Characterization of cervical lymph nodes by means of qualitative multiparametric Ultrasound (mpUS) evaluation

Introduction In case of a persistent enlargement of cervical lymph nodes (CLN) radiological and histopathological evaluation is recommended. CLN can easily be examined with ultrasound (US). We could show that quantitative evaluation of shear-wave-elastography (SWE) allows the differentiation of malignant and benign. In this study we wanted to evaluate whether the qualitative assessment of multiparametric US (mpUS) can optimize the preoperative characterization of CLN.

Methods Shear-wave elastography (SWE) and contrast enhanced ultrasound (CEUS) were applied for all patients before surgery in addition to standard US-examination. Raw data were assessed and rated by experienced US-users.

Results 107 CLN (39 benign, 68 malignant) were included in the qualitative assessment of B-mode-US, SWE and CEUS. All three modalities showed significant differences between benign and malignant CLN (p<0.001) with mpUS showing a higher sensitivity (SWE: 68%; CEUS 89%; B-mode: 81%) and specificity (SWE 85%; CEUS 82%; B-mode 54%) as well as higher positive predictive values (PPV; SWE 88%; CEUS 87%; B-mode 75%) and negative predictive values (NPV; SWE 60%; CEUS 76 %; B-mode 62%). We found significant group differences between malignant and benign CLN and CEUS perfusion patterns (p = 0.002; sensitivity 61%; specificity 68%, PPV 78%, NPV 49%) with benign CLN showing centrifugal and malignant CLN showing centripetal patterns.

Discussion The qualitative mpUS-assessment allowed a more precise evaluation of CLN compared to B-mode-US. Additionally, the differentiation of benign and malignant CLN is possible by interpreting perfusion patterns. Therefore, the qualitative assessment of mpUS seems to elevate the preoperative diagnostical CLN rating.

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Artikel online veröffentlicht:
12. Mai 2023