Malignant Cervical Lymph Nodes Research Articles

Diagnostic Efficacy of Diffusion-Weighted Magnetic Resonance Imaging (DWI) in the Differentiation of Benign and Malignant Cervical Lymphadenopathies

Background: Pre-operative differentiation of benign from malignant cervical adenopathies remains a challenge. Several studies indicate parameters to discriminate between benign and malignant lymph nodes, which has not yet been enough. Objectives: The aim of the current study was to assess the diagnostic efficacy of diffusion-weighted MR imaging (DWI) to differentiate benign from malignant cervical lymph nodes. Patients and Methods: In all patients, we assessed axial and coronal fast spin echo T2 and T1-weighted images and T1-weighted after contrast injection. DWI sequences were implemented before contrast injection, in axial and coronal planes (b factor of 50, 500 and 1000 s/mm2) and the apparent diffusion coefficient (ADC) maps were reconstructed. Data were assessed in mixed model analysis and results were compared with postoperative histopathologic findings. Results: Thirty seven subjects were enrolled, 10 with benign lymphadenopathy and 27 patients with malignant lymphadenopathies before treatment. The mean ADC of the benign neck lymph nodes was (1.00 ± 0.34) × 10-3 mm2/s, while it was (0.76 ± 0.16) × 10-3 mm2/s in malignant ones (P = 0.058). The mean ADC of the metastatic nodes was (0.81 ± 0.14) × 10-3 mm2/s, while it was (0.56 ± 0.04) × 10-3 mm2/s in lymphoma (P < 0.001). The mean ADC of poorly differentiated metastatic nodes was significantly lower than that of good and moderately differentiated ones [(0.86 ± 0.13) × 10-3 mm2/s vs. (0.66 ± 0.02) × 10-3 mm2/s respectively; P = 0.001]. The area under the ROC curve of ADC was 0.69 [95%CI = 0.52 - 0.83]. Considering cut off points of 0.6 × 10-3, 0.95 × 10-3, and 1.2 × 10-3 yielded sensitivities were 15%, 92.5%, and 100%, respectively; while, in these cutoff points, specificities were 80%, 50%, and 40%, respectively. Conclusion: DWI could be considered as an important diagnostic tool to differentiate enlarged cervical lymphadenopathies.

The effect of regions-of-interest and elasticity modulus selection on differentiating benign and malignant cervical lymph nodes with shear wave elastography

OBJECTIVE:Imaging diagnosis of cervical lymphadenopathy has conventionally used ultrasonography. Shear wave elastography (SWE) is a recent ultrasound technological advancement that has shown promise in the important medical problem of differentiating between benign and malignant cervical lymph nodes based on quantitative measurements of elasticity modulus. However, widely varying elasticity modulus metrics and regions-of-interest (ROIs) were used in existing studies, leading to inconsistent findings and results that are hard to compare with each other.METHODS:Using a large dataset of 264 cervical lymph nodes from 200 patients, we designed a study comparing three elasticity modulus metrics (Emax, Emean, and standard deviation-SD) with three different ROIs to evaluate the effect of such selections. The metric values were compared between the benign and malignant node groups. The different ROI and metric selections were also compared through receiver operating characteristics curve analysis.RESULTS:For all ROIs, all metric values were significantly different between the two groups, indicting their diagnostic potential. This was confirmed by the ≥0.80 area under the curve (AUC) values achieved with these metrics. Different ROIs had no effect on Emax, whereas all ROIs achieved high performance at 0.88 AUC. For Emean, the smallest ROI focusing on the area of the highest elasticity achieved the best diagnostic performance. In contrast, the larger ROIs achieved higher performances for SD.CONCLUSIONS:This study illustrated the effect of elasticity modulus and ROI selection on the diagnostic performance of SWE on cervical lymphadenopathy. These new findings help guide relevant future studies and clinical applications of this important quantitative imaging modality.

Diffusion-Weighted Magnetic Resonance Imaging in Characterization of Neck Lymph Nodes in Head and Neck Cancer

Aim: to prospectively determine if diffusion weighted magnetic resonance imaging can help in discrimination between benign and malignant lymph nodes in patients with head and neck cancer, using histological results as the standard of reference. Patients & Methods: 40 patients complaining of palpable cervical lymph nodes with unknown primary malignancy or having known head and neck cancer. MRI neck study was done for all patients, including pre and post contrast sequences and DWI. Histopathology was done for all patients. Statistical analysis of the differences in ADC values for benign and malignant nodes was performed, together with further analysis of the differences between the ADC values of metastatic lymph nodes and lymphoma. Results: 30 patients were histopathological proved malignant lymphadenopathy (20 metastatic from head and neck malignancy and 10 primary lymphomas) and 10 patients were histopathological proved benign lymphadenopathy (1 acute reactive lymphadenitis, 1 chronic granulomatous inflammation, 4 chronic non-specific inflammation & 4 reactive lymphoid hyperplasia). A statistically significant difference between ADC values of benign and malignant cervical nodes was reported with a threshold ADC value equal to 1.30 ×10^-3 mm2/sec was identified. The ADC value for lymphoma was less than that for metastatic carcinoma, with high specificity and sensitivity values and a threshold ADC value equal to 0.9 ×10^-3 mm2/sec was identified. Conclusion: MR diffusion imaging is helpful non-invasive method in differentiation between benign and malignant lymph nodes, and to the same extent differentiation between the variant types of malignant lymphadenopathy.

Utility of Ultrasound Elastography to Differentiate Benign from Malignant Cervical Lymph Nodes.

Background:The purpose of this study was to evaluate the usefulness of strain elastography and acoustic radiation force impulse (ARFI) imaging in the differentiation of benign and malignant cervical lymph nodes (LNs).Materials and Methods:In this prospective study, 50 enlarged cervical LNs (33 benign and 17 malignant) were examined by B-mode ultrasound (US), color Doppler, and strain elastography. Elastographic patterns (1–5) were categorized based on distribution of hard area within LN. The shear wave velocity (SWV) of LNs was evaluated by ARFI imaging. Diagnostic performance of sonoelastographic parameters was compared taking histopathology of LN as a reference standard. Optimal cutoff value of the mean SWV values for predicting malignancy was determined using receiver operating characteristic curve analysis.Results:Among US parameters, borders of LN had the highest diagnostic accuracy (80%), while echogenicity had the least (48%). Majority of benign LNs (n = 31) had elastography patterns 1 and 2, while majority of malignant LNs (n = 16) had patterns 3–5 (P = 0.000). The sensitivity, specificity, and accuracy of elastography were 94.1%, 93.9%, and 94%, respectively. The mean SWV of benign LNs (1.670 ± 0.367 m/s) differed significantly from malignant LNs (2.965 ± 0.826 m/s; P = 0.000). A cutoff value of 2.05 m/s predicted malignancy with 88.2% sensitivity and 84.8% specificity and gave an area under the curve of 0.949 (95% confidence interval: 0.70–1.20).Conclusion:Elastography has high diagnostic accuracy in differentiating benign and malignant cervical LNs and can be potentially useful in selecting the LN with high probability of malignancy, on which fine-needle aspiration cytology/biopsy can be performed.

Differentiating cervical metastatic lymphadenopathy and lymphoma by shear wave elastography

Shear wave elastography (SWE) is a recent technological advance of ultrasonography (US) to assess tissue stiffness. The purpose of this study is to assess tissue stiffness of malignant cervical lymph nodes (LN) with SWE, to reveal diagnostic performance of SWE in differentiating metastatic LN from lymphoma, and to assess inter-observer agreement of SWE. We assessed 62 malignant LN (24 lymphomas and 38 metastatic LN) and their median speed was 6.34 m/s and median elasticity was 69.7 kPa. Add of SWE with conventional US improved diagnostic accuracy of differentiating metastasis from lymphoma (16.13, 8.07 and 11.3% for three radiologists). Kendall’s Coefficient of Concordance of three readers for analyzing SWE patterns was 0.86. SWE can be a useful tool to discriminate metastatic cervical LN from lymphoma with improvement of diagnostic accuracy when using with conventional US.

Incorporation of shear wave elastography into a prediction model in the assessment of cervical lymph nodes

Rationale and objectivesTo assess the performance of shear wave elastography (SWE) and an extended model in predicting malignant cervical lymph nodes (LNs).Materials and methods109 patients who underwent ultrasound (US) and SWE before needle biopsy were enrolled. The optimal cutoff value of elasticity indices (EIs) was determined by receiver operating characteristic (ROC) curves. The c-statistic, net reclassification improvement (NRI) and integrated discrimination improvement (IDI) were used to compare extended model and traditional one.ResultsMalignant LNs had higher EIs than benign nodes (p < 0.001). The optimal cutoff point was 42 kilopascal, corresponding to 83.3% sensitivity, 64.7% specificity, and 68.8% overall accuracy. A multivariable logistic regression analysis confirmed that EI was an independent predictor for malignancy. The new extended prediction model had a positive NRI (0.96) and IDI (0.10) for predicting malignant neck LNs. Nevertheless, the c-statistic was not significantly different between the two models.ConclusionThe parameter of SWE theoretically improve the model performance. However, its real clinical impact is minor, as the parameters of US-based model is already very robust. SWE can be considered as an adjunctive quantitative tool beyond conventional US examination.

Differentiation of benign and malignant cervical lymph nodes on MRI with special emphasis on DWI

Aim and objectives: Evaluation of cervical lymph nodes with MRI, utility of DWI in differentiation of benign and malignant cervical lymph nodes.Methods: Prospective study was carried out on 71 patients of cervical lymphadenopathy in Dr. D.Y. Patil Medical College, Hospital and Research Centre, Pimpri, Pune over a period of two years. Patients were evaluated with Siemens MAGNETOM Avanto 1.5 T MRI machine. Characteristics of cervical lymph nodes on T1WI, T2WI, STIR and Diffusion weighted images with ADC values were studied. Comparison was made with histopathological reports to study accuracy of MRI DWI in differentiating benign and malignant lymph nodes. Results: Out of the total 71 cases, 41 cases were of benign lymph nodes and 30 cases were of malignant lymph nodes. Characteristics of lymph nodes were studied on MRI. Malignant lymph nodes showed diffusion restriction with corresponding low ADC values. Mean ADC value of benign lymph nodes was 1.1×10-3mm2/s (±0.9 SD) and for malignant lymph nodes was 0.7×10-3mm2/s (±0.2 SD).The suggested ADC cut off value in our study for differentiating benign from malignant lymph nodes was to be 0.93×10-3 mm2/s. Conclusion: Diffusion weighted imaging (DWI) is an important non-invasive diagnostic method for differentiation of benign and malignant cervical lymph nodes in case of head, neck cancers.

The Role of Ultrasound and Shear-Wave Elastography in Evaluation of Cervical Lymph Nodes.

Aim To evaluate the prognostic value of ultrasound and shear-wave elastography (SWE) in diagnosing malignant cervical lymph nodes. Methods A total of 99 patients with enlarged lymph nodes (99 lymph nodes presenting as a neck mass) were examined clinically with conventional ultrasound including Doppler examination and shear-wave elastography. The results of the examinations were compared with the final diagnosis. Results There were 43 benign and 56 malignant lymph nodes in our cohort. Age and sex were significant predictors of malignancy. The standard ultrasound parameters—node size, long/short axis ratio, hilum, vascularization, and the presence of microcalcifications—were also statistically significant. Lymph node volume combined with age showed the best predictive power. The maximum stiffness found on SWE was also a significant predictor of malignancy. The combination of epidemiologic, classic ultrasound, and elastographic parameters yielded the highest sensitivity and specificity in the prediction of malignancy; however, the additional impact of elastographic parameters was low. Conclusion A combination of epidemiologic and classic ultrasound parameters can discriminate between malignant and benign lymph nodes with satisfactory sensitivity and specificity. Examining the stiffness of lymph nodes by means of SWE does not add much new predictive power.

Shear wave elastography in differentiating between benign and malignant cervical lymph nodes in patients with oral carcinoma.

To evaluate shear wave elastography in differentiating between benign and malignant cervical lymph nodes in patients with oral carcinoma. 77 patients with oral squamous cell carcinoma were examined by B-mode and shear wave elastography with a 14 MHz linear transducer. The integrated shear wave elastography software allowed the operator to place regions of interest of various sizes within the elastography window, and automatically displayed shear elastic modulus data (kPa) for each region of interest. The relationship between size and shear elastic modulus of cervical lymph nodes was assessed by Pearson's rank correlation test. The shear elastic modulus of cervical lymph nodes in benign and malignant were evaluated using the Mann-Whitney U test. The analyses were used with a 5% significance level. We plotted shear elastic modulus (X) against minimal axial diameter of cervical lymph nodes (Y), and observed a significant correlation [ Y = 0.091 X + 4.648 (R2 = 0.603, p = 0.000, N = 77)]. Furthermore, the shear elastic modulus of the malignant cervical lymph nodes (105.9 ± 5.2 kPa) was higher than that of benign (11.9 ± 4.4 kPa, p = 0.000). The shear wave elastography is an effective technique for the objectively and quantitatively diagnosis of cervical lymph node metastases of the oral carcinoma.

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.

Value of Elasticity Contrast Index of Ultrasonography in Differentiating Benign and Malignant Cervical Lymph Nodes

Objective To investigate the diagnostic value of elasticity contrast index(ECI)in the differential diagnosis between benign and malignant cervical lymph nodes.Methods Cervical lymph nodes of 48 patients were examined by traditional ultrasound and ECI in Peking University Third Hospital between December 2016 and April 2017. Patients were further divided into free-hand group and non-free-hand group according to the use of manual compression or not. With pathological or clinical follow-up results as the gold standard,we compared the diagnostic values of traditional ultrasound,ECI,and their combination in the differential diagnosis between benign and malignant lymph nodes.Results Totally 138 lymph nodes were collected from 46 patients,among which 76 were benign and 62 were malignant. The ECI value of malignant lymph nodes(1.69±0.89)were significantly higher than that of benign lymph nodes(1.32±0.87)(t=-2.46,P=0.015).The area under receiver operating characteristic(ROC)curve for traditional ultrasound in discrimination of malignant cervical lymph nodes with benign ones was 0.899,with an optimal cut-off value of 7,which had a sensitivity of 93.5% and a specificity of 84.2%. The area under ROC curve for ECI was 0.649,with an optimal cut-off value of 1.25,which had a sensitivity of 59.7% and a specificity of 60.5%. For their combination,the area under ROC curve was 0.724,with a sensitivity of 93.5% and a specificity of 51.3%. In the group without using free-hand technique,the mean ECI value was 1.77±0.94 for malignant nodes,which was significantly higher than that(1.26±0.81)for benign nodes(t=-3.09,P=0.003). In the group requiring free-hand technique,the ECI value for malignant nodes was 1.33(1.01,1.44),showing no significant difference with benign ones[1.32(0.78,2.18);z=-0.20,P=0.843].Conclusions Conventional ultrasound has higher diagnostic value than ECI and their combination in differentiating benign and malignant lymph nodes. The role of ECI in evaluating other organs requires further investigations.

AIUM-ACR-SPR-SRU Practice Parameter for the Performance and Interpretation of a Diagnostic Ultrasound Examination of the Extracranial Head and Neck.

AIUM-ACR-SPR-SRU Practice Parameter for the Performance and Interpretation of a Diagnostic Ultrasound Examination of the Extracranial Head and Neck.

Evaluation of the efficacy of ultrasound in the diagnosis of cervical lymphadenopathy

Background: Cervical lymph nodes are prone to involved by a number of pathologic processes. They are common sites for lymphoma, metastasis, and reactive enlargement in a number of conditions. Aims of the study:-Clinical evaluation of patients with cervical lymphadenopathy. Differentiation between benign and malignant lymph nodes by means of ultra sounds (US) and Correlate the US findings with cytological and/or histopathological findings of cervical lymph nodes. Subjects, Materials and Methods:-The present study was carried out over a period of 6 months and included 81 patients of different age groups presenting with cervical lymphadenopathy. Each patient was examined clinically, then comprehensive sonographic examination of the neck for cervical lymph nodes (L.Ns) was performed using ultrasound machine (GE Wipro Proseries). The scanning was performed with the patient in the supine position, and with the neck hyperextended using a pad or pillow under the shoulders in order to provide optimum exposure of the neck. The parameters considered in this study include: site, long axis (L), short axis (S), shape index (S/L), echotexture, margins, ancillary features like calcification, necrosis, matting and surrounding tissue changes. These findings were correlated with fine-needle aspiration cytology, core and excisional biopsy. The nodes were classified as benign (reactive) and malignant (lymphomatous and metastatic). Results: The age of patients ranged from five to seventy five years, they were 45 male and 36 females, there was association between family history and development of malignant lesions. Regarding clinical evaluation, and according to consistency, (13) hard L.Ns were malignant and (1) was benign, (27) rubbery L.Ns were malignant and 40 soft L.Ns were benign. According to fixation to underlying structure, forty one L.Ns were fixed, (40) were malignant and (1) was benign. Forty L. Ns were not fixed, on histopathological evaluation all were benign. On US, the results showed that malignant lymph nodes are mostly appeared as round shape, homogenous echotexture, nodal shape (S/L ratio) accurate for differentiating benign from malignant lymph nodes. Most of the malignant nodes had well-defined borders. Calcifications, necrosis, matting, were characteristically found in benign lymph node. A combined ultrasound-guided and fine-needle aspiration (FNA) diagnosis had a high accuracy as compared with situations in which they were used alone. Conclusions: Sonographic findings have a high accuracy in differentiating benign from malignant cervical lymph nodes. An ultrasound scan can be used as the first-line imaging tool in the diagnostic evaluation of cervical lymphadenopathy. Using gray scale features are particularly useful to identify the causes of cervical lymphadenopathy.

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.

The Role Of High Resolution Ultrasonography To Differentiate Between Benign And Malignant Cervical Lymph Nodes In Oral Squamous Cell Carcinoma

Objectives:The purpose of the study was to evaluate the role of high resolution ultrasonography to differentiate between benign and malignant cervical lymph nodes in oral squamous cell carcinoma.Materials &amp; Methods:The study was conducted in the Department of Oral and Maxillofacial Surgery, BSMMU,Dhaka, Bangladesh, during a period of January -2010 to December - 2011. A total number of 41 patients with clinical evidence of palpable cervical lymph nodes in oral squamous cell carcinoma were evaluated with high resolution ultrasonography. To evaluate the diagnostic accuracy of high resolutionultrasonography, the high resolution ultrasonography findings were compared and correlat- ed with histopathological examination after neck dissection.Results: All patients were pre-operatively examined by palpation and high resolution ultrasonography evaluation was done.Among them 41 study subjects, on high resolution ultrasonography evaluation 23(56.09%) lymph nodes were metastatic and 18(43.90%) lymph nodes were reactive. After postop- erative excisional histopathology examination 22(53.66%) lymph nodes were metastatic and 19(46.34%) lymph nodes were reactive in nature. Correlation of vascular flow pattern with histopatho- logical diagnosis showed that central flow for benign nodes, mixed &amp; peripheral flow for malignant nodes were highly significant parameters (P&lt;0.001). High resolution ultrasonography has specificity 78.94%, sensitivity 86.36% and diagnostic accuracy of the high resolution ultrasonography was 82.92%.Conclusion: High resolution ultrasonography can plays a definite role as an adjunct to the clinical evaluation of palpable cervical lymph nodes and proves its value as an important noninvasive investi- gation procedure for differentiating between benign and malignant cervical lymph nodes in oral squa- mous cell carcinoma.Update Dent. Coll. j: 2017; 7 (2): 19-27

Diagnostic accuracy of sonoelastography in different diseases.

The objective of this study was to evaluate the diagnostic accuracy of sonoelastography in patients of primary and secondary health care settings. Google scholar, PubMed, Medline, Medscape, Wikipedia and NCBI were searched in October 2017 for all original studies and review articles to identify the relevant material. Two reviewers independently selected articles for evaluation of the diagnostic accuracy of sonoelastography in different diseases based on titles and abstracts retrieved by the literature search. The accuracy of sonoelastography in different diseases was used as the index text, while B-mode sonography, micro pure imaging, surgery and histological findings were used as reference texts. Superficial lymph nodes, neck nodules, malignancy in thyroid nodules, benign and malignant cervical lymph nodes, thyroid nodules, prostate carcinoma, benign and malignant breast abnormalities, liver diseases, parotid and salivary gland masses, pancreatic masses, musculoskeletal diseases and renal disorders were target conditions. The data extracted by the two reviewers concerning selected study characteristics and results were presented in tables and figures. In total, 46 studies were found for breast masses, lymph nodes, prostate carcinoma, liver diseases, salivary and parotid gland diseases, pancreatic masses, musculoskeletal diseases and renal diseases, and the overall sensitivity of sonoelastography in diagnosing all these diseases was 83.14% while specificity was 81.41%. This literature review demonstrates that sonoelastography is characterized by high sensitivity and specificity in diagnosing different disorders of the body.

Presurgical evaluation of malignant neck nodes by assessment it’s Intranodal vascularity using the color Doppler ultra sound

Color Doppler ultra sound is an ideal imaging tool for initial assessment ofintranodular vascularity which may reflect some pathological behaviors of tumorsand lymph nodes in patients with cervical lymphadenopathy. The aim of this studywas to evaluate the usefulness of Color Doppler ultra sound in differentiatingbenign from malignant cervical lymph nodes by the assessment of Nodalvascularity. In a prospective study of 24 untreated patient with 65 cervical lymphnodes clinically including enlarged hard and soft palpable and non palpable lymphnodes . All these lymph nodes were evaluated with Color Doppler ultra sound as apre-surgical diagnostic tool, the findings were compared with histo-pathalogicalresults.Fine needle Aspiration cytology was used for 15 palpable enlarged cervicallymph nodes, most of these lymph nodes 12 lymph nodes were associated withreactive lymph nodes and not operated on, just follow up with antibiotic treatmentand performed only 3 lymph nodes were associated with malignant lymph nodeswhich removed surgically and assessed histopathologically.Upon Color Doppler ultra sound examination pre-operatively of 65 cervicallymph nodes were found 20 lymph nodes as a reactive lymph nodes and 45 asmalignant lymph nodes.After neck dissection, all lymph nodes histo-pathologically examined whichshowed 22 benign lymph nodes and 43 lymph nodes containing metastases. Nodalvasculature were classified into:· Hilar· Capsular· Hilar with capsular vascularityResults: most of the malignant nodes showed the presence of capsular vascularity andcapsular with hilar vascularity, 37.2% and 48.8% respectively, where as themajority of the reactive nodes showed hilar vascularity 77.3% and the different washighly significant P&lt;0.01 when chi-square was used.Conclusion: the distribution of intra nodal vascularity appears to be useful indifferentiating benign from malignant cervical lymph nodes by means ColorDoppler ultra sound which consider as a routine pre-surgical tool to provide thesurgeons with a valuable information that aids them to modify their surgicalmanagement

How reliable are ADC measurements? A phantom and clinical study of cervical lymph nodes

ObjectiveTo assess the reliability of ADC measurements in vitro and in cervical lymph nodes of healthy volunteers.MethodsWe used a GE 1.5 T MRI scanner and a first ice-water phantom according to recommendations released by the Quantitative Imaging Biomarker Alliance (QIBA) for assessing ADC against reference values. We analysed the target size effect by using a second phantom made of six inserted spheres with diameters ranging from 10 to 37 mm. Thirteen healthy volunteers were also scanned to assess the inter- and intra-observer reproducibility of volumetric ADC measurements of cervical lymph nodes.ResultsOn the ice-water phantom, the error in ADC measurements was less than 4.3 %. The spatial bias due to the non-linearity of gradient fields was found to be 24 % at 8 cm from the isocentre. ADC measure reliability decreased when addressing small targets due to partial volume effects (up to 12.8 %). The mean ADC value of cervical lymph nodes was 0.87.10-3 ± 0.12.10-3 mm2/s with a good intra-observer reliability. Inter-observer reproducibility featured a bias of -5.5 % due to segmentation issues.ConclusionADC is a potentially important imaging biomarker in oncology; however, variability issues preclude its broader adoption. Reliable use of ADC requires technical advances and systematic quality control.Key Points• ADC is a promising quantitative imaging biomarker.• ADC has a fair inter-reader variability and good intra-reader variability.• Partial volume effect, post-processing software and non-linearity of scanners are limiting factors.• No threshold values for detecting cervical lymph node malignancy can be drawn.

Artificial Intelligence Based Diagnosis for Cervical Lymph Node Malignancy Using the Point-Wise Gated Boltzmann Machine

This paper aims to build an artificial intelligence (AI) architecture for automated extraction of learned-from-data image features from contrast-enhanced ultrasound (CEUS) videos and to evaluate the AI architecture for classification between benign and malignant cervical lymph nodes. An AI architecture for CEUS feature extraction and classification was constructed by using the point-wise gated Boltzmann machine (PGBM). The PGBM consisted of task-relevant and task-irrelevant hidden units for both feature learning and feature selection, and the task-relevant units were connected to the support vector machine (SVM) to yield the likelihood for classification. The synthetic minority over-sampling technique was used to improve the classification ability for an unbalanced data set. Experimental evaluation was performed with the five-fold cross validation on a database of 127 lymph nodes (39 benign and 88 malignant) from 88 patients. The SVM likelihood exhibited a significant difference between benign and malignant cervical lymph nodes (0.74 ± 0.21 versus 0.33 ± 0.28, $p ). On the test set, the accuracy, precision, sensitivity, specificity, and Youden’s index of the AI architecture were 82.55%, 89.58%, 84.75%, 77.56%, and 62.32%, respectively. The AI architecture using the PGBM shows promising classification results, and it may be potentially used in clinical diagnosis for cervical lymph node malignancy.

Magnetic resonance imaging: dynamic contrast enhancement and diffusion-weighted imaging to identify malignant cervical lymph nodes

ObjectiveTo examine the potential of two magnetic resonance imaging (MRI) techniques-dynamic contrast enhancement (DCE) and diffusion-weighted imaging (DWI)-for the detection of malignant cervical lymph nodes.Materials and MethodsUsing DCE and DWI, we evaluated 33 cervical lymph nodes. For the DCE technique, the maximum relative enhancement, relative enhancement, time to peak enhancement, wash-in rate, wash-out rate, brevity of enhancement, and area under the curve were calculated from a semi-quantitative analysis. For the DWI technique, apparent diffusion coefficients (ADCs) were acquired in the region of interest of each lymph node. Cystic or necrotic parts were excluded. All patients underwent neck dissection or node biopsy. Imaging results were correlated with the histopathological findings. None of the patients underwent neoadjuvant treatment before neck dissection.ResultsRelative enhancement, maximum relative enhancement, and the wash-in rate were significantly higher in malignant lymph nodes than in benign lymph nodes (p < 0.009; p < 0.05; and p < 0.03, respectively). The time to peak enhancement was significantly shorter in the malignant lymph nodes (p < 0.02). In the multivariate analysis, the variables identified as being the most capable of distinguishing between benign and malignant lymph nodes were time to peak enhancement (sensitivity, 73.7%; specificity, 69.2%) and relative enhancement (sensitivity, 89.2%; specificity, 69.2%).ConclusionAlthough DCE was able to differentiate between benign and malignant lymph nodes, there is still no consensus regarding the use of a semi-quantitative analysis, which is difficult to apply in a clinical setting. Low ADCs can predict metastatic disease, although inflammatory processes might lead to false-positive results.