AR and SWV compared to benign nodes, and SWV was the most accurate parameter. ARFI accurately identifies malignant nodes, hence could potentially avoid unwarranted biopsy.

Ultrasound Elastography in the Diagnosis of Malignant Cervical Lymphadenopathy in Children: Can It Replace Surgical Biopsy?

We aimed to assess the accuracy of ultrasound elastography in detecting pediatric malignant cervical lymph nodes, and if this modality can obviate the need for surgical biopsies. A prospective study from September 2017 to September 2020 included 64 children with persistent cervical lymphadenopathy. Patients were evaluated by meticulous history and physical assessment. B-mode ultrasound, color Doppler, and sonoelastography were conducted thereafter. Elastography scans were classified into five patterns, and patterns from 3 to 5 were considered as malignancies. All children underwent open biopsies followed by pathological examination. Results of tissue diagnosis were compared with patterns of elastography to determine its accuracy. Twenty-eight patients (43.8%) had malignant nodes and the remaining 36 (56.2%) were due to benign causes. Elastography patterns of 1 and 2 were documented in 30 patients, and all of them were diagnosed as benign lesions. Patterns of 3 to 5 were demonstrated in 34 patients. Out of them, 28 were confirmed as malignancies, while 6 children were of benign nature (false positive). Ultrasound elastography achieved sensitivity and specificity of 100 and 85.7%, respectively, and an overall accuracy of 90.6% in the differentiation between malignant and benign entities. The overall accuracy of B-mode and color Doppler were 75 and 82.2%, respectively. Elastography is a useful tool that should be added to ultrasound modalities during the diagnosis of pediatric cervical lymphadenopathy. Surgical biopsy in eligible patients is imperative to commence proper therapy or to discharge the child. Despite favorable results of elastography, it cannot replace surgical biopsy or change its indications.

Application of multimodal ultrasonography for differentiating benign and malignant cervical lymphadenopathy.

The purpose of this study was to evaluate the diagnostic value of multimodal ultrasonography, including SWE and CEUS, for the differentiation of benign and malignant cervical lymphadenopathy. A total of 103 patients with 109 enlarged neck lymph nodes underwent SWE and CEUS. There were 25 hyperplastic lymph nodes, 66 metastatic lymph nodes, and 18 cases of lymphoma. Using 31.6 kPa as the Emax cutoff, the sensitivity, specificity and accuracy of measurements on both benign and malignant cervical lymph nodes were 55.95%, 96%, and 65.2%, respectively. CEUS showed that lymph nodes with reactive hyperplasia mainly exhibited uniform perfusion via the lymphatic hilum (18/25; 72%; P < 0.01). The main manifestation of lymphoma was uniform perfusion through the lymphatic hila (10/18; 55.6%; P < 0.01). Metastatic lymph nodes mainly exhibited uneven perfusion (57/66; 86.4%; P < 0.01). The sensitivity, specificity, and accuracy of multimodal ultrasonography for the diagnosis of benign and malignant cervical lymphadenopathies were 90.5%, 72%, and 86.2%, respectively. Our findings suggest that multimodal ultrasonography can detect the stiffness (elasticity), perfusion pattern, and characteristics of lymph nodes and is a valuable tool for differentiating between benign and malignant lymphadenopathies.

English

BACKGROUND Grey scale ultrasonography can be used as a first line imaging modality along with histopathology for evaluation of cervical lymphadenopathy. Morphologic features like size, shape, hilum and necrosis within the lymph node and vascularity are analysed. We wanted to identify the role of Grey scale ultrasonography and colour Doppler in characterisation of enlarged cervical lymph nodes, evaluate findings in benign and malignant cervical lymphadenopathy and assess the sensitivity, specificity, predictive value, likelihood ratios and accuracy in malignant and benign cervical lymph node enlargement. METHODS This was a cross sectional study with diagnostic test evaluation. All suspected cases of cervical lymphadenopathy referred for sonological evaluation to the Department of Radiodiagnosis of Govt. T.D. Medical College, Alappuzha were included in the study. About 75 patients included in the study, underwent Grey scale and colour Doppler sonography of cervical lymphadenopathy. RESULTS When three criteria were positive for malignancy, the sensitivity and specificity of grey scale ultrasonography and colour Doppler were 100 % and 73.80 %, and when four criteria were positive, the sensitivity and specificity were 72.73 %, and 90.48 % respectively. When we analysed individual variables, status of hilum (absence / presence) has reasonably good sensitivity and specificity, positive predictive value, negative predictive value and accuracy (90.09 %, 92.90 %, 90.09 %, 92.90 % and 92.0 % respectively). In our study the important criteria positive for malignant lymph nodes were size &gt; / 11 mm in short axis diameter, round shape, absent hilum and peripheral and central + peripheral type of vascularity of cervical lymph nodes. For benign lymph nodes, oval shape, presence of hilum and central vascularity were the important criteria noted. CONCLUSIONS Grey scale ultrasonography can be complemented by colour Doppler ultrasonography (USG) in patients presenting with cervical lymphadenopathy to differentiate between benign and malignant lesions by reducing unnecessary biopsies by more accurate discrimination. KEY WORDS Grey Scale Ultrasonography, Malignant, Benign Lymph Nodes, Histopathology

A vivid way of differentiating benign and malig-nant cervical lymph node through b-mode ultrasonography and sonoelastography

Cervical lymphadenopathy is not a diagnosis but it is a sign or symp-tom. The etiology could be inflammatory or degenerative or neoplastic. Cervical lymph node evaluation plays a vital role in patients with head and neck cancers because the results determine the prognosis and choice of therapy. Ultrasonography can be used to assess the mor-phology, site, number, size and vascularity of cervical lymph node. However, the ultrasound criteria for metastatic lymph nodes are con-troversial. Sonoelastography is a novel imaging modality introduced as a non-invasive technique for evaluating cervical lymph nodes and to map the elastic properties of examined soft tissue. Neck lymph nodes are easily accessible and can be efficiently compressed against under-lying anatomical structures, with use of an ultrasound transducer for elastographic tissue characterization. The detail about the rigidity of a lymph node gives us the direction for percutaneous biopsy and nodal dissection under ultrasound guidance. Use of this information can also improve patient follow-up by enabling detection of cancer recurrence at an early stage. The study aims to differentiate benign and malignant cervical lymph nodes by observing the morphology, vascular Pattern and strain ratio cut-off value. In this trial 40 patients with cervical lym-phadenopathy were studied and the study concluded that Ultrasound elastography is a specific test unlike B-mode ultrasonography in dif-ferentiating benign and malignant cervical lymphadenopathy. The strain ratio cut-off value for benign vs malignant lymphadenopathy is 1.78. Thus Sonoelastography along with B-mode ultrasound increases the rate of detection of malignancy.

Diagnostic Value of Conventional Fine Needle Aspiration Cytology in Cervical Lymphadenopathy

Abstract Background: Lymphadenopathy is a common clinical presentation in outpatient clinics. Fine needle aspiration cytology (FNAC) of the enlarged lymph node is an easy and simple tool for clinical management. This is because it is fast and minimally invasive with minimal complications. Aim of Study: To evaluate the reliability and validity of conventional FNAC of cervical lymphadenopathy. Patients and Methods: This prospective study was carried out on 50 patients with cervical lymphadenopathy. The cy-topathological diagnoses obtained by FNAC were compared with the histopathological results of the ongoing excised nodes. Results: Fifty four percent of our cases were females. Seventy four percent of our cases were less than 40 years. The cytological diagnoses were benign in 29 cases (58%) and malignant (diagnostic or suspicious for malignancy) in 21 cases (42%). The sensitivity, specificity, positive predictive value, and negative predictive value were 84%, 100%, 100%, and 86.2%, respectively. The overall diagnostic accuracy was 92% (46/50), while the overall discordance rate was 8% (4/50). Conclusions: FNAC is a reliable method for diagnosis of tuberculous lymphadenitis. It shows a high specificity for malignant cervical lymphadenopathy and provides the physi-cian with valuable information for patient management. The sensitivity of FNAC in detection of malignancy is relatively low in cases of lymphoid neoplasm owing to missing Hodgkin's cells in the aspiration of Hodgkin's lymphoma and to difficulty in cytodiagnosis of low-grade lymphoma without use of flow cytometry.

Evaluation of B-Mode and Color Doppler Ultrasound in the Diagnosis of Malignant Cervical Lymphadenopathy.

BackgroundB-mode ultrasound (BMUS) and color doppler ultrasound (CDUS) could be valuable in evaluating cervical lymphadenopathy compared to palpation. This study aimed at evaluating the efficacy of BMUS and CDUS in differentiating cervical lymph nodes into benign and malignant nature. MethodologyIn this cross-sectional analytical study, a total of 166 patients, who were referred for US-guided fine-needle aspiration cytology (FNAC) of cervical nodes, were included. Patients with cystic/ necrotic cervical nodes or without FNAC/biopsy report were excluded. All study patients underwent BMUS and CDUS, followed by the reference investigation of FNAC/biopsy for analysis. In BMUS, short-axis diameter (SAD), short-axis/long-axis diameter ratio (S/L), presence or absence of echogenic hilum and well defined or ill-defined borders were analyzed. In CDUS, the vascular pattern of a cervical node was categorized as hilar, peripheral or mixed. In cases with multiple cervical lymph nodes, the node having the most suspicious features on the greyscale US was chosen. The results were compared with the final FNAC/biopsy reports.ResultsA total of 166 patients were analyzed in this study. The cut-off point of SAD and S/L ratio for the cervical lymph nodes was 1.28cm and 0.595. The S/L ratio was the best BMUS parameter with a sensitivity of 75%, the specificity of 81%, and an accuracy of 79%. Loss of echogenic hilum was the most sensitive parameter in this study with a sensitivity of 95.4% and an accuracy of 79.5%. The presence of ill-defined margins was significantly higher in the malignant nodes than the benign nodes with a p-value <0.001. The presence of peripheral/mixed vascularity was higher in the malignant nodes than the benign nodes with a p-value <0.001.ConclusionsMalignant nodes had significantly higher SAD, higher S/L ratio, loss of echogenic hilum, presence of ill-defined margins and peripheral/mixed vascularity compared to benign nodes. The loss of echogenic hilum was the most accurate and sensitive parameter, while the S/L ratio was found to be the most specific BMUS parameter in the detection of malignant nodes. BMUS and CDUS identify malignant nodes and also helps in guiding FNAC/biopsy.

Abstract #807012: A Shocking Mimic of Malignant Cervical Lymphadenopathy in a Patient with a Thyroid Nodule

Abstract #807012: A Shocking Mimic of Malignant Cervical Lymphadenopathy in a Patient with a Thyroid Nodule

Differentiation of benign from malignant cervical lymphadenopathy by ultrasonography in children.

The most common causes of cervical lymphadenopathy (LAP) are inflammatory and reactive conditions; only a small proportion have serious pathology, such as malignancy. The objective of this study was to evaluate the relationship between USG findings and histopathological diagnosis of the cervical LAP. This retrospective study comprised the cases of cervical LAP in patients aged under 20 years old followed in our center between January 2007 to December 2016. Based on pathology reports, we divided the patients into two groups: benign and malignant. Pathology results and USG findings were compared. After the analyze of the histopathological results and USG findings, 107 patients with persistent cervical LAP (44 malignant; 63 benign) were included in the study. Mean age of malignant and benign group were 14 ± 6.1; 11.9 ± 4.8 years, respectively. Hilar vascularity for benign LAP was highly statistically significant (P < 0.0001) and peripheral flow and mixed vascularity for malignant LAP were also statistically significant (p < 0.05). There was not a significant difference in the maximum diameter (27.3 ± 11.1 mm and 29.8 ± 12.3 mm, respectively), however, there was a significant difference in the minimum diameter between benign and malignant groups (13.7 ± 7.3 mm and 18.7 ± 8.8 mm, respectively). The present study suggests that there is a relationship between US and biopsy findings for the differentiation of benign from malignant LAP, especially in terms of nodal hilus and intranodal vascular pattern.

Comparison and evaluation by USG and CT with histological findings of cervical lymphadenopathy in head and neck malignancies

Purpose: Comparing and evaluating cervical lymph nodes by USG and CT with Histopathological correlation in patients with head and neck malignancy. To assess the diagnostic accuracy of both Ultrasonography [USG] and Computed Tomography [CT] in preoperative evaluation of the cervical nodal status in patients with head and neck malignancy. Materials and Methods: A prospective study was done from October 2017 to march 2019 on all patients with suspected primary or recurrent head and neck malignancy who are referred to Department of Radio-Diagnosis, Siddhartha Medical College Hospital and Research centre, Tumkur. After obtaining the consent, we analyze cervical lymph nodes (metastatic and nonmetastatic) from patients with head and neck malignancy. All these nodes will be examined on gray-scale and power Doppler sonography and also on CT. Topographic correlations, between dissected nodes and sonograms and between dissected nodes and CT images, will be performed for each node. Results: Our study out of 36 subjects evaluated for head and neck malignancy USG had a high sensitivity of 96%, Specificity of 49%, positive predictive value of 87% and also a negative predictive value of 66% with accuracy of 86%, CT had a high sensitivity of 96%, Specificity of 56%, positive predictive value of 90% and also a negative predictive value of 75% with accuracy of 88%. The above table has a p value of 0.001 which is considered as very highly significant. Kappa Statistics was calculated and it was found to be 0.712, which is considered as good agreement.Conclusion: Ultrasonographic examination is very sensitive in differentiating between cystic/necrotic foci and solid swellings. Colour Doppler Sonography provides additional information on vasculature of the lymph nodes and plays an important role in differentiating between the benign, reactive and malignant cervical lymphadenopathy. Multidetector CT provides improved localisation and characterization of cervical lymph nodes.

Cervical lymphadenopathy as initial presentation of genito-urinary cancer

&lt;p class="abstract"&gt;Head and neck cancers rank fifth amongst the most affected cancers in the world. Metastasis to cervical lymph nodes is primarily from sites in head and neck. About 1% of all malignant cervical adenopathies are encountered as metastasis from remote primary site. We present here our experience of four cases in last five years. Patients presented as cervical lymphadenopathy with unknown primary, which on evaluation was found to be of genitourinary source from different sites. It is a single centre retrospective study. We reviewed cancer registry. We found four cases of genitourinary cancer with cervical lymph node metastasis. Patients presented as cervical lymphadenopathy of unknown primary. Among those one papillary renal cell cancer with rhabdoid differentiation, one testicular cancer, two prostate cancer. One case was a 67 year male patient, who revealed papillary renal cell carcinoma with rhabdoid features. Another patient was a male of 31 years, who had left testicular mass with retroperitoneal and cervical lymphadenopathy. Two patients of 68 year and 74 year respectively had metastatic prostate cancer. All patients underwent proper treatment and regularly followed up. Although rare, malignant cervical lymphadenopathy may be the first clinical manifestation of metastasis from genitourinary tumors. Evaluation of genitourinary system must be included in the protocol for uncovering the primary tumor site in cases of isolated cervical adenopathy.&lt;/p&gt;&lt;p class="abstract"&gt; &lt;/p&gt;

The Clinical Value of New Scoring System of Cervical Lymph Node.

To distinguish malignant cervical lymphadenopathy, we established a new scoring system based on ultrasound features. Two hundred sixty-three patients with cervical lymphadenopathy received ultrasonic examination and underwent ultrasound-guided core needle biopsy or fine needle aspiration. The scoring system was proposed by multivariate logistic regression analysis and compared with Liao scoring system (0.06 × age + 4.76 × shortest-to-longest axis ratio + 2.15 × internal echo + 1.80 × vascular pattern). A new scoring system model, 1.346 × margin + 1.339 × hilum + 2.411 × calcification + 2.619 × vascular pattern + 0.837 × shortest-to-longest axis ratio, was generated. Lymph nodes were regarded as malignancy when the score was ≥2.4. Compared with the Liao scoring system, the new scoring system had larger area under the curve (0.86 versus 0.76, P = 0.036), specificity (86.7% versus 75.0%, P = 0.001), accuracy (87.1% versus 80.6%, P = 0.007), and positive predictive value (89.0% versus 80.0%, P = 0.043). Sensitivity (87.4% versus 85.3%, P = 0.647) and negative predictive value (85.0% versus 81.0%, P = 0.395) did not differ. We concluded that the new scoring system is more reliable and can play an important role in the differential diagnosis of cervical lymph nodes.

Reliability of sonoelastography in predicting pediatric cervical lymph node malignancy

Controversy exists as regards the best non-invasive diagnostic tool for pediatric cervical lymphadenopathy. The current work aimed to evaluate the reliability, sensitivity, specificity, and accuracy of sonoelastography in diagnosing benign and/or malignant pediatric cervical lymphadenopathy. Prospective study took place over a period of 4years from January 2013 to December 2016. A total of 177 lymph nodes (LNs) in 128 children with an age ranging from 11months to 12years were recruited in this study. Patients were 77 males and 51 females with a ratio of 3:2. All patients underwent a thorough history taking and clinical examination of the neck focusing on the cervical lymph nodes. After that, a B-mode sonography, Color Doppler ultrasound, and Sonoelastography were performed. Elastographic patterns of 1-5 were evaluated, whereas patterns of 3-5 (firm to hard) were suspected to have a malignant nature. Sonographic-guided aspiration cytology took place in 107 lymph nodes and excisional biopsy in 102 lymph nodes, whereas 13 lymph nodes responded adequately to conservative treatment. They proved to be benign reactive hyperplasia. The majority of LNs (87%) were of the malignant type that showed an elastographic pattern of 3-5. The same patterns were observed in only 6 (3.4%) of the benign LNs. Sonoelastography showed a sensitivity of 85.9%, specificity of 100%, PPV of 100%, NPV of 75.96%, and overall accuracy of 90.23% in distinguishing benign from malignant lymph nodes. Using the B-Mode ultrasound, an abnormal hilum was seen in 75%. The accuracy of color Doppler US reached 82.7%. Sonoelastography may be superior to other US modalities in elucidating different cervical lymph node biopsy helping to distinguish benign from malignant lesions. This may replace the lymph node biopsies in the future. Moreover, its use in the follow-up of patients with cervical malignancies may reduce the number of future biopsies. Further studies with more patients may be needed for a better assessment of results.

PET and Neck Ultrasound for the Detection of Cervical Lymphadenopathy in Patients with Lung Cancer and Mediastinal Lymphadenopathy

Background: Cervical lymph nodes are frequently involved in patients with lung cancer and indicate inoperability. Some guidelines recommend neck ultrasound (NUS) in patients with bulky mediastinal lymphadenopathy. Positron emission tomography (PET) is indicated for patients with potentially curable disease. Objectives: We aimed to assess the diagnostic yield of NUS and the diagnostic accuracy of PET for cervical lymphadenopathy in this group with a high pre-test probability of N3 disease. Methods: Records of all patients with lung cancer who underwent an NUS over a consecutive 5-year period were reviewed. Only patients with mediastinal lymphadenopathy on computerised tomography (CT) were included. The diagnostic accuracy of PET was assessed with NUS-guided fine needle aspiration cytology used as the reference test. Results: During the study period, 123 patients met the inclusion criteria. Malignant cervical lymphadenopathy was confirmed in 49/123 (39.8% [95% CI 31.1–49.1]). PET-CT had a specificity of 81.1%, sensitivity of 87.5%, negative predictive value of 96.8% and positive predictive value of 50% for the detection of cervical lymphadenopathy, and it contributed no additional staging information in the neck area. Overall, PET led to a change in management in only 2.2% of cases. Conclusion: A significant proportion of patients with lung cancer and mediastinal lymphadenopathy have cervical lymphadenopathy detected by NUS. In this group of patients, PET offers minimal additional value in staging and management.

73P PET and neck US for the detection of cervical lymphadenopathy in patients with lung cancer and mediastinal lymphadenopathy

Background: Cervical lymph nodes are frequently involved in patients with lung cancer and indicate inoperability. Some guidelines recommend neck ultrasound (NUS) in patients with bulky mediastinal lymphadenopathy. Positron emission tomography (PET) is indicated for patients with potentially curable disease. We aimed to assess the diagnostic yield of NUS and the diagnostic accuracy of PET for cervical lymphadenopathy among patients with suspected lung cancer and mediastinal lymphadenopathy. Methods: Records of all patients with lung cancer who underwent a NUS over a consecutive 5-year period were reviewed. Only patients with mediastinal lymphadenopathy on CT were included. The diagnostic accuracy of PET was assessed with NUS-guided fine needle aspiration cytology used as the reference test. Results: During the study period 123 patients met the inclusion criteria. Malignant cervical lymphadenopathy was confirmed in 39.8% (95% CI 31.1–49.1%). PET-CT had a specificity of 81.1%, sensitivity of 87.5%, negative predictive value of 96.8% and positive predictive value of 50% for the detection of cervical lymphadenopathy, and it contributed no additional staging information in the neck area. Overall, PET led to changes in management in only 2.2% of cases. Conclusions: A significant proportion of patients with lung cancer and mediastinal lymphadenopathy have cervical lymphadenopathy detected by NUS. In this group of patients PET offers minimal additional value in staging and management. Legal entity responsible for the study: Galway University Hospital Funding: Has not received any funding Disclosure: All authors have declared no conflicts of interest.