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Application of multimodal ultrasonography for differentiating benign and malignant cervical lymphadenopathy

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Abstract

Objectives

The purpose of this study was to evaluate the diagnostic value of multimodal ultrasonography, including SWE and CEUS, for the differentiation of benign and malignant cervical lymphadenopathy.

Methods

A total of 103 patients with 109 enlarged neck lymph nodes underwent SWE and CEUS. There were 25 hyperplastic lymph nodes, 66 metastatic lymph nodes, and 18 cases of lymphoma.

Results

Using 31.6 kPa as the Emax cutoff, the sensitivity, specificity and accuracy of measurements on both benign and malignant cervical lymph nodes were 55.95%, 96%, and 65.2%, respectively. CEUS showed that lymph nodes with reactive hyperplasia mainly exhibited uniform perfusion via the lymphatic hilum (18/25; 72%; P < 0.01). The main manifestation of lymphoma was uniform perfusion through the lymphatic hila (10/18; 55.6%; P < 0.01). Metastatic lymph nodes mainly exhibited uneven perfusion (57/66; 86.4%; P < 0.01). The sensitivity, specificity, and accuracy of multimodal ultrasonography for the diagnosis of benign and malignant cervical lymphadenopathies were 90.5%, 72%, and 86.2%, respectively.

Conclusions

Our findings suggest that multimodal ultrasonography can detect the stiffness (elasticity), perfusion pattern, and characteristics of lymph nodes and is a valuable tool for differentiating between benign and malignant lymphadenopathies.

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References

  1. Gyorki DE, Boyle JO, Ganly I, Morris L, Shaha AR, Singh B, et al. Incidence and location of positive nonsentinel lymph nodes in head and neck melanoma. Eur J Surg Oncol. 2014;40:305–10.

    Article  CAS  PubMed  Google Scholar 

  2. Ying M, Ahuja A, Brook F. Accuracy of sonographic vascular features in differentiating causes of cervical lymphadenopathy. Ultrasound Med Biol. 2004;3:441–7.

    Article  Google Scholar 

  3. Esen G. Ultrasound of superficial lymph nodes. Eur J Radiol. 2006;58:345–59.

    Article  PubMed  Google Scholar 

  4. Taylor K, O’Keeffe S, Britton PD, Wallis MG, Treece GM, Housden J, et al. Ultrasound elastography as an adjuvant to conventional ultrasound in the preoperative assessment of axillary lymph nodes in suspected breast cancer: a pilot study. Clin Radiol. 2011;66:1064–71.

    Article  CAS  PubMed  Google Scholar 

  5. Ahuja AT, Ying M, King A, Yuen HY. Lymph node hilus: gray scale and power Doppler sonography of cervical nodes. J Ultrasound Med. 2001;20:987–92.

    Article  CAS  PubMed  Google Scholar 

  6. Tschammler A, Ott G, Schang T, Seelbach-Goebel B, Schwager K, Hahn D. Lymphadenopathy: differentiation of benign from malignant disease—color Doppler ultrasound assessment of intranodal angioarchitecture. Radiology. 1998;208:117–23.

    Article  CAS  PubMed  Google Scholar 

  7. Kwak JY, Han KH, Yoon JH, Moon HJ, Son EJ, Park SH, et al. Thyroid imaging reporting and data system for US features of nodules: a step in establishing better stratification of cancer risk. Radiology. 2011;260:892–9.

    Article  PubMed  Google Scholar 

  8. Dudea SM, Lenghel M, Botar-Jid C, Vasilescu D, Duma M. Ultrasonography of superficial lymph nodes: benign vs. malignant. Med Ultrason. 2012;14:294–306.

    PubMed  Google Scholar 

  9. Cui XW, Jenssen C, Saftoiu A, Ignee A, Dietrich CF. New ultrasound techniques for lymph node evaluation. World J Gastroenterol. 2013;19:4850–60.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Park CH, Song CM, Ji YB, Pyo JY, Yi KJ, Song YS, et al. Significance of the extracapsular spread of metastatic lymph nodes in papillary thyroid carcinoma. Clin Exp Otorhinolaryngol. 2015;8:289–94.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Ahuja AT, Ying M. Sonographic evaluation of cervical lymph nodes. Am J Roentgenol. 2005;184:1691–9.

    Article  Google Scholar 

  12. Moritz JD, Ludwig A, Oestmann JW. Contrast-enhanced color Doppler sonography for evaluation of enlarged cervical lymph nodes in head and neck tumors. Am J Roentgenol. 2000;174:1279–84.

    Article  CAS  Google Scholar 

  13. Yu M, Liu Q, Song HP, Han ZH, Su HL, He GB, et al. Clinical application of contrast enhanced ultrasonography in diagnosis of superficial lymphadenopathy. J Ultrasound Med. 2010;29:735–40.

    Article  PubMed  Google Scholar 

  14. Moritz JD, Ludwig A, Oestmann JW. Contrast-enhanced color Doppler sonography for evaluation of enlarged cervical lymph nodes in head and neck tumors. AJR Am J Roentgenol. 2000;174:1279–84.

    Article  CAS  PubMed  Google Scholar 

  15. Bercoff J, Tanter M, Fink M. Supersonic shear imaging: a new technique for soft tissue elasticity mapping. IEEE Trans Ultrason Ferroelectr Freq Control. 2004;51:396–409.

    Article  PubMed  Google Scholar 

  16. Alam F, Naito K, Horiguchi J, Fukuda H, Tachikake T, Ito K. Accuracy of sonographic elastography in the differential diagnosis of enlarged cervical lymph nodes: comparison with conventional B-mode sonography. AJR Am J Roentgenol. 2008;191:604–10.

    Article  PubMed  Google Scholar 

  17. Bhatia KS, Cho CC, Tong CS, Yuen EH, Ahuja AT. Shear wave elasticity imaging of cervical lymph nodes. Ultrasound Med Biol. 2012;38:195–201.

    Article  PubMed  Google Scholar 

  18. Bhatia K, Tong CS, Cho CC, Yuen EH, Lee J, Ahuja AT. Reliability of shear wave ultrasound elastography for neck lesions identified in routine clinical practice. Ultraschall Med. 2012;33:463–8.

    Article  CAS  PubMed  Google Scholar 

  19. Lyshchik A, Higashi T, Asato R, Tanaka S, Ito J, Hiraoka M, et al. Cervical lymph node metastases: diagnosis at sonoelastography—initial experience. Radiology. 2007;243:258–67.

    Article  PubMed  Google Scholar 

  20. Das D, Gupta M, Kaur H, Kalucha A. Elastography: the next step. J Oral Sci. 2011;53:137–41.

    Article  PubMed  Google Scholar 

  21. Hong Y-R, Luo Z-Y, Mo G-Q, Wang P, Ye Q, Huang P-T. Role of contrast-enhanced ultrasound in the pre-perative diagnosis of cervical lymph node metastasis in patients with papillary thyroid carcinoma. Ultrasound Med Biol. 2017;43:2567–75.

    Article  PubMed  Google Scholar 

  22. Ito Y, Fukushima M, Higashiyama T, Kihara M, Takamura Y, Kobayashi K, et al. Tumor size is the strongest predictor of microscopic lymph node metastasis and lymph node recurrence of N0 papillary thyroid carcinoma. Endocr J. 2013;60:113–7.

    Article  PubMed  Google Scholar 

  23. Kim SS, Lee BJ, Lee JC, Kim SJ, Lee SH, Jeon YK, et al. Preoperative ultrasonographic tumor characteristics as a predictive factor of tumor stage in papillary thyroid carcinoma. Head Neck. 2011;33:1719–26.

    Article  PubMed  Google Scholar 

  24. Dewall RJ. Ultrasound elastography: principles, techniques, and clinical applications. Crit Rev Biomed Eng. 2013;41:1–19.

    Article  PubMed  Google Scholar 

  25. Suh CH, Choi YJ, Baek JH, Lee JH. The diagnostic performance of shear wave elastography for malignant cervical lymph nodes: a systematic review and meta-analysis. Eur Radiol. 2017;27:222–30.

    Article  PubMed  Google Scholar 

  26. Desmots F, Fakhry N, Mancini J, Reyre A, Vidal V, Jacquier A, et al. Shear wave elastography in head and neck lymph node assessment: image quality and diagnostic impact compared with B-mode and Doppler ultrasonography. Ultrasound Med Biol. 2016;42:387–98.

    Article  PubMed  Google Scholar 

  27. Poanta L, Serban O, Pascu I, Pop S, Cosgarea M, Fodor D. The place of CEUS in distinguishing benign from malignant cervical lymph nodes: a prospective study. Med Ultrason. 2014;16:7–14.

    Article  PubMed  Google Scholar 

  28. Xiang D, Hong Y, Zhang B, Huang P, Li G, Wang P, et al. Contrast-enhanced ultrasound (CEUS) facilitated US in detecting lateral neck lymph node metastasis of thyroid cancer patients: diagnosis value and enhancement patterns of malignant lymph nodes. Eur Radiol. 2014;24:2513–9.

    Article  PubMed  Google Scholar 

  29. Slaisova R, Benda K, Jarkovsky J, Petrasova H, Szturz P, Valek V. Contrast-enhanced ultrasonography compared to gray-scale and power Doppler in the diagnosis of peripheral lymphadenopathy. Eur J Radiol. 2013;82:693–8.

    Article  PubMed  Google Scholar 

  30. Rubaltelli L, Corradin S, Dorigo A, Tregnaghi A, Adami F, Rossi CR. Automated quantitative evaluation of lymph node perfusion on contrast-enhanced sonography. AJR Am J Roentgenol. 2007;188:977–83.

    Article  PubMed  Google Scholar 

  31. Rubaltelli L, Beltrame V, Tregnaghi A, Scagliori E, Frigo AC, Stramare R. Contrast-enhanced ultrasound for characterizing lymph nodes with focal cortical thickening in patients with cutaneous melanoma. AJR Am J Roentgenol. 2011;196:W8-12.

    Article  PubMed  Google Scholar 

  32. Zenk J, Bozzato A, Steinhart H, Greess H, Iro H. Metastatic and inflammatory cervical lymph nodes as analyzed by contrast-enhanced color-coded Doppler ultrasonography: quantitative dynamic perfusion patterns and histopathologic correlation. Ann Otol Rhinol Laryngol. 2005;114:43–7.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Ultrasonics, The First Affiliated Hospital of Xi’an Jiaotong University, No. 277 Yanta West Road, Xi’an, 710061, Shaanxi, China

    Jin-Ru Yang, Yan Song, Yu-Li Jia & Li-Tao Ruan

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  1. Jin-Ru Yang
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  2. Yan Song
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  3. Yu-Li Jia
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  4. Li-Tao Ruan
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Correspondence to Jin-Ru Yang.

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Yang, JR., Song, Y., Jia, YL. et al. Application of multimodal ultrasonography for differentiating benign and malignant cervical lymphadenopathy. Jpn J Radiol 39, 938–945 (2021). https://doi.org/10.1007/s11604-021-01131-7

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  • DOI: https://doi.org/10.1007/s11604-021-01131-7

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