Malignant Cervical Lymph Nodes Research Articles

A real-time prediction model for post-irradiation malignant cervical lymph nodes.

To establish a real-time predictive scoring model based on sonographic characteristics for identifying malignant cervical lymph nodes (LNs) in cancer patients after neck irradiation. One-hundred forty-four irradiation-treated patients underwent ultrasonography and ultrasound-guided fine-needle aspirations (USgFNAs), and the resultant data were used to construct a real-time and computerised predictive scoring model. This scoring system was further compared with our previously proposed prediction model. A predictive scoring model, 1.35 × (L axis) + 2.03 × (S axis) + 2.27 × (margin) + 1.48 × (echogenic hilum) + 3.7, was generated by stepwise multivariate logistic regression analysis. Neck LNs were considered to be malignant when the score was ≥ 7, corresponding to a sensitivity of 85.5%, specificity of 79.4%, positive predictive value (PPV) of 82.3%, negative predictive value (NPV) of 83.1%, and overall accuracy of 82.6%. When this new model and the original model were compared, the areas under the receiver operating characteristic curve (c-statistic) were 0.89 and 0.81, respectively (P < .05). A real-time sonographic predictive scoring model was constructed to provide prompt and reliable guidance for USgFNA biopsies to manage cervical LNs after neck irradiation.

Efficiency of B-mode Ultrasound and Strain Elastography in Differentiating Between Benign and Malignant Cervical Lymph Nodes.

The purpose of this study was to evaluate the diagnostic accuracy and efficiency of ultrasonography (US), especially when combined with strain elastography (SE), in differentiating between benign and malignant cervical lymph nodes (LNs). Forty-one LNs were examined by B-mode US, power Doppler US, and SE. The following imaging features were analyzed: shape, echogenicity, echogenic hilum, calcification, intranodal vascular pattern, elasticity scores (5 categories), and strain ratio. The average strain ratio was calculated as the mean strain of the adjacent sternocleidomastoid muscle divided by the mean strain of the target LN. The results of the US and SE features were compared with the histopathologic findings. The imaging features that were significantly associated with malignant LNs were an increased short-to-long axis diameter ratio, abnormal or absence of hilum, microcalcification, type 2-3-4 vascularity, 3-4-5 elasticity scores, and a high level of strain ratio (P < 0.05). The cutoff value of the strain index was detected as 1.18. According to this, there was a significant difference (P = 0.004) in the strain index between benign and malignant LNs. Strain elastography is useful in differentiating between benign and malignant cervical LNs, thereby informing decisions to perform a biopsy and/or surgery, and facilitating follow-up.

FDG uptake in cervical lymph nodes in children without head and neck cancer.

Reactive cervical lymphadenopathy is common in children and may demonstrate increased 18F-fluoro-deoxyglucose (18F-FDG) uptake on positron emission tomography/computed tomography (PET/CT). We sought to evaluate the frequency and significance of 18F-FDG uptake by neck lymph nodes in children with no history of head and neck cancer. The charts of 244 patients (114 female, mean age: 10.4years) with a variety of tumors such as lymphoma and post-transplant lymphoproliferative diseases (PTLD), but no head and neck cancers, who had undergone 18F-FDG PET/CT were reviewed retrospectively. Using the maximum standardized uptake value (SUVmax), increased 18F-FDG uptake by neck lymph nodes was recorded and compared with the final diagnosis based on follow-up studies or biopsy results. Neck lymph node uptake was identified in 70/244 (28.6%) of the patients. In 38 patients, the lymph nodes were benign. In eight patients, the lymph nodes were malignant (seven PTLD and one lymphoma). In 24 patients, we were not able to confirm the final diagnosis. Seven out of the eight malignant lymph nodes were positive for PTLD. The mean SUVmax was significantly higher in malignant lesions (4.2) compared with benign lesions (2.1) (P=0.00049). 18F-FDG uptake in neck lymph nodes is common in children and is frequently due to reactive lymph nodes, especially when the SUVmax is <3.2. The frequency of malignant cervical lymph nodes is higher in PTLD patients compared with other groups.

Evaluation of the role of sono-elastography in diagnosis of enlarged cervical lymph nodes

PurposeEvaluation of the role of real-time elastography in differentiating between benign and malignant cervical lymph nodes (LNs), comparison with B-mode and Doppler Ultrasonography. Patients and methodsThis prospective study included 30 patients, with cervical lymphadenopathy, their age ranged from (18–79years). The total number of the examined lymph nodes (LNs) was 75LNs. These (LNs) subjected to B-mode US followed by Doppler evaluation, then elastographic evaluation including strain ratio which was calculated for each lesion, and compared with the histological results after fine needle aspiration cytology. ResultsWe evaluate the size, shape, echogenicity, and hilum on the B-mode images. The presence of the hilum showed the highest accuracy & sensitivity. Doppler Ultrasonography evaluation of nodal vascular pattern was of high sensitivity & specificity. The calculated sensitivity of elastographic pattern and scoring was 86%, specificity was 100%, PPV and NPV were 100% and 78.1% respectively, and the total accuracy was 90%. The mean elastographic strain ratio for malignant LNs (3.4±1.2) was significantly greater than that for benign LNs (mean, 1.2±0.3). ConclusionElastography is a promising improvement for differentiation between benign and malignant cervical lymphadenopathy. Sensitivity and specificity of elastography increased especially if combined with gray scale US and Doppler US.

Differentiating Benign from Malignant Cervical Lymph Nodes with Sonoelastography

In the clinical practice, there is many overlap in diagnostic criteria between benign and malignant lymph nodes by grayscale and Doppler sonography. This study was carried out on 30 patients who suffered from enlarged cervical lymph nodes examined with B-mode US, Doppler US and Sonoelastography in the Sonoelastography unit of the Radiology department of Tanta university hospitals to prospectively estimate the accuracy of sonoelastography in the differentiation between benign and malignant cervical lymph nodes. Sonoelastography had the highest sensitivity (92.1%), specificity (95.5%) and accuracy (93.3%) in the differentiation between benign and malignant cervical lymph nodes, so Sonoelastography is a promising technique that is easy and rapid non-invasive to perform and help identifying cervical lesions that are likely to be malignant to avoid hazards that found in tissue biopsy especially in patients with bleeding disorders.

Combined diffusion-weighted MRI and MR spectroscopy: Feasibility to improve the MRI capability in differentiation between benign and malignant neck lymphadenopathy

The study aims to evaluate the additional value of MRS and DWI in differentiating malignant and benign neck lymphadenopathy.Materials and methods: Thirty-three patients with enlarged neck lymph nodes of malignant suspicious underwent DWI and MRS. ADC values, presence of Cho peak and Cho/Creatine ratio of the dominant node were assessed and results were compared with histopathological results.Results: the patients were classified into benign (n=9) and malignant (n=24: 17 metastases and 7 lymphoma). The mean ADC values of the benign, metastasis and lymphoma patients were 1.56±0.23, 1.01±0.23 and 0.71±0.02×10−3mm2/s respectively. It was significantly higher in benign than malignant (p<0.0001) and in metastatic than lymphomatous (p=0.001) as well as in well- and moderately than poorly differentiated metastatic (p=0.01) lymph nodes. Using the receiver operating characteristic (ROC), cutoff value of 1.15×10−3mm2/s of ADC could differentiate benign from malignant nodes with sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) of 91.6%, 77.7%, 91.9%, 77.7%, KAPPA=0.69 and p<0.001 respectively.Malignant nodes showed a significant choline peak (n=24, 100%) while benign nodes showed choline peak in only two cases (22%). Mean Cho/Cr ratio was significantly higher in malignant nodes than benign ones (2.64±1.16 versus 1.09±0.04) (p<0.0001), furthermore it was significantly higher in lymphoma versus metastatic (4.3±0.35 versus 1.94±0.34, p<0.001) as well as poor versus Well- to moderately differentiated metastases (2.3±0.11 versus 1.69±0.18, p<0.01). The MRS sensitivity, specificity, PPV, NPV and Kappa in differentiating benign and malignant cervical lymph nodes were 100.0, 77.7, 92.3, 100.0% and 0.83 and p value=0.001.Combination of DWI and MRS showed higher diagnostic value than DWI or MRS alone with sensitivity, specificity, PPV, NPV and Kappa of 100, 88.9, 96, 100% and 0.92 respectively (p<0.0001).Conclusion: ADC and MRS can help in the differentiation between malignant and benign neck lymph nodes. Combination of both techniques achieved higher diagnostic performance.

Role of Color Doppler Ultrasound in Predicting Malignancy in Cervical Lymph Nodes

Role of Color Doppler Ultrasound in Predicting Malignancy in Cervical Lymph Nodes

Ultrasound elastography in pathological enlarged cervical lymph nodes compared to histopathology

ObjectiveTo detect the diagnostic efficiency of ultrasound elastography in differentiation between benign and malignant enlarged cervical lymph nodes. Patient and methodsThis study included 27 patients, ranging in age from 21 to 70 years. Enlarged cervical lymph nodes were defined in this study as those nodes having short axis measuring more than 8 mm. Approval was taken from our hospital institutional review board and an informed consent was obtained from each patient before participating in the study. All patients were subjected to B-mode ultrasound and ultrasound elastography. ResultsB-mode score had the highest sensitivity in this study (sensitivity=100%) and the least specificity and positive predictive value. Ultrasound Elastography (UE) and strain ration (SR) showed higher specificity (75%) and PPV (81.3% and 82.4% respectively). There was a statistical significant difference between the diagnostic performance of ES and B-mode score (p=0.034), and a nearly significant difference between SR and B-mode score (p=0.059). ROC curve analysis for SR measurements (cutoff value ⩾1.62) showed sensitivity=93.3%, specificity=75% and overall accuracy=85.2%. However, no statistically significant difference was shown between the performance of ES and SR (p=0.317). ConclusionHardness on more than 50% of the node surface and SR>1.62 are fair to good indicators of malignancy.

Predicting malignant neck lymphadenopathy using color duplex sonography based on multivariate analysis.

To select the best predictors of cervical lymph node malignancy based on gray-scale and power Doppler sonography using multivariate analysis. We evaluated sonographically a total of 97 lymph nodes in the neck that were subjected to fine-needle aspiration biopsy. The gray-scale and power Doppler sonography parameters that we analyzed using multivariate logistic regression included size, shape, echogenicity, echotexture, margins, hilum, presence of microcalcifications or necrosis, vascularization, and resistance index (RI). The three variables with a diagnostic accuracy exceeding 80% were an altered vascularization, heterogeneous echotexture, and abnormal hilum. Malignant nodes exhibited higher RI and larger sizes than benign nodes, and the best cutoff values to distinguish malignant from benign lymph nodes were an RI of 0.77 and a short axis ≥ 0.9 cm. Altered vascularization, a short axis ≥ 0.9 cm, and abnormal hilum were the best predictors of malignancy. The best sonographic predictors of lymph node malignancy are, in descending order, an altered vascularization, a short axis ≥ 0.9 cm, an abnormal hilum, and a heterogeneous echotexture. © 2016 Wiley Periodicals, Inc. J Clin Ultrasound 44:587-594, 2016.

The diagnostic performance of shear wave elastography for malignant cervical lymph nodes: A systematic review and meta-analysis.

To evaluate the diagnostic performance of shear wave elastography for malignant cervical lymph nodes. We searched the Ovid-MEDLINE and EMBASE databases for published studies regarding the use of shear wave elastography for diagnosing malignant cervical lymph nodes. The diagnostic performance of shear wave elastography was assessed using bivariate modelling and hierarchical summary receiver operating characteristic modelling. Meta-regression analysis and subgroup analysis according to acoustic radiation force impulse imaging (ARFI) and Supersonic shear imaging (SSI) were also performed. Eight eligible studies which included a total sample size of 481 patients with 647 cervical lymph nodes, were included. Shear wave elastography showed a summary sensitivity of 81% (95% CI: 72-88%) and specificity of 85% (95% CI: 70-93%). The results of meta-regression analysis revealed that the prevalence of malignant lymph nodes was a significant factor affecting study heterogeneity (p < .01). According to the subgroup analysis, the summary estimates of the sensitivity and specificity did not differ between ARFI and SSI (p = .93). Shear wave elastography is an acceptable imaging modality for diagnosing malignant cervical lymph nodes. We believe that both ARFI and SSI may have a complementary role for diagnosing malignant cervical lymph nodes. • Shear wave elastography is acceptable modality for diagnosing malignant cervical lymph nodes. • Shear wave elastography demonstrated summary sensitivity of 81% and specificity of 85%. • ARFI and SSI have complementary roles for diagnosing malignant cervical lymph nodes.

The Role of Ultrasonography for Differentiating and Management of Malignant Cervical Lymph Nodes

Objective:To investigate the value of grey scale and Doppler ultrasonography in the assessment of metastatic and lymphomatous cervical lymph nodes.Methods:One hundred and nineteen malignant cervical lymph nodes in 119 patients diagnosed as malignant according to grey scale, color Doppler and spectral Doppler ultrasonography features were included in this study. The sizes, shape, echo pattern, echogenic hilus, nodal border, cystic necrosis and coagulation necrosis, vascular distribution pattern, resistivity and pulsatility index values of lymph nodes were noted. All patients had histopathological diagnosis.Results:The final diagnosis of the 42 lymph nodes was lymphoma, and of the 77 lymph nodes was carcinoma metastasis (33 thyroid carcinoma metastasis and 44 squamous cell carcinoma metastasis). While a hyperechoic pattern and calcification were detected in the lymph nodes originating from thyroid carcinoma as 39% and 33%, respectively, a reticular pattern (26%) and low resistive and pulsatility indices were detected in lymph nodes originating from lymphoma. These criteria were statistically significant for the differential diagnosis (p<0.05). Size, shape, hypoechoic echo pattern, absence of echogenic hilus, nodal border, cystic necrosis, coagulation necrosis and vascular distribution pattern were not found to be significant for the detection of a primary tumour.Conclusion:Hyperechoic echo pattern, reticular pattern, calcification, low resistivity and pulsatility indices are useful parameters for the differential diagnosis of malignant cervical lymph nodes. These ultrasonography critaria can be used for assesment and management of unknown primary malign neck nodes.

Accuracy of MRI in Prediction of Tumour Thickness and Nodal Stage in Oral Tongue and Gingivobuccal Cancer With Clinical Correlation and Staging.

Squamous cell carcinoma of lower gingivo-buccal complex and tongue are the most common cancer in the Indian sub-continent. The value of imaging in the staging of Oral Squamous Cell Carcinoma (OSCC) is in judging operability, assessment of the prognostic characteristics and dimensions of the primary tumour, depth of tumour invasion, the presence of cervical metastasis and detection of bone infiltration. This study evaluated squamous cell carcinomas of the oral cavity (tongue and gingivo-buccal complex) on the basis of their appearance, soft tissue extent, depth of tumour invasion and staging. Further, this study assessed the accuracy of MRI in the detection of cervical lymph nodal metastasis on the basis of ADC values on diffusion weighted MR sequence. T1- and T2-weighted MR, diffusion-weighted sequences and post contrast T1W sequences were performed in various planes on biopsy proven squamous cell carcinomas (61 cases) involving tongue and/or gingivo-buccal region. Depth of tumour invasion was calculated on axial images of post contrast T1W images. The Apparent Diffusion Coefficient (ADC) was measured by using two b factors (500 and 1000 s/mm(2)). MRI findings were compared clinically and histopathologically. Average depth of invasion calculated on MRI was 8.47mm and by histopathology was 6.85mm. Pearson's correlation coefficient was 0.988. Shrinkage factor was 0.8. A 71% of patients with depth of invasion greater than 9mm showed evidence of cervical lymph nodal metastasis at one or another levels. Cut-off value to discriminate between malignant and benign lymph nodes was 1.038 x10-3 mm(2)/s in the present study. Depth of tumour invasion in oral malignancies can be measured reliably on MRI which helps in predicting cervical lymph node metastasis. Benign or malignant cervical lymph nodes can be differentiated on diffusion-weighted imaging of MRI on the basis of their ADC values.

Diagnostic efficacy of color Doppler ultrasound in evaluation of cervical lymphadenopathy.

To evaluate the efficacy of color Doppler ultrasound (CDUS) in differentiating benign and malignant cervical lymph nodes by detecting differences in blood flow patterns. In this cross-sectional prospective study, 25 untreated patients with clinical evidence of cervical lymphadenopathy were evaluated. CDUS was performed for 80 cervical lymph nodes. The gray scale parameters of the lymph node and intranodal perfusion sites were the key CDUS features used to differentiate between reactive and metastatic lymph nodes. Histopathological confirmations were obtained and compared with the results of CDUS. Initially, 53 cervical lymph nodes were evaluated by clinical examination. Twenty-seven additional lymph nodes (53 + 27 = 80) were discovered by CDUS evaluation. Gray scale parameters for lymph nodes such as size of lymph node, shape of lymph node, and presence or absence of hilum revealed highly significant results (P < 0.0001). Color Doppler flow signals revealed that central/hilar flow was characteristic for benign nodes whereas peripheral/mixed flow was characteristic for malignant nodes, the findings were highly significant (P < 0.0001). Gray scale and color Doppler features are used to differentiate benign and malignant nodes. Within the limitations of this study, CDUS evaluation was found to be highly significant with a high sensitivity and specificity over clinical evaluation CDUS examination provides a prospect to reduce the need for biopsy/fine needle aspiration cytology in reactive nodes.

Virtual Touch Tissue Imaging Quantification Shear Wave Elastography: Prospective Assessment of Cervical Lymph Nodes

The goal of this study was to prospectively evaluate the diagnostic performance of Virtual Touch tissue imaging quantification (VTIQ) shear wave elastography in the discrimination of benign and malignant cervical lymph nodes in routine clinical practice. Shear wave velocity was analyzed using VTIQ in 100 patients with 100 histologically proven cervical lymph nodes. Diagnostic performance was evaluated using receiver operating characteristic curve analysis and leave-one-out cross-validation. Agreement between measurements was assessed with intra-class correlation coefficients. The mean shear wave velocity was significantly higher in metastatic lymphadenopathy (4.46 ± 1.46 m/s) than in benign lymphadenopathy (2.71 ± 0.85 m/s) (p < 0.001) at a cutoff level of 3.34 m/s. The cross-validated accuracy, sensitivity and specificity were 77%, 78.9% and 74.4%, respectively. Agreement of measurements with VTIQ was excellent (intra-class correlation coefficient = 0.961). VTIQ shear wave elastography may be a feasible quantitative imaging method for differentiating benign and malignant cervical lymph nodes.

Diffusion-weighted imaging in oral squamous cell carcinoma using 3 Tesla MRI: is there a chance for preoperative discrimination between benign and malignant lymph nodes in daily clinical routine?

Preoperative staging of cervical lymph nodes is important to determine the extent of neck dissection in patients with oral squamous cell carcinoma (OSCC). To evaluate whether a preoperative discrimination of benign and malignant cervical lymph nodes with diffusion-weighted imaging (DWI) (3T) is feasible for clinical application. Forty-five patients with histological proven OSCC underwent preoperative 3T-MRI. DWI (b = 0, 500, and 1000 s/mm(2)) was added to the standard magnetic resonance imaging (MRI) protocol. Mean apparent diffusion coefficients (ADCmean) were measured for lymph nodes with 3 mm or more in short axis by two independent readers. Finally, these results were matched with histology. Mean ADC was significantly higher for malignant than for benign nodes (1.143 ± 0.188 * 10(-3) mm(2)/s vs. 0.987 ± 0.215 * 10(-3) mm(2)/s). Using an ADC value of 0.994 * 10(-3) mm(2)/s as threshold results in a sensitivity of 80%, specificity of 65%, positive predictive value of 31%, and negative predictive value of 93%. Due to a limited sensitivity and specificity DWI alone is not suitable to reliably discriminate benign from malignant cervical lymph nodes in daily clinical routine. Hence, the preoperative determination of the extent of neck dissection on the basis of ADC measurements is not meaningful.

Differentiation of benign from malignant cervical lymph nodes in patients with head and neck cancer using PET/CT imaging

PurposeTo differentiate malignant from benign cervical lymph nodes in patients with head/neck cancer. MethodsIn this retrospective study, 39 patients with primary head/neck cancer who underwent Positron Emission Tomography (PET)/Computerized Tomography (CT) and image-guided lymph node biopsy were included. ResultsOverall, 23 (59%) patients had biopsy-proven malignant cervical lymphadenopathy. Malignant lymph nodes had higher maximum standardized uptake (SUV-max) value (P<.001) and short-axis diameter (P=.015) compared to benign nodes. An SUV-max of ≥2.5 was 100% sensitive, and an SUV-max ≥5.5 was 100% specific for malignant lymphadenopathy. ConclusionThe PET/CT SUV-max value can help with differentiation of malignant cervical lymph nodes in patients with head/neck cancer.

Lymphoepithelioma-like Carcinoma of the Skin in the Cheek with a Malignant Metastatic Cervical Lymph Node.

Lymphoepithelioma-like Carcinoma of the Skin in the Cheek with a Malignant Metastatic Cervical Lymph Node.

Comparative study of three sonoelastographic scores for differentiation between benign and malignant cervical lymph nodes

PurposeThe aim of the study was to explore the diagnostic value of three different sonoelastographic scoring systems (labeled S1–S3) for the differentiation between benign and malignant cervical lymph nodes. Materials and methodThe authors propose a six pattern scoring system of the elastographic images with pattern 1 – representing purely soft nodes, pattern 2 – predominantly soft nodes, pattern 3 – predominantly soft nodes with focal had area, pattern 4 – predominantly hard node, pattern 5 – entirely hard node and pattern 6 – node with necrosis. The sonoelastographic images of 50 benign and 70 malignant lymph nodes were assessed. The area under the ROC curve (AUROC) for the differentiation between benign vs. malignant and benign vs. metastatic nodes were analyzed for the three scoring systems. ResultsWhen all the malignant lymph nodes were considered, the S1 score showed an AUROC=0.873 (95%CI [0.805–0.918], where CI=confidence interval; p<0.001), sensibility (Se)=58.57%, and specificity (Sp)=96%. For S2 score the AUROC was 0.890 (95%CI [0.824–0.933], p<0.001), Se=92.86%, and Sp=72%. For S3 score, the AUROC was 0.852 (95%CI [0.778–0.902], p<0.001), Se=64.29%, and Sp=94%). When lymphomatous nodes were excluded, for S1 the AUROC was 0.884 (95%CI [0.809–0.932], p<0.001), Se=64%, and Sp=96%. For S2 the AUROC was 0.894 (95%CI [0.818–0.939], p<0.001), Se=92%, and Sp=72%. For S3, the AUROC was 0.856 (95%CI [0.771–0.911], p<0.001), Se=66%, and Sp=94%. In the S3 scoring system, setting the benign vs. malignant cut off at pattern 3 increases the sensibility (41–65%) with minimal loss of specificity (96–94%). From the gray-scale and Doppler criteria, changes of the nodular margins and the presence of the vessels in the cortical part of the lymph node showed both very high sensibility and specificity, the others criteria taken into account had either very good sensibility with low specificity or high specificity and low sensibility. ConclusionsOur study suggests that there are no significant differences between the three scoring systems in terms of overall diagnostic value.

The value of preoperative 18F-FDG PET/CT for the assessing contralateral neck in head and neck cancer patients with unilateral node metastasis (N1-3).

The purpose of this study was to determine whether preoperative (18) F-FDG PET/CT is useful in assessing contralateral lymph node metastasis in the neck. A retrospective review of medical records was performed. Patients treated at a single institute. One hundred and fifty-seven patients whose pathology results were positive for unilateral node metastasis (N1-3) involvement and underwent preoperative (18) F-FDG PET/CT for head and neck squamous cell carcinoma (HNSCC) were reviewed. Prognostic factors and nodal SUVmax were studied to identify the risk of contralateral disease. Thirty-six (22.9%) patients had contralateral cervical lymph node metastases. The (18) F-FDG PET/CT had a sensitivity of 80% and a specificity of 96% in identifying the contralateral cervical lymph node metastases on a level-by-level basis. The median SUVmax values of the ipsilateral and contralateral lymph nodes were 3.99±3.36 (range, 0-20.4) and 2.94±2.04 (range, 0-8.7), respectively (P=0.001). There was a significant difference in the median SUVmax of contralateral nodes between the benign and malignant cervical lymph nodes (2.31±0.62 versus 3.28±2.43, P=0.014). The cut-off value of contralateral median SUVmax in the context of contralateral cervical metastasis was 2.5 with the sensitivity of 75% and the specificity of 94%. A median contralateral lymph node SUVmax ≥2.5 was associated with 5-year disease-specific survival (P=0.038). (18) F-FDG PET/CT median SUVmax cut-off values of contralateral lymph nodes ≥2.5 were associated with contralateral cervical lymph node metastases and 5-year disease-specific survival in HNSCC patients with unilateral metastases.

Comparison of Two Elasticity Scoring Systems in the Assessment of the Cervical Lymph Nodes

Background Real-time elastography (RTE) and elasticity scoring system is a new diagnostic tool in the evaluation of enlarged cervical lymph nodes (LNs). The aim of the study was to investigate the validity and reliability of two elasticity scoring systems in discriminating cervical lymphadenopathies. Materials and methods The study protocol was approved by the institutional review board of the local ethics committee. Ninety-eight consecutive patients underwent ultrasound-guided fine needle aspiration biopsy after conventional ultrasound and RTE evaluation. Elasticity scores were divided into four and five categories according to signal distribution, based on previously determined models. Two independent raters analyzed the elastographic data. Results Final histology revealed 60 benign and 38 malignant cervical LNs. In the four-point scoring system, 41/60 benign LNs were classified as score 1 or 2 and 28/38 malignant nodes as score 3 or 4 [sensitivity 73.7%, specificity 68.3%, positive predictive value (PPV) 59.6%, negative predictive value (NPV) 80.4%]. Using the five-point scoring system, 28/60 benign nodes were classified as score 1 or 2 and 31/38 malignant nodes as score 3–5 (sensitivity 79.0%, specificity 45.0%, PPV 47.6%, NPV 80.4%). In the four-point scoring system, rates of concordance between raters (κ = 0.63) and with the same rater (κ = 0.75) were both good with statistical significance (both p Conclusion For qualitative RTE, the four-point scoring system had value similar to the five-point scoring system in predicting malignancy in cervical LNs. Furthermore, the reliability was comparable in both scoring systems. For the purpose of simplified evaluation, we suggested using the four-point scoring system to rate the qualitative RTE in the future.