Malignant Cervical Lymph Nodes Research Articles

Differential diagnosis of cervical lymphadenopathy: Integration of postvascular phase of contrast-enhanced ultrasound and predictive nomogram model

BackgroundDistinguishing benign from malignant cervical lymph nodes is critical yet challenging. This study evaluates the postvascular phase of contrast-enhanced ultrasound (CEUS) and develops a user-friendly nomogram integrating demographic, conventional ultrasound, and CEUS features for accurate differentiation. MethodsWe retrospectively analyzed 395 cervical lymph nodes from 395 patients between January 2020 and December 2022. The cohort was divided into training and validation sets using stratified random sampling. A predictive model, based on demographic, ultrasound, and CEUS features, was created and internally validated. ResultsThe training set included 280 patients (130 benign, 150 malignant nodes) and the validation set 115 patients (46 benign, 69 malignant). Relative hypoenhancement in the postvascular phase emerged as a promising indicator for MLN, with sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of 96.7 %,52.3 %, 70.0 %, 93.2 %, and 76.1 %, respectively in the training set and 95.7 %, 52.2 %, 75.0 %, 88.9 %, and 74.8 % in the validation set. Age over 50 years, history of malignancy, short-axis diameter greater than 1.00 cm, focal hyperechogenicity, ill-defined borders, and centripetal perfusion were also identified as independent MLN indicators. The nomogram prediction model showed outstanding accuracy, with an area under the curve (AUC) of 0.922 (95 % CI: 0.892–0.953) in the training set and 0.914 (95 % CI: 0.864–0.963) in the validation set. ConclusionRelative hypoenhancement in the postvascular phase of CEUS, combined with demographics and ultrasound features, is effective for identifying MLNs. The developed prediction model, with a user-friendly nomogram, can facilitate clinical decision-making.

Improved Cervical Lymph Node Characterization among Patients with Head and Neck Squamous Cell Carcinoma Using MR Texture Analysis Compared to Traditional FDG-PET/MR Features Alone.

Accurate differentiation of benign and malignant cervical lymph nodes is important for prognosis and treatment planning in patients with head and neck squamous cell carcinoma. We evaluated the diagnostic performance of magnetic resonance image (MRI) texture analysis and traditional 18F-deoxyglucose positron emission tomography (FDG-PET) features. This retrospective study included 21 patients with head and neck squamous cell carcinoma. We used texture analysis of MRI and FDG-PET features to evaluate 109 histologically confirmed cervical lymph nodes (41 metastatic, 68 benign). Predictive models were evaluated using area under the curve (AUC). Significant differences were observed between benign and malignant cervical lymph nodes for 36 of 41 texture features (p < 0.05). A combination of 22 MRI texture features discriminated benign and malignant nodal disease with AUC, sensitivity, and specificity of 0.952, 92.7%, and 86.7%, which was comparable to maximum short-axis diameter, lymph node morphology, and maximum standard uptake value (SUVmax). The addition of MRI texture features to traditional FDG-PET features differentiated these groups with the greatest AUC, sensitivity, and specificity (0.989, 97.5%, and 94.1%). The addition of the MRI texture feature to lymph node morphology improved nodal assessment specificity from 70.6% to 88.2% among FDG-PET indeterminate lymph nodes. Texture features are useful for differentiating benign and malignant cervical lymph nodes in patients with head and neck squamous cell carcinoma. Lymph node morphology and SUVmax remain accurate tools. Specificity is improved by the addition of MRI texture features among FDG-PET indeterminate lymph nodes. This approach is useful for differentiating benign and malignant cervical lymph nodes.

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.

The value of multimodal ultrasound in diagnosis of cervical lymphadenopathy: can real-time elastography help identify benign and malignant lymph nodes?

AimTo investigate the multimodal ultrasound(MMUS) features of cervical lymphadenopathy and to assess its value in the differential diagnosis of benign and malignant cervical lymph nodes.MethodsA retrospective analysis of 169 patients with cervical lymph node enlargement who attended Hangzhou Red Cross Hospital from March 2020 to October 2022. All patients underwent conventional ultrasound (CUS), contrast-enhanced ultrasound (CEUS), and real-time elastography (RTE), and were divided into training set and validation set. Univariate analysis was applied to screen out statistically significant parameters, and CUS model and MMUS model were constructed by multifactorial logistic regression analysis. The receiver operator characteristic (ROC) curve was established, and the area under the curve (AUC) was used to compare CUS model with MMUS model to assess the value of MMUS.ResultsOf the cervical 169 lymph nodes in 169 patients included in the study. The 169 enrolled patients were divided into a training set (132 patients) and a validation set (37 patients). In the training set, univariate analysis showed statistically significant differences in long diameter/short diameter(L/S), border, margin, hilus, dermal medulla boundary, blood flow type, enhancement mode, enhancement type, and RTE score (all p&amp;lt; 0.05). Multifactor logistic analysis showed that L/S, blood flow type, enhancement mode and enhancement type were correlates of malignant lymph nodes (all p&amp;lt; 0.05). The comparison of AUC demonstrated that the discriminative ability of the MMUS model was superior to using the CUS model, both in the training set(p = 0.004) and validation set (p&amp;lt;0.001).ConclusionIn this study, MMUS shows higher diagnostic efficiency than CUS. Ultrasound features such as L/S, blood flow type, mode of enhancement, type of enhancement are helpful in distinguishing benign and malignant lymphadenopathy. The addition of CEUS can greatly improve the sensitivity and specificity of ultrasonic diagnosis of malignant cervical lymph nodes. RTE score is of limited value in the diagnosis of malignant cervical lymph nodes.

OGC P64 Additional value of cervical ultrasonography in the detection of cervical lymph node metastases in patients with esophageal cancer

Abstract Background External ultrasound for detection of cervical lymph node metastases used to be standard in the diagnostic work-up for esophageal cancer patients in the Netherlands. This study aimed to assess the additional value of cervical ultrasonography over 18F-FDG PET-CT for the detection of cervical lymph node metastases in esophageal cancer patients. 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 for presence of suspect cervical lymph node(s). Primary outcome was incidence, etiology and visibility on ultrasound and/or 18F-FDG PET-CT. Results This study included 789 patients, with a median age of 67 years. Patients were predominantly male (75.2%) and the majority had an adenocarcinoma (71.7%). Suspected cervical lymph nodes were documented in 170 patients (21.6%), 57 proved malignant (33.5%). Of these malignant lymph nodes, seven (12.3%) were visualized on ultrasound, but negative on 18F-FDG PET-CT. One was detected with 18F-FDG PET-CT but not visualized on ultrasound. Lymph node biopsy was conducted for 150 out of 170 patients. Of those, 79 proved benign. 60 patients underwent biopsy for a benign cervical lymph node suspected on ultrasound but negative on 18F-FDG PET-CT. Conclusions As 12.3% of malignant cervical lymph nodes were only visualized with ultrasound, but negative on 18F-FDG PET-CT, cervical ultrasound is of additional value in the detection of cervical lymph node metastases. However, routine cervical ultrasound also attributes to the number of biopsies taken for benign lesions.

Role of Dynamic Contrast-Enhanced MRI in Differentiation Between Malignant and Benign Cervical Lymph Nodes: A Case-Control Study

Background: Changes in signals and parameters of time-signal intensity curve (TIC) resulting from dynamic magnetic resonance imaging (MRI) have been considered for determining malignancy. However, the specific diagnostic criteria of TIC for detecting malignancy in various organs, such as lymph nodes, are not yet well-established. Objectives: This study aimed to evaluate the role of some TIC parameters in identifying malignant cervical lymph nodes. Patients and Methods: In this case-control study, patients with cervical lymphadenopathy were examined by dynamic contrast-enhanced MRI (DCE-MRI) before excisional biopsy. They were then divided into malignant and benign groups based on histopathology. Malignant patients were considered as the case group, while benign cases were considered as the control group. The TIC parameters included the signal intensity (SI) at 45 seconds, 90 seconds, 120 seconds, 5 minutes, and 10 minutes, as well as maximum signal intensity (SImax), the time at which the maximum signal intensity occurs (Tmax), the peak signal intensity (SI peak), and the time at which the peak signal intensity occurs (T peak). Additionally, the enhancement slope (ES), washout ratio (WR), and washout slope (WS) were evaluated at 5 and 10 minutes. Results: A total of 63 patients were enrolled in the study, including 31 (49.2%) patients with benign lymphadenopathies and 32 (50.8%) patients with malignant lymphadenopathies. Among the variables under study, significant differences were observed between the malignant (M) group and the benign (B) group in terms of the SI-5 min, SI-10 min, WR-5 min, WR-10 min, and WS-5 min (SI-5 min: 124.4 ± 145 (B) vs. 219.2 ± 93.8 (M), P = 0.003; SI-10 min: 109.9 ± 134.6 (B) vs. 188.9 ± 83.7 (M), P = 0.007; WR-5 min: 0.58 ± 0.38 (B) vs. 0.15 ± 0.13 (M), P &lt; 0.001; WR-10 min: 0.63 ± 0.36 (B) vs. 0.26 ± 0.17 (M), P &lt; 0.001; and WS-5 min: 0.93 ± 1.20 (B) vs. 1.40 ± 4.44 (M), P = 0.001). In the receiver operating characteristic (ROC) curve analysis, WS-5 min showed specificity of 29.1%, 75%, 90%, and 95% and sensitivity of 88.2%, 70.6%, 47.1%, and 47.1% at cutoff points of 0.1, 0.37, 0.57, and 0.66, respectively. Conclusion: The WR-5 min can be considered as a potential TIC index in DCE-MRI for the diagnosis of malignant cervical lymphadenopathies.

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.

AIUM Practice Parameter for the Performance and Interpretation of Diagnostic Ultrasound of the Thyroid and Extracranial Head and Neck.

AIUM Practice Parameter for the Performance and Interpretation of Diagnostic Ultrasound of the Thyroid and Extracranial Head and Neck.

Clinical application of ultrasound-guided Core Needle Biopsy Histology and Fine Needle Aspiration Cytology in Cervical Lymph Nodes.

To investigate the difference of application of core needle biopsy histology and fine needle aspiration cytology in cervical lymphadenopathy. A retrospective analysis was made on 80 patients with cervical lymphadenopathy admitted to Baoding No.1 Central Hospital from to October 2018 to February 2020, and they were randomly divided into two groups: core needle group and fine needle group. Patients in the core needle group were given core needle biopsy histology, while those in the fine needle group were given fine needle aspiration cytology, and the puncture results and surgical complications were compared between the two groups. The accuracy rates of the core needle group and the fine needle group in the diagnosis of malignant cervical lymph nodes were 95.83% and 72.22% respectively, with a statistically significant difference (χ²=4.683, p=0.030). The sensitivity, specificity, positive predictive value and negative predictive value of the core needle group were 100.00%, 93.75%, 95.83% and 100.00% respectively, while those of the fine needle group were 86.67%, 90.00%, 86.67% and 90.00% respectively, with no statistically significant differences between the two groups (p>0.05). The complication rate in the core needle group was 22.50%, which was higher than the 5.00% in the fine needle group (χ²=5.165, p=0.023). No significant difference was observed between core needle biopsy histology and fine needle aspiration cytology in diagnosing cervical lymphadenopathy, but the former has a high complication rate.

Preliminary study on CT contrast-enhanced radiomics for predicting central cervical lymph node status in patients with thyroid nodules.

To explore the feasibility of using a contrast-enhanced CT image-based radiomics model to predict central cervical lymph node status in patients with thyroid nodules. Pretreatment clinical and CT imaging data from 271 patients with surgically diagnosed and treated thyroid nodules were retrospectively analyzed. According to the pathological features of the thyroid nodules and central lymph nodes, the patients were divided into three groups: group 1: papillary thyroid carcinoma (PTC) metastatic lymph node group; group 2: PTC nonmetastatic lymph node group; and group 3: benign thyroid nodule reactive lymph node group. Radiomics models were constructed to compare the three groups by pairwise classification (model 1: group 1 vs group 3; model 2: group 1 vs group 2; model 3: group 2 vs group 3; and model 4: group 1 vs groups (2 + 3)). The feature parameters with good generalizability and clinical risk factors were screened. A nomogram was constructed by combining the radiomics features and clinical risk factors. Receiver operating characteristic (ROC) curve, calibration curve and decision curve analysis (DCA) were performed to assess the diagnostic and clinical value of the nomogram. For radiomics models 1, 2, and 3, the areas under the curve (AUCs) in the training group were 0.97, 0.96, and 0.93, respectively. The following independent clinical risk factors were identified: model 1, arterial phase CT values; model 2, sex and arterial phase CT values; model 3: none. The AUCs for the nomograms of models 1 and 2 in the training group were 0.98 and 0.97, respectively, and those in the test group were 0.95 and 0.87, respectively. The AUCs of the model 4 nomogram in the training and test groups were 0.96 and 0.94, respectively. Calibration curve analysis and DCA revealed the high clinical value of the nomograms of models 1, 2 and 4. The nomograms based on contrast-enhanced CT images had good predictive efficacy in classifying benign and malignant central cervical lymph nodes of thyroid nodule patients.

CYSTIC METASTASIS FROM TONSILLAR CANCER – A CASE REPORT

INTRODUCTION Brachial cleft cyst is the most common cause of cystic lesion in the neck in younger population. But in patients above 40 years of age, about 80% of the cystic neck lesions were reported to be malignant. The incidence of such type of metastasis from Waldeyer's ring accounts for 33-62%. CASE REPORT A 60 year old male presented with a painless swelling in the left side of the neck for 8 months. Clinical features, imaging and FNAC favoured infected brachial cyst. Excision biopsy showed metastatic carcinomatous deposits with high mitotic index. Panendoscopy with tonsillectomy done. Biopsy of left tonsil showed moderately differentiated squamous cell carcinoma. Then adjuvant Radiotherapy was given to the patient and on 6th month follow up, patient had no features of recurrence.CONCLUSION For any cystic neck lesion in an adult, metastatic disease must be considered as a differential diagnosis. And for proven malignant cystic cervical lymph node, a primary malignancy involving Waldeyer's ring should be suspected. Initially imaging and FNAC may be taken. If FNAC is inconclusive, excision biopsy may be done. Then depending upon the biopsy finding, pan endoscopy with guided biopsies and tonsillectomy may be done.

Advances in the application of contrast-enhanced ultrasound in the differential diagnosis of benign and malignant cervical lymph nodes

The accurate diagnosis and differential diagnosis of cervical lymph node lesions are very important for making scientific diagnosis and treatment strategy and evaluating the prognosis of the disease. Contrast-enhanced ultrasound (CEUS) can continuously observe the microcirculation and blood flow perfusion of lymph nodes, and significantly improve the accuracy of diagnosis of cervical lymph nodes, it has been gradually applied to localize the sentinel lymph node, guide biopsy, evaluate the treatment effect of lymph node and molecular imaging. This article reviews the recent advances in the application of CEUS in the diagnosis of benign and malignant cervical lymph nodes.

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Radiofrequency ablation of malignant cervical lymph nodes: an unusual treatment for dysphagia.

Radiofrequency ablation of malignant cervical lymph nodes: an unusual treatment for dysphagia.

Contrast-enhanced ultrasound characteristics of preoperative central cervical lymph node metastasis in papillary thyroid carcinoma

This study evaluated the preoperative diagnostic value of lymph node ultrasonography in distinguishing between benign and malignant central cervical lymph nodes (CCLNs) in patients with papillary thyroid carcinoma (PTC). A total of 176 patients who had PTC with 216 CCLNs (49 benign and 155 malignant) were enrolled in this study and preoperatively imaged by ultrasonography, including conventional ultrasound (US) and contrast-enhanced ultrasound (CEUS). We evaluated the ultrasonography parameters for each lymph node. Binary logistic regression analysis indicated that multifocality of PTC and the absence of Hashimoto’s thyroiditis are independent clinical features related to patients with PTC who also have malignant CCLNs. For preoperative ultrasonography features, heterogeneous enhancement and centripetal perfusion are independent ultrasonographic features to identify malignant and benign CCLNs. This study demonstrated that preoperative CEUS characteristics help to distinguish malignant CCLNs from benign CCLNs.

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.

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.

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.