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1
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Chawla S, Loevner L, Mohan S, Lin A, Sehgal CM, Poptani H. Dynamic contrast-enhanced MRI and Doppler sonography in patients with squamous cell carcinoma of head and neck treated with induction chemotherapy. JOURNAL OF CLINICAL ULTRASOUND : JCU 2022; 50:1353-1359. [PMID: 36205388 DOI: 10.1002/jcu.23361] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 09/05/2022] [Accepted: 09/15/2022] [Indexed: 06/16/2023]
Abstract
In view of the inherent limitations associated with performing dynamic contrast enhanced-magnetic resonance imaging (DCE-MRI) in clinical settings, current study was designed to provide a proof of principle that Doppler sonography and DCE-MRI derived perfusion parameters yield similar hemodynamic information from metastatic lymph nodes in squamous cell carcinomas of head and neck (HNSCCs). Strong positive correlations between volume fraction of plasma space in tissues (Vp ) and blood volume (r = 0.72, p = 0.02) and between Vp and %area perfused (r = 0.65, p = 0.04) were observed. Additionally, a moderate positive correlation trending towards significance was obtained between volume transfer constant (Ktrans ) and %area perfused (r = 0.49, p = 0.09).
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Affiliation(s)
- Sanjeev Chawla
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Laurie Loevner
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Suyash Mohan
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Alexander Lin
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Chandra M Sehgal
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Harish Poptani
- Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, UK
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2
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Eun NL, Kim JA, Gweon HM, Youk JH, Son EJ. Preoperative Nodal US Features for Predicting Recurrence in N1b Papillary Thyroid Carcinoma. Cancers (Basel) 2021; 14:cancers14010174. [PMID: 35008339 PMCID: PMC8750311 DOI: 10.3390/cancers14010174] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 12/13/2021] [Accepted: 12/24/2021] [Indexed: 11/26/2022] Open
Abstract
Simple Summary The presence of lateral neck lymph node (LN) metastasis (N1b) is a known prognostic factor for poor prognosis and high morbidity after surgery in papillary thyroid carcinoma (PTC). Previous studies have suggested that tumor size and metastatic LN characteristics, including LN size, number, ratio, and extranodal extension, are associated with recurrence; however, the prognostic role of imaging features of LNs in the lateral neck have rarely been reported. In this study, we investigated whether ultrasound imaging features of lateral neck LN metastases can be prognostic markers for predicting recurrence and thereby guide surgical extent and posttreatment surveillance in N1b PTC. Abstract This study aimed to investigate whether preoperative ultrasonographic (US) features of metastatic lymph nodes (LNs) are associated with tumor recurrence in patients with N1b papillary thyroid carcinoma (PTC). We enrolled 692 patients (mean age, 41.9 years; range, 6–80 years) who underwent total thyroidectomy and lateral compartment LN dissection between January 2009 and December 2015 and were followed-up for 12 months or longer. Clinicopathologic findings and US features of the index tumor and metastatic LNs in the lateral neck were reviewed. A Kaplan-Meier analysis and Cox proportion hazard model were used to analyze the recurrence-free survival rates and features associated with postoperative recurrence. Thirty-seven (5.3%) patients had developed recurrence at a median follow-up of 66.5 months. On multivariate Cox proportional hazard analysis, male sex (hazard ratio [HR], 2.277; 95% confidence interval [CI]: 1.131, 4.586; p = 0.021), age ≥55 years (HR, 3.216; 95% CI: 1.529, 6.766; p = 0.002), LN size (HR, 1.054; 95% CI: 1.024, 1.085; p < 0.001), and hyperechogenicity of LN (HR, 8.223; 95% CI: 1.689, 40.046; p = 0.009) on US were independently associated with recurrence. Preoperative US features of LNs, including size and hyperechogenicity, may be valuable for predicting recurrence in patients with N1b PTC.
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Affiliation(s)
| | | | | | | | - Eun Ju Son
- Correspondence: ; Tel.: +82-2-2019-3510; Fax: +82-2-3462-5472
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Tamanini G, Cominardi A, Brighi N, Fusaroli P, Lisotti A. Endoscopic ultrasound assessment and tissue acquisition of mediastinal and abdominal lymph nodes. World J Gastrointest Oncol 2021; 13:1475-1491. [PMID: 34721779 PMCID: PMC8529915 DOI: 10.4251/wjgo.v13.i10.1475] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 04/16/2021] [Accepted: 07/21/2021] [Indexed: 02/06/2023] Open
Abstract
The differential diagnosis between benign and malignant lymph nodes (LNs) has a fundamental role in the characterization and staging of malignant conditions, as well as in subsequent patients’ management. All imaging modalities (i.e. computed tomography and magnetic resonance imaging) rely mainly on size; endoscopic ultrasound (EUS) criteria based on B-mode evaluation and Doppler features fail to adequately characterize with high specificity LNs nature. The introduction of EUS-elastography and contrast-enhanced harmonic EUS are useful techniques to increase the diagnostic yield in identifying metastatic LNs, to identify which suspicious LN should require pathological characterization and, finally, to target tissue acquisition. EUS-guided tissue acquisition (EUS-TA) is increasingly being used for diagnosing lymphadenopathy whenever the characterization modifies patients’ subsequent management and when no superficial LN is accessible. Since target therapy are currently available (i.e. lung cancer, breast cancer), EUS-TA of malignant LNs could be required to identify tumor biology. In this field, both fine needle aspiration and biopsy needles are able to guarantee accurate results with almost perfect specificity and sub-optimal sensitivity. We finally propose a diagnostic algorithm based on most recent, high-level evidence for the diagnostic approach to suspected LNs assessment.
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Affiliation(s)
- Giacomo Tamanini
- Department of Gastroenterology Unit, Hospital of Imola, University of Bologna, Imola 40026, BO, Italy
| | - Anna Cominardi
- Department of Gastroenterology Unit, Hospital of Imola, University of Bologna, Imola 40026, BO, Italy
| | - Nicole Brighi
- Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola 47014, FC, Italy
| | - Pietro Fusaroli
- Department of Gastroenterology Unit, Hospital of Imola, University of Bologna, Imola 40026, BO, Italy
| | - Andrea Lisotti
- Department of Gastroenterology Unit, Hospital of Imola, University of Bologna, Imola 40026, BO, Italy
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Fischerova D, Garganese G, Reina H, Fragomeni SM, Cibula D, Nanka O, Rettenbacher T, Testa AC, Epstein E, Guiggi I, Frühauf F, Manegold G, Scambia G, Valentin L. Terms, definitions and measurements to describe sonographic features of lymph nodes: consensus opinion from the Vulvar International Tumor Analysis (VITA) group. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2021; 57:861-879. [PMID: 34077608 DOI: 10.1002/uog.23617] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 11/29/2020] [Accepted: 02/08/2021] [Indexed: 06/12/2023]
Abstract
In centers with access to high-end ultrasound machines and expert sonologists, ultrasound is used to detect metastases in regional lymph nodes from melanoma, breast cancer and vulvar cancer. There is, as yet, no international consensus on ultrasound assessment of lymph nodes in any disease or medical condition. The lack of standardized ultrasound nomenclature to describe lymph nodes makes it difficult to compare results from different ultrasound studies and to find reliable ultrasound features for distinguishing non-infiltrated lymph nodes from lymph nodes infiltrated by cancer or lymphoma cells. The Vulvar International Tumor Analysis (VITA) collaborative group consists of gynecologists, gynecologic oncologists and radiologists with expertise in gynecologic cancer, particularly in the ultrasound staging and treatment of vulvar cancer. The work herein is a consensus opinion on terms, definitions and measurements which may be used to describe inguinal lymph nodes on grayscale and color/power Doppler ultrasound. The proposed nomenclature need not be limited to the description of inguinal lymph nodes as part of vulvar cancer staging; it can be used to describe peripheral lymph nodes in general, as well as non-peripheral (i.e. parietal or visceral) lymph nodes if these can be visualized clearly. The association between the ultrasound features described here and histopathological diagnosis has not yet been established. VITA terms and definitions lay the foundations for prospective studies aiming to identify ultrasound features typical of metastases and other pathology in lymph nodes and studies to elucidate the role of ultrasound in staging of vulvar and other malignancies. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- D Fischerova
- Department of Obstetrics and Gynecology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - G Garganese
- Gynecology and Breast Care Center, Mater Olbia Hospital, Olbia, Italy
- Dipartimento Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - H Reina
- Department of Gynecological Ultrasound and Prenatal Diagnostics, Women's Hospital, University Hospital of Basel, Basel, Switzerland
| | - S M Fragomeni
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | - D Cibula
- Department of Obstetrics and Gynecology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - O Nanka
- Institute of Anatomy, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - T Rettenbacher
- Department Radiologie, Universitäts Klinik für Radiologie II, Innsbruck, Austria
| | - A C Testa
- Dipartimento Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, Rome, Italy
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | - E Epstein
- Department of Clinical Science and Education, Karolinska Institute, Sodersjukhuset, Stockholm, Sweden
- Department of Obstetrics and Gynecology, Sodersjukhuset, Stockholm, Sweden
| | - I Guiggi
- Department of Obstetrics and Gynecology, North West Tuscany Hospital, Livorno, Italy
| | - F Frühauf
- Department of Obstetrics and Gynecology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - G Manegold
- Department of Gynecological Ultrasound and Prenatal Diagnostics, Women's Hospital, University Hospital of Basel, Basel, Switzerland
| | - G Scambia
- Dipartimento Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, Rome, Italy
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | - L Valentin
- Department of Obstetrics and Gynecology, Skåne University Hospital, Malmö, Sweden
- Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
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Application of multimodal ultrasonography for differentiating benign and malignant cervical lymphadenopathy. Jpn J Radiol 2021; 39:938-945. [PMID: 33970452 DOI: 10.1007/s11604-021-01131-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 05/01/2021] [Indexed: 12/16/2022]
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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Abstract
CLINICAL/METHODICAL ISSUE Daily tasks in sonographic diagnostics include detection and characterization of peripheral and abdominal lymph nodes. STANDARD RADIOLOGICAL METHODS In addition to the B‑mode methods, color-coded Doppler sonography (CCDS) plays an important role in the evaluation of lymph nodes. METHODICAL INNOVATIONS Contrast-enhanced ultrasound (CEUS) has become a standard procedure in vascular and organ diagnostics. Tissue perfusion can be recorded visually and retrospectively in real time using time-dependent intensity analysis. The contrast agent dosage depends primarily on the location of the lymph nodes and the type and frequency of the transducer. Vascular and tumor cell density, intranodal pressure due to increased vascular permeability and preservation or destruction of the capsule must be taken into account when interpreting the findings. PERFORMANCE The indication for CEUS results from the B‑mode and CCDS findings and plays an important role especially in the verification of vitality before and after therapy. Uneven or apparently non-perfused areas allow a targeted puncture of vital tumor tissue. ACHIEVEMENTS Especially in abdominal lymph nodes, CEUS has a high diagnostic reliability. It is not always possible to differentiate between inflamed lymph nodes and lymph nodes altered by lymphoma filtration. PRACTICAL RECOMMENDATIONS CEUS helps to better assess the dignity of lymph nodes by visualizing their micro- and macrovascularization. After frustrated puncture, vital areas can be specifically biopsied. CEUS is particularly valuable in assessing the success of therapy.
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Affiliation(s)
- H-P Weskott
- Ultraschall Ambulanz, Klinikum Siloah-Oststadt-Heidehaus, Klinikum Region Hannover, Stadionbrücke 4, 30459, Hannover, Deutschland.
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Altinbas NK, Yagci C. Sonoelastographic evaluation for benign neck lymph nodes and parathyroid lesions. J Ultrason 2019; 18:284-289. [PMID: 30763011 PMCID: PMC6444318 DOI: 10.15557/jou.2018.0041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2018] [Indexed: 12/12/2022] Open
Abstract
Aim: The aim of the study was to evaluate the performance of real-time strain sonoelastography for comparison of perithyroidal lymph nodes of Hashimoto thyroiditis patients, jugular lymph nodes of healthy individuals and parathyroid lesions. Material and methods: Fifty parathyroid lesions (Group 1), 52 lymph nodes in Hashimoto thyroiditis patients (Group 2) and 51 reactive jugular lymph nodes (Group 3) were examined by ultrasound, and elastography was performed for a total of 95 patients. Real-time strain sonoelastography using elasticity score (E-index) was performed. The differences in E-index between the three groups were evaluated. Results: The mean E-index and size of parathyroid lesions were 2.30 ± 0.91 and 13.46 ± 5.69 mm, respectively. Parathyroid hyperplasia was detected by parathyroidectomy in two patients (2/37; 5%) with a total of four lesions (4/50; 8%). The remaining lesions were considered as adenomas. The mean E-index and size in Group 2 were 2.70 ± 0.93 and 7.83 ± 3.35 mm, respectively. The mean E-index and size in Group 3 were 1.88 ± 0.59 and 11.60 ± 4.96 mm, respectively. There were statistically significant differences between the groups in terms of E-index (p <0.01). Conclusions: When reactive jugular lymph nodes, perithyroidal lymph nodes of Hashimoto thyroiditis patients and parathyroid lesions are compared, it seems that strain sonoelastography indices add a benefit to routine practice in the differential diagnosis of parathyroid lesions and benign neck lymph nodes.
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Affiliation(s)
- Namik Kemal Altinbas
- Department of Radiology, Ankara University, Faculty of Medicine , Ankara , Turkey
| | - Cemil Yagci
- Department of Radiology, Ankara University, Faculty of Medicine , Ankara , Turkey
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8
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Abstract
Actually, there is still no consensus related to diagnostic and management algorithms in case of head and neck lymphadenopathy in children. The aim of our study was to analyze the causes of head and neck lymphadenopathy in children to determine a systematic diagnostic approach. We enrolled all cases of head and neck lymphadenopathy in children under the age of 18 diagnosed at the Unit of Hemato-Oncology, Pediatric Department of University "Luigi Vanvitelli," Naples, over a 15-year period (January 2003-December 2017). In total, 405 patients (271 males) were enrolled in the study. Thirteen cases due to other causes, were left off the study. Therefore, the study was performed on 392 cases. A total of 220 patients (56.1%) had a history of infection, 66 cases (16.8%) a diagnosis of neoplasia, and 101 (24.9%) cases a diagnosis of reactive inflammatory changes of nonspecific origin. We have observed the following from our study: (1) the acute infections are the most common causes of head and neck lymphadenopathy in the pediatric population; (2) in about a quarter of patients, the lymphadenopathy resulted by nonspecific origin; (3) the supraclavicular nodes should be regarded with a high index of suspicion of malignancy.
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Akheel M, George R, Jain A, Chahwala Q, Wadhwania A. Depth of tumor infiltration as a prognosticator in pT1-2 cN0 oral squamous cell carcinoma thereby need for elective neck dissection – A meta-analysis. CANCER RESEARCH, STATISTICS, AND TREATMENT 2019. [DOI: 10.4103/crst.crst_24_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Tan S, Miao LY, Cui LG, Sun PF, Qian LX. Value of Shear Wave Elastography Versus Contrast-Enhanced Sonography for Differentiating Benign and Malignant Superficial Lymphadenopathy Unexplained by Conventional Sonography. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2017; 36:189-199. [PMID: 27925679 DOI: 10.7863/ultra.16.01014] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Accepted: 03/30/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVES This study aimed to compare the efficacy of shear wave elastography (SWE) and contrast-enhanced sonography in the differential diagnosis of superficial lymphadenopathy with abnormal imaging findings, which could not be otherwise confirmed by conventional sonography. METHODS Forty-two enlarged superficial lymph nodes in 42 patients who met the screening criteria for this study were evaluated by both contrast-enhanced sonography and SWE. All lymph nodes underwent both methods using biopsy pathologic findings as a reference standard. RESULTS The maximum elastic modulus, mean elastic modulus, and standard deviation of the elastic modulus were the main distinguishing features on SWE; they were significantly higher in malignant lesions than benign ones. The threshold value for the maximum elastic modulus was set at 37.9 kPa, and the sensitivity, specificity, and accuracy of differential diagnosis of superficial lymph nodes were 81.8%, 80.0%, and 81.0%, respectively. The diagnosis of benignity and malignancy by this index was statistically significant (P < .001). The lymph nodes were divided into benign and malignant groups according to different types based on the degree and range of intensity on contrast-enhanced sonography: intense or moderate homogeneous enhancement (n = 26) and heterogeneous, low homogeneous, or absent enhancement (n = 16). The sensitivity, specificity, and accuracy of contrast-enhanced sonography were 27.3%, 50.0%, and 38.1%. There was no statistically significant difference in the values between the benign and malignant groups (χ2 = 2.295; P = .130). CONCLUSIONS Compared with contrast-enhanced sonography, SWE has better diagnostic value and efficiency in differentiation of superficial lymph nodes unexplained by conventional sonography. When conventional sonography cannot differentiate malignant superficial lymph nodes from benign ones, SWE is a useful adjunctive tool for assessment of lymph nodes.
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Affiliation(s)
- Shi Tan
- Department of Ultrasound, Beijing Friendship Hospital, Capital Medical University, Beijing, China
- Department of Ultrasound, Peking University Third Hospital, Beijing, China
| | - Li-Ying Miao
- Department of Ultrasound, Peking University Third Hospital, Beijing, China
| | - Li-Gang Cui
- Department of Ultrasound, Peking University Third Hospital, Beijing, China
| | - Peng-Fei Sun
- Department of Ultrasound, Peking University Third Hospital, Beijing, China
| | - Lin-Xue Qian
- Department of Ultrasound, Beijing Friendship Hospital, Capital Medical University, Beijing, China
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Machado MRM, Tavares MR, Buchpiguel CA, Chammas MC. Ultrasonographic Evaluation of Cervical Lymph Nodes in Thyroid Cancer. Otolaryngol Head Neck Surg 2016; 156:263-271. [PMID: 28145839 DOI: 10.1177/0194599816676472] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Objective To determine what ultrasonographic features can identify metastatic cervical lymph nodes, both preoperatively and in recurrences after complete thyroidectomy. Study Design Prospective. Setting Outpatient clinic, Department of Head and Neck Surgery, School of Medicine, University of São Paulo, Brazil. Subjects and Methods A total of 1976 lymph nodes were evaluated in 118 patients submitted to total thyroidectomy with or without cervical lymph node dissection. All the patients were examined by cervical ultrasonography, preoperatively and/or postoperatively. The following factors were assessed: number, size, shape, margins, presence of fatty hilum, cortex, echotexture, echogenicity, presence of microcalcification, presence of necrosis, and type of vascularity. The specificity, sensitivity, positive predictive value, and negative predictive value of each variable were calculated. Univariate and multivariate logistic regression analyses were conducted. A receiver operator characteristic (ROC) curve was plotted to determine the best cutoff value for the number of variables to discriminate malignant lymph nodes. Results Significant differences were found between metastatic and benign lymph nodes with regard to all of the variables evaluated ( P < .05). Logistic regression analysis revealed that size and echogenicity were the best combination of altered variables (odds ratio, 40.080 and 7.288, respectively) in discriminating malignancy. The ROC curve analysis showed that 4 was the best cutoff value for the number of altered variables to discriminate malignant lymph nodes, with a combined specificity of 85.7%, sensitivity of 96.4%, and efficiency of 91.0%. Conclusion Greater diagnostic accuracy was achieved by associating the ultrasonographic variables assessed rather than by considering them individually.
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Affiliation(s)
- Maria Regina Marrocos Machado
- 1 Department of Radiology and Oncology, Hospital das Clínicas, School of Medicine, University of São Paulo, São Paulo, SP, Brazil
| | - Marcos Roberto Tavares
- 2 Department of Head & Neck Surgery, Hospital das Clínicas, School of Medicine, University of São Paulo, São Paulo, SP, Brazil
| | - Carlos Alberto Buchpiguel
- 1 Department of Radiology and Oncology, Hospital das Clínicas, School of Medicine, University of São Paulo, São Paulo, SP, Brazil
| | - Maria Cristina Chammas
- 1 Department of Radiology and Oncology, Hospital das Clínicas, School of Medicine, University of São Paulo, São Paulo, SP, Brazil
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Patel NU, McKinney K, Kreidler SM, Bieker TM, Russ P, Roberts K, Glueck DH, Albuja-Cruz M, Klopper J, Haugen BR. Ultrasound-based clinical prediction rule model for detecting papillary thyroid cancer in cervical lymph nodes: A pilot study. JOURNAL OF CLINICAL ULTRASOUND : JCU 2016; 44:143-151. [PMID: 26402153 DOI: 10.1002/jcu.22309] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2014] [Revised: 08/06/2015] [Accepted: 08/22/2015] [Indexed: 06/05/2023]
Abstract
PURPOSE To identify sonographic features of cervical lymph nodes (LNs) that are associated with papillary thyroid cancer (PTC) and to develop a prediction model for classifying nodes as metastatic or benign. METHODS This retrospective study included the records of postthyroidectomy patients with PTC who had undergone cervical ultrasound and LN biopsy. LN location, size, shape, hilum, echopattern, Doppler flow, and microcalcifications were assessed. Model selection was used to identify features associated with malignant LNs and to build a predictive, binary-outcome, generalized linear mixed model. A cross-validated receiver operating characteristic analysis was conducted to assess the accuracy of the model for classifying metastatic nodes. RESULTS We analyzed records from 71 LNs (23 metastatic) in 44 patients (16 with PTC). The predictive model included a nonhomogeneous echopattern (odds ratio [OR], 5.73; 95% confidence interval [CI], 1.07-30.74; p = 0.04), microcalcifications (OR, 4.91; 95% CI, 0.91-26.54; p = 0.06), and volume (OR, 2.57; 95% CI, 0.66-9.99; p = 0.16) as predictors. The model had an area under the curve of 0.74 (95% CI, 0.60-0.85), sensitivity of 65% (95% CI, 50% to 78%), and specificity of 85% (95% CI, 73% to 94%) at the Youden optimal cut point of 0.38. CONCLUSIONS Nonhomogeneous echopattern, microcalcifications, and node volume were predictive of malignant LNs in patients with PTC. A larger sample is needed to validate this model.
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Affiliation(s)
- Nayana U Patel
- Department of Radiology, University of Colorado School of Medicine, Aurora, CO, 80045
| | - Kristin McKinney
- Department of Radiology, University of Colorado School of Medicine, Aurora, CO, 80045
| | - Sarah M Kreidler
- Department of Radiology, University of Colorado School of Medicine, Aurora, CO, 80045
| | | | - Paul Russ
- Department of Radiology, University of Colorado School of Medicine, Aurora, CO, 80045
| | - Katherine Roberts
- Department of Biostatistics and Informatics, University of Colorado School of Public Health, Aurora, CO, 80045
| | - Deborah H Glueck
- Department of Biostatistics and Informatics, University of Colorado School of Public Health, Aurora, CO, 80045
| | - Maria Albuja-Cruz
- Department of GI Tumor and Endocrine Surgery, University of Colorado School of Medicine, Aurora, CO, 80045
| | - Joshua Klopper
- Department of Medicine, Division of Endocrinology, University of Colorado School of Medicine and University of Colorado Cancer Center, Aurora, CO, 80045
| | - Bryan R Haugen
- Department of Medicine, Division of Endocrinology, University of Colorado School of Medicine and University of Colorado Cancer Center, Aurora, CO, 80045
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Medas F, Erdas E, Longheu A, Gordini L, Pisano G, Nicolosi A, Calò PG. Retrospective evaluation of the pre- and postoperative factors influencing the sensitivity of localization studies in primary hyperparathyroidism. Int J Surg 2016; 25:82-7. [DOI: 10.1016/j.ijsu.2015.11.045] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Accepted: 11/22/2015] [Indexed: 10/22/2022]
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Ryoo I, Suh S, Lee YH, Seo HS, Seol HY. Comparison of Ultrasonographic Findings of Biopsy-Proven Tuberculous Lymphadenitis and Kikuchi Disease. Korean J Radiol 2015; 16:767-75. [PMID: 26175575 PMCID: PMC4499540 DOI: 10.3348/kjr.2015.16.4.767] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Accepted: 03/24/2015] [Indexed: 12/25/2022] Open
Abstract
Objective Although tuberculous lymphadenitis and Kikuchi disease are common causes of cervical lymphadenopathy in Asians and exhibit similar clinical manifestations, their treatment strategies are totally different. The purpose of this study was to identify ultrasonographic features that distinguish these two diseases. Materials and Methods This study was approved by the Institutional Review Board. The study included 77 patients with tuberculous lymphadenitis and 135 patients with Kikuchi disease. The sex and age distributions of the patients were analyzed. The size and shape of lymph nodes (LNs), presence of conglomeration, increased perinodal echogenicity, echogenic hilum, posterior neck involvement, internal calcification, patterns of internal necrosis, laterality of involved LNs, and hilar vascular patterns on ultrasonography were compared between the two groups. Multiple logistic regression analysis was conducted to identify independent findings to discriminate tuberculous lymphadenitis from Kikuchi disease. Finally, diagnostic accuracies were calculated using the independent findings. Results The presence of an echogenic hilum, internal calcification, patterns of internal necrosis, and LN hilar vascular structures on power Doppler ultrasonography were independent findings that discriminated tuberculous lymphadenitis from Kikuchi disease. The diagnostic accuracy of each of these four factors was 84.9% (181/212), 76.9% (163/212), 84% (178/212), and 89.2% (189/212), respectively. A combination of internal calcification and hilar vascular structures showed the best accuracy of 89.6% (190/212) (sensitivity, 86.7% [117/135]; specificity, 94.8% [73/77]) for diagnosing Kikuchi disease. Conclusion The presence of an echogenic hilum, internal calcification, pattern of internal necrosis, and LN hilar vascular structures are useful ultrasonographic findings to differentiate tuberculous lymphadenitis from Kikuchi disease.
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Affiliation(s)
- Inseon Ryoo
- Department of Radiology, Guro Hospital, Korea University College of Medicine, Seoul 152-703, Korea
| | - Sangil Suh
- Department of Radiology, Guro Hospital, Korea University College of Medicine, Seoul 152-703, Korea
| | - Young Hen Lee
- Department of Radiology, Ansan Hospital, Korea University College of Medicine, Ansan 425-707, Korea
| | - Hyung Suk Seo
- Department of Radiology, Ansan Hospital, Korea University College of Medicine, Ansan 425-707, Korea
| | - Hae Young Seol
- Department of Radiology, Guro Hospital, Korea University College of Medicine, Seoul 152-703, Korea
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Eberhardt F, Köhler C, Winter K, Alef M, Kiefer I. [Sonographically detectable changes in abdominal lymph nodes in dogs with malignant lymphoma. Evaluation with special consideration of the Solbiati-Index]. TIERAERZTLICHE PRAXIS AUSGABE KLEINTIERE HEIMTIERE 2015; 43:309-16. [PMID: 26076988 DOI: 10.15654/tpk-150078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Accepted: 05/22/2015] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Characterization of the disorders of abdominal lymph nodes in dogs with malignant lymphoma and evaluation of the Solbiati-Index (SI) and the relationship between the short axis and the length of the lymph node (S : L ratio) as malignancy criteria. MATERIAL AND METHODS Retrospective analysis of data from dogs with malignant lymphoma. Inclusion criteria were cytological or histological diagnosis of the malignant lymphoma and an ultrasound examination of the abdomen prior to initiation of therapy. Criterion for exclusion was the application of a cytostatic agent prior to diagnosis. Furthermore, abdominal lymph nodes with non-neoplastic disorders were examined, when sonography as well as cytological/histological examinations were available. RESULTS A total of 261 lymph nodes (127 dogs) with malignant lymphoma and 17 lymph nodes (nine dogs) with benign disorders were evaluated. Sonography revealed massively rounded, clearly enlarged lymph nodes in 115/127 dogs (91%) with malignant lymphoma, while the lymph nodes of the other 12 dogs (9%) displayed an enlargement in the long axis. All 17 lymph nodes with benign disorders were enlarged in the long axis. The nodal parenchyma of 91% of the 127 dogs (malignant lymphoma) presented as hypoechoic to anechoic, and the cortex and medulla could not be differentiated. In the remaining 9% of dogs, a physiological isoechoic nodal parenchyma was observed. The parenchyma of lymph nodes with benign disorders was sonographically inconspicuous. In 71% of the 127 dogs with malignant lymphoma, the SI was < 2 and the S : L ratio > 0.5 (indicative for malignancy). Of the nine dogs with benign lymph node disorders, 71% had an SI of > 2 and 76% of them had an S : L ratio < 0.5 (indicative of a benign process). CONCLUSION AND CLINICAL RELEVANCE The significant increase in the size, rounding and hypoechoic changes in the lymph nodes in dogs with malignant lymphoma are indicative parameters of malignancy. In addition, the SI and the S:L ratio serve as a differentiation between benign and malign processes. Because of blurred boundaries between the malignant and benign changes, the various parameters should always be considered in conjunction.
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Affiliation(s)
- F Eberhardt
- Franziska Eberhardt, Klinik für Kleintiere, der Universität Leipzig, An den Tierkliniken 23, 04104 Leipzig, E-Mail:
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Lenghel LM, Botar Jid C, Bolboaca SD, Ciortea C, Vasilescu D, Baciut G, Dudea SM. Comparative study of three sonoelastographic scores for differentiation between benign and malignant cervical lymph nodes. Eur J Radiol 2015; 84:1075-82. [PMID: 25802207 DOI: 10.1016/j.ejrad.2015.02.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2014] [Revised: 02/10/2015] [Accepted: 02/21/2015] [Indexed: 12/21/2022]
Abstract
PURPOSE The 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 METHOD The 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. RESULTS When 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. CONCLUSIONS Our study suggests that there are no significant differences between the three scoring systems in terms of overall diagnostic value.
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Affiliation(s)
- Lavinia Manuela Lenghel
- Iuliu Hatieganu University of Medicine and Pharmacy, Department of Radiology, Clinicilor Street, No. 3-5, 400006 Cluj-Napoca, Romania.
| | - Carolina Botar Jid
- Iuliu Hatieganu University of Medicine and Pharmacy, Department of Radiology, Clinicilor Street, No. 3-5, 400006 Cluj-Napoca, Romania.
| | - Sorana D Bolboaca
- Iuliu Hatieganu University of Medicine and Pharmacy, Department of Medical Informatics and Biostatistics, Louis Pasteur Street, No. 6, 400349 Cluj-Napoca, Romania.
| | - Cristiana Ciortea
- Cluj District University Emergency, Department of Radiology, Clinicilor Street, No. 3-5, 400006 Cluj-Napoca, Romania.
| | - Dan Vasilescu
- Iuliu Hatieganu University of Medicine and Pharmacy, Department of Radiology, Clinicilor Street, No. 3-5, 400006 Cluj-Napoca, Romania.
| | - Grigore Baciut
- Iuliu Hatieganu University of Medicine and Pharmacy, Department of Cranio-Maxillo-Facial Surgery, Cardinal Iuliu Hossu Street, No. 37, 400029 Cluj-Napoca, Romania.
| | - Sorin M Dudea
- Iuliu Hatieganu University of Medicine and Pharmacy, Department of Radiology, Clinicilor Street, No. 3-5, 400006 Cluj-Napoca, Romania.
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Real-time prediction of mediastinal lymph node malignancy by endobronchial ultrasound. Arch Bronconeumol 2014; 50:228-34. [PMID: 24512940 DOI: 10.1016/j.arbres.2013.12.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2013] [Revised: 11/20/2013] [Accepted: 12/16/2013] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To evaluate the utility of different ultrasonographic (US) features in differentiating benign and malignant lymph node (LN) by endobronchial ultrasound (EBUS) and validate a score for real-time clinical application. METHODS 208 mediastinal LN acquired from 141 patients were analyzed. Six different US criteria were evaluated (short axis ≥10 mm, shape, margin, echogenicity, and central hilar structure [CHS], and presence of hyperechoic density) by two observers independently. A simplified score was generated where the presence of margin distinction, round shape and short axis ≥10 mm were scored as 1 and heterogeneous echogenicity and absence of CHS were scored as 1.5. The score was evaluated prospectively for real-time clinical application in 65 LN during EBUS procedure in 39 patients undertaken by two experienced operators. These criteria were correlated with the histopathological results and the sensitivity, specificity, positive and negative predictive values (PPV and NPV) were calculated. RESULTS Both heterogenicity and absence of CHS had the highest sensitivity and NPV (≥90%) for predicting LN malignancy with acceptable inter-observer agreement (92% and 87% respectively). On real-time application, the sensitivity and specificity of the score >5 were 78% and 86% respectively; only the absence of CHS, round shape and size of LN were significantly associated with malignant LN. CONCLUSIONS Combination of different US criteria can be useful for prediction of mediastinal LN malignancy and valid for real-time clinical application.
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Park YJ, Kim JA, Son EJ, Youk JH, Park CS. Quantitative shear wave elastography as a prognostic implication of papillary thyroid carcinoma (PTC): elasticity index can predict extrathyroidal extension (ETE). Ann Surg Oncol 2013; 20:2765-71. [PMID: 23463092 DOI: 10.1245/s10434-013-2927-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2012] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To investigate whether the quantitative elasticity index of shear wave elastography (SWE) can predict extrathyroidal extension (ETE) of papillary thyroid carcinoma (PTC) preoperatively. METHODS A total of 208 patients with pathology confirmed PTC whom underwent SWE during preoperative staging US between April 2011 to June 2012 were included.SWE indices of E mean, E max, E min of the index malignancy, the ratios between E mean of the lesion and parenchyma (E ratio-P), and muscle (E ratio-M), and grayscale US findings, including ETE, multifocality, bilaterality, and central and lateral lymph node (LN) metastasis were evaluated. The correlations of SWE indices and grayscale US findings with pathologic prognostic factors of PTC were analyzed by Chi square or Fisher's exact test, and multivariate regression analysis. RESULTS ETE was associated with E mean, E max, E min, and E ratio-M (P = 0.005, 0.009, 0.016 and <0.001, respectively), multifocality was associated with E mean, E max, and E min (P = 0.028, 0.007, and 0.004, respectively), and central LN metastasis was associated with E ratio-M (P = 0.03). On multivariate analysis, E mean and E min were independent factors for predicting ETE (P = 0.032, 0.049, respectively). CONCLUSIONS Quantitative elasticity index of SWE could predict pathologic ETE, and SWE could be a complimentary method to grayscale US for preoperative prediction of prognostic factors of PTC.
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Affiliation(s)
- Yun Joo Park
- Department of Radiology, Yonsei University College of Medicine, Gangnam Severance Hospital, Seoul, South Korea
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Causes of discordant or negative ultrasound of parathyroid glands in treatment naïve patients with primary hyperparathyroidism. Eur J Radiol 2012; 81:3956-64. [PMID: 23017194 DOI: 10.1016/j.ejrad.2012.08.019] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2012] [Revised: 08/26/2012] [Accepted: 08/28/2012] [Indexed: 11/22/2022]
Abstract
OBJECTIVES To describe causes of discordant or negative parathyroid ultrasound and to assess factors influencing them. MATERIALS AND METHODS Retrospective review of patients who underwent parathyroidectomy between 2000 and 2012 was done. Imaging findings were compared with operative findings and pathology to identify discrepant (n=60; 32 negative, 28 incorrect) parathyroid ultrasounds. RESULTS Fifty (83.3%) patients had parathyroid adenoma, of which 10 (16.6%) were ectopic and three were double adenomas; 8 (13.3%) had multigland hyperplasia and two had parathyroid carcinoma. Discrepant reports were due to incorrect localisation in 8 (13.3%); difficulty in differentiating thyroid from parathyroid lesion in 12 (20%); large and small size in two and three patients, respectively; overcall in 5 (8.3%) and satisfaction of search in 7 (11.7%) patients. There was significant correlation between presence of multi-nodular goitre and incorrect reports (χ(2)=4.112, p=0.04). Experience of ultrasound operators performing initial and second look ultrasound was significantly different (p<0.0001). Second look ultrasound was concordant with surgical findings in 39(65%) patients; 21 (66%) patients with initially negative ultrasound and four out of five extra-mediastinal ectopic lesions. Ten patients with negative initial ultrasound had elongated parathyroid lesion. Scintigraphy was concordant in 44 (73.3%) patients and nine were ectopic. CONCLUSION Second look ultrasound performed by experienced operator for negative or discordant initial ultrasound of parathyroid is a useful strategy which will improve the accuracy of parathyroid ultrasound. Being able to differentiate thyroid from parathyroid lesion is a factor which will influence performance of parathyroid ultrasound.
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Moon HJ, Kim EK, Yoon JH, Kwak JY. Differences in the diagnostic performances of staging US for thyroid malignancy according to experience. ULTRASOUND IN MEDICINE & BIOLOGY 2012; 38:568-573. [PMID: 22341048 DOI: 10.1016/j.ultrasmedbio.2012.01.002] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2011] [Revised: 01/04/2012] [Accepted: 01/04/2012] [Indexed: 05/31/2023]
Abstract
The aim was to compare the diagnostic performances of physicians with different levels of experience for completing preoperative staging ultrasonography (US) for thyroid malignancy. From March 2009 to December 2009, 1421 patients underwent preoperative staging US by six physicians according to the sixth edition of TNM classification. Extrathyroidal extension was defined as a perimeter in contact with >25% of the thyroid capsule in a malignant lesion or loss of the capsule line. US features in diagnosis of lymph node metastases were round shape, hyperechogenicity, microcalcifications, cystic change, and peripheral vascularity. Diagnostic performances of the three experienced physicians (>7 y) and the three less experienced physicians (<2 y) were compared. The overall diagnostic performances of T, N1a, multifocality and bilaterality by the experienced and less experienced physicians were comparable. The positive predictive value of N1b by experienced physicians was 64%, whereas that by less experienced physicians was 38.5%. These results suggest that evaluation of lateral lymph node metastasis requires more experience than other aspects of staging US for thyroid malignancy.
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Affiliation(s)
- Hee Jung Moon
- Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
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Moon HJ, Kim EK, Yoon JH, Kwak JY. Clinical implication of elastography as a prognostic factor of papillary thyroid microcarcinoma. Ann Surg Oncol 2012; 19:2279-87. [PMID: 22246427 DOI: 10.1245/s10434-011-2212-3] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2011] [Indexed: 12/21/2022]
Abstract
BACKGROUND A firm and hard thyroid nodule on palpation is known to be associated with an increased risk of thyroid malignancy. Elastography has been introduced to evaluate the tissue hardness objectively. We investigated the clinical implications of elastography as a prognostic factor in patients with papillary thyroid microcarcinoma. METHODS Elastography images were classified according to Rago scores of 1-5. Malignancies with Rago scores of 4 or 5 were considered as "hard" and remaining malignancies as "soft." Clinicopathologic characteristics were compared between patients with hard or soft malignancies according to the extrathyroidal extension and central and lateral lymph node metastasis by using chi-square tests, Fisher's exact test, and independent t tests. Odds ratios with 95% confidence intervals were calculated for evaluating the factors for predicting extrathyroidal extension and central and lateral lymph node metastasis. RESULTS A hard malignancy on the Rago score was significantly associated with pathologic extrathyroidal extension compared with a soft malignancy (P=0.001). The odds ratio of a hard malignancy on the Rago score for predicting extrathyroidal extension was 5.060 (95% confidence interval, 1.565-16.358). A hard malignancy on Rago scores was not associated with central or lateral lymph node metastasis. CONCLUSIONS A hard malignancy on the Rago score of elastography was an independent factor for predicting pathologic extrathyroidal extension on pathology.
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Affiliation(s)
- Hee Jung Moon
- Department of Radiology, Yonsei University College of Medicine, Severance Hospital, Seoul, Republic of Korea
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Kagawa T, Yuasa K, Fukunari F, Shiraishi T, Miwa K. Quantitative evaluation of vascularity within cervical lymph nodes using Doppler ultrasound in patients with oral cancer: relation to lymph node size. Dentomaxillofac Radiol 2011; 40:415-21. [PMID: 21960398 DOI: 10.1259/dmfr/18694011] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES The aim of this study was to quantitatively evaluate the relationship between vascularity within lymph nodes and lymph node size on Doppler ultrasound images of patients with oral cancer. METHODS A total of 310 lymph nodes (86 metastatic, 224 benign) from 63 patients with oral cancer were classified into 4 groups according to their short axis diameters: Group 1, short axis diameters of 4-5 mm; Group 2, 6-7 mm; Group 3, 8-9 mm; and Group 4, ≥ 10 mm. Vascular and scattering indices of lymph nodes on Doppler ultrasound images were analysed quantitatively. The vascular index was defined as the ratio of blood flow area to the whole lymph node area and the scattering index was defined as the number of isolated blood flow signal units. RESULTS For metastatic lymph nodes, the vascular index was highest in Group 1 and decreased as lymph node size increased. The vascular index of benign lymph nodes did not differ significantly among the four groups. The vascular index of metastatic lymph nodes was significantly higher than that of benign lymph nodes in Group 1. For metastatic lymph nodes, the scattering index increased as lymph node size increased and was significantly higher than that of benign lymph nodes in Groups 2-4. CONCLUSIONS An increase in vascularity is a characteristic of Doppler ultrasound findings in small metastatic lymph nodes. As the metastatic lymph node size increases, blood flow signals become scattered, and the scattering index increases.
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Affiliation(s)
- T Kagawa
- Department of Diagnostics & General Care, Fukuoka Dental College, Sawara-ku, Fukuoka, Japan.
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Guide de bonnes pratiques pour l’usage de l’échographie cervicale et des techniques écho-guidées dans la prise en charge des cancers thyroïdiens différenciés de souche vésiculaire. ANNALES D'ENDOCRINOLOGIE 2011; 72:H1-26. [DOI: 10.1016/s0003-4266(11)70001-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Positive Predictive Value and Interobserver Variability of Preoperative Staging Sonography for Thyroid Carcinoma. AJR Am J Roentgenol 2011; 197:W324-30. [DOI: 10.2214/ajr.10.5576] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Yoo JL, Suh SI, Lee YH, Seo HS, Kim KM, Shin BK, Song JY, Seol HY. Gray scale and power Doppler study of biopsy-proven Kikuchi disease. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2011; 30:957-963. [PMID: 21705728 DOI: 10.7863/jum.2011.30.7.957] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVES Kikuchi disease is a benign, self-limiting cause of cervical lymphadenopathy. It can show sonographic features similar to those of other common causes of lymphadenopathy. The purpose of this study was to characterize the sonographic features of Kikuchi disease that can contribute in differentiating between Kikuchi disease and other diseases causing cervical lymphadenopathy. METHODS Sonographic findings of 175 patients with biopsy-proven Kikuchi disease were retrospectively reviewed. The mean age of the patients was 27.3 years, and the female to male ratio was 3.5:1. All patients had undergone sonographically guided core biopsy. Pathologic findings were classified into proliferative (n = 57), necrotizing (n = 109), and xanthomatous (n = 9) types. On gray scale sonography, lymph nodes were assessed by their size, shape (shortest/longest axis ratio), location, echogenicity, presence of conglomeration, gross necrosis, calcification, echogenic nodal hilum, and increased perinodal echogenicity. The vascular pattern was assessed on power Doppler imaging. RESULTS The mean maximum diameter of the lymph nodes was 1.6 cm. Forty-four percent of them (77 of 175) were oval (shortest/longest axis ratio, 0.5-0.7) and 48% (84 of 175) were elongated (shortest/longest axis ratio, <0.5). Most were located in levels II and V. Seventeen lymph nodes showed gross necrosis, and none showed calcification. One hundred fifty-two lymph nodes (86.8%) had an echogenic hilum, and 76% (133 of 175) showed increased perinodal echogenicity. Increased perinodal echogenicity was seen in 93.5% of the necrotizing type (102 of 109) and 43.8% of the proliferative type (25 of 57); the difference between the two types was statistically significant (P = .001). Normal (n = 161), displaced (n = 13), and absent (n = 1) hilar vascularity was seen on power Doppler studies. CONCLUSIONS Sonographic findings of Kikuchi disease can contribute to the differentiation between Kikuchi disease and other causes of cervical lymphadenopathy.
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Affiliation(s)
- Jung Lim Yoo
- Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, 97 Guro-dong, Guro-gu, Seoul 152-703, Korea
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Leenhardt L, Borson-Chazot F, Calzada M, Carnaille B, Charrié A, Cochand-Priollet B, Do Cao C, Leboulleux S, Le Clech G, Mansour G, Menegaux F, Monpeyssen H, Orgiazzi J, Rouxel A, Sadoul JL, Schlumberger M, Tramalloni J, Tranquart F, Wemeau JL. Good practice guide for cervical ultrasound scan and echo-guided techniques in treating differentiated thyroid cancer of vesicular origin. ANNALES D'ENDOCRINOLOGIE 2011; 72:173-97. [PMID: 21641577 DOI: 10.1016/j.ando.2011.04.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2010] [Accepted: 02/05/2010] [Indexed: 12/30/2022]
Abstract
Good practice guide for cervical ultrasound scan and echo-guided techniques in treating differentiated thyroid cancer of vesicular origin. American, European and French Recommendations for the treatment of differentiated vesicular thyroid cancer were recently published. Cervical ultrasound scanning is now considered a key examination in the follow-up of these cancers. This examination is noninvasive, easy to perform and to obtain, is not costly, but remains operator-dependent. To date, there are no recommendations published that assemble all the technical aspects, results, indications and the limits of this examination in the initial medical report and the follow-up of these cancers. In order to standardise the procedure and validate the quality of the examination, a workgroup made up of a panel of experts particularly involved in carrying out ultrasound scans was set up. The aim was to draw up a good practice guide for performing cervical ultrasound scans and echo-guided techniques in treating patients with differentiated thyroid cancer of vesicular origin. The main objectives are to: (a) standardise the procedure and reports, (b) define the criteria for establishing whether lesions identified during a cervical ultrasound scan are malignant or benign, (c) standardise the indications for carrying out cytological tests and an in situ assay of markers, (d) help doctors to select the patients who ought to receive a cervical ultrasound scan and or cytological tests, (e) discuss how frequently the examinations should be carried out depending on the risk of recurrence.
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Affiliation(s)
- L Leenhardt
- Department of Nuclear Medicine, Pitié Salpêtrière Hospital, Paris cedex, France.
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Lee L, Steward DL. Techniques for parathyroid localization with ultrasound. Otolaryngol Clin North Am 2011; 43:1229-39, vi. [PMID: 21044738 DOI: 10.1016/j.otc.2010.08.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Four-gland parathyroid exploration has been the gold standard for parathyroid surgery until recently. Emphasis is now placed on minimally invasive and focused parathyroidectomy. In conjunction with functional sestamibi scanning, ultrasonography permits accurate localization of enlarged parathyroid glands in the vast majority of patients with hyperparathyroidism. Consequently, ultrasound technology applied to parathyroid pathology facilitates directed surgical therapy and minimally invasive applications. As such, ultrasonography holds great promise as a tool that enables cost-effective and advanced patient care.
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Affiliation(s)
- Lisa Lee
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati Medical Center, Cincinnati, OH 45267-0582, USA
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Diagnostic Approach for Evaluation of Lymph Node Metastasis From Thyroid Cancer Using Ultrasound and Fine-Needle Aspiration Biopsy. AJR Am J Roentgenol 2010; 194:38-43. [DOI: 10.2214/ajr.09.3128] [Citation(s) in RCA: 96] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Performance of preoperative sonographic staging of papillary thyroid carcinoma based on the sixth edition of the AJCC/UICC TNM classification system. AJR Am J Roentgenol 2009; 192:66-72. [PMID: 19098181 DOI: 10.2214/ajr.07.3731] [Citation(s) in RCA: 108] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this prospective study was to evaluate the overall performance of sonography for staging papillary thyroid carcinoma. SUBJECTS AND METHODS Ninety-four consecutive patients with papillary thyroid carcinoma underwent preoperative sonography. Two experienced radiologists prospectively evaluated primary tumors (e.g., diameter, number, presence of extrathyroidal invasion) and cervical lymph nodes for metastasis. A 5-point scale grading capsular abutment was used to evaluate the possibility of extrathyroidal invasion. Lymph nodes were divided into central and lateral groups according to N staging requirements. The sonographic criteria for lymph node metastasis were an absent hilum, hyperechoic change, a round shape, calcification, cystic change, or an abnormal color Doppler pattern. Sonographic results were correlated with histopathologic findings. RESULTS One hundred twenty-seven cancers in the 94 patients were proven after surgery. Sonography accurately identified 75.9% (22/29) of patients with multifocal cancer and 83.3% (15/18) of patients with bilateral cancers. Using a cutoff value of 50% or more of the tumor abutting the thyroid capsule (grade 2), the sensitivity, specificity, and accuracy of sonography in predicting extrathyroidal invasion were 85.3%, 70.0%, and 74.5%, respectively, and the overall accuracy of sonography for T staging was 67.0% (63/94). One hundred forty-seven cervical lymph node levels were dissected. All six sonographic findings were significantly more frequent in metastatic lymph nodes in the lateral group. However, in the central group, only two criteria-calcification and abnormal Doppler pattern-were found to significantly predict the presence of metastasis. The overall accuracy of sonography for N staging was 71.3% (67/94). CONCLUSION Sonography is a feasible tool to use for the preoperative staging of papillary thyroid carcinoma.
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Langer JE, Mandel SJ. Sonographic Imaging of Cervical Lymph Nodes in Patients with Thyroid Cancer. Neuroimaging Clin N Am 2008; 18:479-89, vii-viii. [DOI: 10.1016/j.nic.2008.03.007] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Fish SA, Langer JE, Mandel SJ. Sonographic imaging of thyroid nodules and cervical lymph nodes. Endocrinol Metab Clin North Am 2008; 37:401-17, ix. [PMID: 18502334 DOI: 10.1016/j.ecl.2007.12.003] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The initial application of sonography for the evaluation of the neck, more than 30 years ago, was to differentiate cystic and solid thyroid nodules. With improvements in technology, ultrasound has been applied to characterize distinct features in the appearance of thyroid nodules. More recently, its function has been expanded to assess cervical lymph nodes for metastatic thyroid cancer. This article discusses the sonographic features of thyroid nodules associated with malignancy and the role of ultrasound in the management of patients with thyroid cancer.
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Affiliation(s)
- Stephanie A Fish
- Department of Medicine, University of Pennsylvania School of Medicine, 1 Maloney, Endocrinology, HUP, 3400 Spruce Street, Philadelphia, PA 19104, USA
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34
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Abstract
Imaging has an important role in staging, planning treatment and post-treatment follow up of patients with head and neck cancer. The most commonly utilized imaging modalities are discussed in relation to their relative indications, strengths and weaknesses. This is followed by a brief update on the advances in functional magnetic resonance imaging.
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Affiliation(s)
- A D King
- Department of Diagnostic Radiology & Organ Imaging, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR, China.
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Abstract
Ultrasound can be used to detect and evaluate both normal and abnormal lymph nodes, as well as aid in biopsy sampling procedures, an important part of staging procedures in cancer patients. Several parameters can be evaluated using ultrasound; lymph node size, margins, echogenicity, echopattern (echotexture), acoustic transmission, presence and distribution of vascular flow, and vascular flow indices. The most diagnostically helpful include the short/long axis ratio of the lymph node, the pattern of distribution of the blood vessels within the lymph node, and to some extent the resistive and pulsatility indices. This review discusses the use of ultrasound for detecting, evaluating, and sampling peripheral, abdominal and thoracic lymph nodes in small animals.
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Affiliation(s)
- Helena T Nyman
- The University Animal Hospital, Department of Clinical Sciences, Division of Diagnostic Imaging, Swedish University of Agricultural Sciences, Uppsala, Sweden.
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36
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Johnson NA, Tublin ME, Ogilvie JB. Parathyroid imaging: technique and role in the preoperative evaluation of primary hyperparathyroidism. AJR Am J Roentgenol 2007; 188:1706-15. [PMID: 17515397 DOI: 10.2214/ajr.06.0938] [Citation(s) in RCA: 196] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE This article discusses the commonly used techniques for imaging the parathyroid glands and their role in the preoperative evaluation of patients with primary hyperparathyroidism. CONCLUSION The importance of sonography and sestamibi scintigraphy in the preoperative evaluation of patients with primary hyperthyroidism has increased with the adoption of minimally invasive parathyroidectomy techniques at most medical centers. When the results of these studies are concordant, the cure rates of minimally invasive surgery equal those of traditional bilateral neck exploration.
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Affiliation(s)
- Nathan A Johnson
- Department of Radiology, University of Pittsburgh Medical Center and School of Medicine, 200 Lothrop St., 3950 CHP/MT, Pittsburgh, PA 15213, USA
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37
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Abstract
Ultrasonography is a useful imaging modality for assessing cervical lymphadenopathy in patients with head and neck carcinomas. Features of cervical lymph nodes using gray-scale and color and power Doppler ultrasonography can help to distinguish normal and reactive lymph nodes from potentially metastatic lymph nodes. The distinguishing features that separate abnormal from normal cervical lymph nodes include peripheral vascularity, shape, overall lymph node echogenicity, absence of hilus, presence of nodal microcalcifications, and cystic changes. Often, a combination of these features is needed to assign a cervical lymph node as being abnormal.
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Affiliation(s)
- Joe M Chan
- Department of Internal Medicine, Stanford University Medical Center, Stanford, CA 94305-5105, USA
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Abstract
Lymphadenopathy refers to any disease process involving lymph nodes that are abnormal in size and consistency. Lymphadenitis specifically refers to lymphadenopathies that are caused by inflammatory processes. Cervical lymphadenopathy is a common problem in the pediatric age group and is largely inflammatory and infectious in etiology. Although most patients are treated successfully by their primary care physician, surgical consultation is frequently required for patients who fail to respond to initial therapy or for those in whom there is an index of suspicion for a neoplastic process. This article addresses current approaches to the diagnosis and management of cervical lymphadenitis in children.
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Affiliation(s)
- John R Gosche
- Division of Pediatric Surgery, The University of Mississippi Medical Center, Jackson, Mississippi 39216, USA.
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39
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Salwei RM, O'Brien RT, Matheson JS. CHARACTERIZATION OF LYMPHOMATOUS LYMPH NODES IN DOGS USING CONTRAST HARMONIC AND POWER DOPPLER ULTRASOUND. Vet Radiol Ultrasound 2005; 46:411-6. [PMID: 16250400 DOI: 10.1111/j.1740-8261.2005.00075.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Doppler ultrasound has been used in humans to determine angioarchitecture of lymph nodes as the criterion for the determination of malignancy. We hypothesized that the vascular and perfusion patterns of a canine malignant lymph node could be characterized with intravenous microbubble ultrasound contrast media and that contrast harmonic ultrasound could provide better conspicuity of the angioarchitecture when compared with Power Doppler ultrasound. In this study, 11 peripheral lymph nodes in dogs with histologically verified malignant lymphoma were imaged with fundamental ultrasound, Power Doppler ultrasound, and three contrast harmonic pulse sequences to characterize the vascular pattern and perfusion. Vascular imaging was greatly enhanced in these nodes with 2.13 times more vessels seen with contrast harmonic ultrasound compared with Power Doppler ultrasound (P < 0.01). The angioarchitecture of lymphomatous lymph nodes of dogs in this study were similar to those previously described in malignant superficial lymph nodes in human patients; 45.5% of the nodes had displacement of the central hilar vessel, 45.5% had aberrant vessels, 63.6% had pericapsular vessels, 36.4% had subcapsular vessels, and 81.8% had loss of the central hyperechoic band in fundamental sonography. Poor perfusion, indicated by a lower mean pixel intensity increase between pre- and postcontrast administration images, was seen in 36.4% of the lymph nodes while 63.6% had fair to good perfusion. The perfusion patterns in nine of the 11 lymph nodes were homogenous and two showed focal hypoperfused regions. We conclude that Power Doppler and contrast harmonic ultrasound are beneficial in accurately depicting angioarchitechture and can provide additional information in determining the presence of malignant vascular characteristics within lymphomatous nodes in dogs.
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Affiliation(s)
- Rochelle M Salwei
- Department of Surgical Science, School of Veterinary Medicine, University of Wisconsin-Madison, WI 53706, USA
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40
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Nyman HT, Kristensen AT, Skovgaard IM, McEvoy FJ. CHARACTERIZATION OF NORMAL AND ABNORMAL CANINE SUPERFICIAL LYMPH NODES USING GRAY-SCALE B-MODE, COLOR FLOW MAPPING, POWER, AND SPECTRAL DOPPLER ULTRASONOGRAPHY: A MULTIVARIATE STUDY. Vet Radiol Ultrasound 2005; 46:404-10. [PMID: 16250399 DOI: 10.1111/j.1740-8261.2005.00074.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
The objective of this study was to characterize the ultrasonographic patterns of normal superficial lymph nodes and to evaluate whether ultrasonography can help discriminate between different lymphadenopathies (reactive, lymphoma, and metastases) in dogs. Three hundred and eighteen superficial lymph nodes in 142 dogs were studied by B-mode, color flow mapping, power, and spectral Doppler ultrasonography. Size, echogenicity, nodal border definition, presence of a nodal hilus, acoustic enhancement and distribution of vascular flow, as well as perfusion indices were measured. Multivariate statistics using discriminant analysis was used to determine which parameters can be used to predict the diagnosis of the lymph node. The size of the lymph node, distribution of vascular flow within the lymph node, and pulsatility index (PI) in combination gave a classification error of 23% for the four groups of lymph nodes. This was improved to 11% if the nodes were divided into two groups: benign and malignant. There was a significant difference in resistive index (RI) and PI between benign and malignant nodes. Cut-off values were determined using receiver operator curves, 0.68 RI and 1.49 PI.
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Affiliation(s)
- Helena T Nyman
- Department of Small Animal Clinical Sciences, The Royal Veterinary and Agricultural University, Copenhagen, Denmark.
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Nyman HT, Kristensen AT, Flagstad A, McEvoy FJ. A review of the sonographic assessment of tumor metastases in liver and superficial lymph nodes. Vet Radiol Ultrasound 2004; 45:438-48. [PMID: 15487569 DOI: 10.1111/j.1740-8261.2004.04077.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Diagnostic imaging techniques are an important part of the diagnostic workup and staging of cancer patients. Ultrasound is of particular interest in this respect. In so far as tumor metastases are concerned, ultrasonography of regional lymph nodes and of the liver can provide valuable information. In humans many criteria, some of them objective, have been evaluated as indicators of malignancy. The most diagnostically helpful of these include the short/long axis ratio of the lymph node, the pattern of distribution of the blood vessels within the lymph node, and to some extent the calculated values for resistive and pulsatility indices. Putative objective criteria to improve the specificity of ultrasound for metastases detection in the liver have also been evaluated. These include perfusion indices, primarily using analysis of Doppler frequencies (Doppler perfusion index) and hepatic venography using an ultrasound contrast agent. Contrast-enhanced ultrasonography is a new and promising area to help the initial diagnosis and characterization of malignancy, particularly for focal lesions in the liver. This review discusses the use of ultrasound for detection of metastases and presents material from four veterinary cases.
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Affiliation(s)
- Helena T Nyman
- Department of Small Animal Clinical Sciences, The Royal Veterinary and Agricultural University, The Small Animal Hospital, Dyrlaegevej 16, 1870 Frederikksberg C, Copenhagen, Denmark.
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Baskin HJ. Detection of recurrent papillary thyroid carcinoma by thyroglobulin assessment in the needle washout after fine-needle aspiration of suspicious lymph nodes. Thyroid 2004; 14:959-63. [PMID: 15671775 DOI: 10.1089/thy.2004.14.959] [Citation(s) in RCA: 92] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
To evaluate an efficient method of surveillance of low-risk patients with thyroid cancer, ultrasound was performed on 74 postoperative patients being followed for stage I and II papillary carcinoma. All patients were clinically free of cancer 1-43 years after a total thyroidectomy, and were screened with ultrasound and thyroglobulin (Tg) measurement while taking thyroid hormone suppression. Ultrasound revealed findings suspicious of recurrent disease in the lymph nodes of the neck in 21 patients. An ultrasound-guided fine-needle aspiration (FNA) to obtain material for cytology and Tg analysis was done on these 21 patients, 7 of whom tested positive for Tg in their needle washout. Only 3 of the 7 had detectable Tg in their serum, and only 5 of the 7 had positive cytology. Ultrasound (with FNA-Tg analysis of needle washout of suspicious lymph nodes) is proposed as an effective and efficient method of surveillance in these low-risk patients. Presence of Tg in the needle washout proved to be more sensitive than cytology in diagnosing cancer in the lymph nodes and was not affected by positive anti-Tg antibodies in the serum.
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Affiliation(s)
- H Jack Baskin
- Florida Thyroid and Endocrine Clinic, Orlando, Florida 32804, USA.
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43
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Rubaltelli L, Khadivi Y, Tregnaghi A, Stramare R, Ferro F, Borsato S, Fiocco U, Adami F, Rossi CR. Evaluation of lymph node perfusion using continuous mode harmonic ultrasonography with a second-generation contrast agent. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2004; 23:829-836. [PMID: 15244307 DOI: 10.7863/jum.2004.23.6.829] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
OBJECTIVE To evaluate the contribution of continuous mode contrast-enhanced harmonic ultrasonography (CE-HUS) with a second-generation contrast agent to the characterization of superficial lymphadenopathies with respect to conventional ultrasonographic techniques (B-mode and power Doppler). METHODS Fifty-six lymph nodes from 45 patients were studied both by conventional techniques and by CE-HUS. The dimensions, intranodal architecture, margins, and location of vessels were evaluated. Subsequently, all the lymph nodes were examined by CE-HUS, and enhancement of echogenicity was evaluated. The diagnoses obtained by means of fine-needle aspiration cytologic examination, surgical biopsy, or both were compared with those obtained by ultrasonography. RESULTS Of the lymph nodes examined, 30 were benign and 26 were malignant (18 metastases and 8 non-Hodgkin lymphomas). The study using CE-HUS showed intense homogeneous enhancement in 28 of 30 reactive lymph nodes; perfusion defects in 17, of which 15 were neoplastic and 2 were inflammatory; intense but inhomogeneous speckled enhancement in the early arterial phase in 5 cases of lymphoma; and, last, scarce or absent intranodal enhancement in 4 metastases. The specificity, sensitivity, and accuracy of conventional techniques in differentiation between benign and malignant lymph nodes were 76%, 80%, and 78% versus 93%, 92%, and 92.8% for CE-HUS. The increase in correct diagnoses was significant (P = .05) when conventional ultrasonography was tested against CE-HUS. CONCLUSIONS Superficial lymph nodes can be characterized as being neoplastic or benign with a high degree of diagnostic accuracy on the basis of the perfusion characteristics evaluated by CE-HUS. This technique has been shown to afford a higher degree of accuracy than currently obtainable by any other ultrasonographic technique.
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Affiliation(s)
- Leopoldo Rubaltelli
- Department of Medical Diagnostic Sciences and Special Therapies, University of Padua, Padua, Italy.
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Abstract
Grey scale and power Doppler sonography play an important role in assessment of cervical lymphadenopathy. However, before examination of pathological nodes, a clear understanding of the anatomy of cervical nodes, scanning technique and sonographic appearances of normal cervical nodes is essential. This article reviews these topics in order to provide a baseline for sonographic examination of cervical lymphadenopathy.
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Affiliation(s)
- M Ying
- Department of Optometry and Radiography, The Hong Kong Polytechnic University, Hung Hom, Kowloon, SAR, Hong Kong, People's Republic of China
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Ahuja A, Ying M. Sonographic evaluation of cervical lymphadenopathy: is power Doppler sonography routinely indicated? ULTRASOUND IN MEDICINE & BIOLOGY 2003; 29:353-359. [PMID: 12706185 DOI: 10.1016/s0301-5629(02)00759-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Routine sonographic examination of neck nodes now includes both grey-scale and Doppler sonography. Although the addition of Doppler sonography to the well-established practice of grey-scale sonography increases the amount of information obtained by sonography, it also increases the examination time, particularly if spectral Doppler and estimation of vascular resistance is performed. This study was, therefore, undertaken to evaluate whether Doppler sonography is routinely indicated in every case or its use should be limited to those cases where grey-scale sonography is equivocal. We evaluated the grey-scale and power Doppler sonograms of 101 fine-needle aspiration cytology (FNAC)-proven metastatic nodes and 72 FNAC-proven nonmetastatic nodes. All lymph nodes were evaluated with grey-scale and power Doppler sonography. The shape, echogenicity, internal architecture, vascular distribution and vascular resistance of the lymph nodes were evaluated. Grey-scale sonographic features evaluated in this study had a high sensitivity (95%) and specificity (83%) in classifying metastatic and nonmetastatic nodes. Metastatic and nonmetastatic lymph nodes that could not be classified by grey-scale sonography demonstrated Doppler features that helped in their correct identification. Power Doppler sonography is not necessary for every case in routine clinical practice, but is essential and useful in patients where grey-scale sonography is equivocal. In this study, power Doppler sonography aided in the diagnosis in 5% and 17% of patients with metastatic and nonmetastatic nodes, respectively.
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Affiliation(s)
- Anil Ahuja
- Department of Diagnostic Radiology and Organ Imaging, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, NT, Hong Kong.
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Abstract
RATIONALE AND OBJECTIVES Gray scale and power Doppler sonography are commonly used to evaluate cervical lymph nodes. This study was undertaken to identify which of the features used in ultrasound of cervical lymph nodes is readily applicable in routine clinical practice. METHODS Two hundred and eight-six patients diagnosed with cervical lymphadenopathy were included in the study. The largest node in each patient was included in the study and the nature of the node was assessed by fine-needle aspiration cytology. Lymph nodes were assessed for their gray scale and Doppler sonographic features. RESULTS Metastatic, lymphomatous, and tuberculous nodes were round (63-94%) and without echogenic hilus (57-91%). Sharp borders were found in metastatic and lymphomatous nodes (56-100%), but uncommon in tuberculosis (49%). Capsular or mixed vascularity is common in metastatic, lymphomatous, and tuberculous nodes but not found in reactive nodes. Except metastatic nodes from papillary carcinoma of the thyroid that showed low resistance, metastatic nodes had a higher vascular resistance than reactive nodes. Micronodular echo pattern is common in lymphomatous nodes. Hyperechogenicity and punctate calcification are typical features for metastatic nodes from papillary carcinoma of the thyroid. Intranodal cystic necrosis, adjacent soft tissue edema, matting and displaced hilar vascularity are common features in tuberculosis. CONCLUSIONS Using gray scale and power Doppler sonography, metastatic, lymphomatous, and tuberculous nodes can be differentiated from reactive nodes. Metastatic nodes from papillary carcinoma, lymphoma, and tuberculosis can be identified. However, it is difficult to differentiate metastatic nodes from squamous cell carcinomas, nasopharyngeal carcinoma, and infraclavicular carcinomas, and differentiate metastatic nodes (nonthyroid primary) from tuberculous lymphadenitis.
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Affiliation(s)
- Anil Ahuja
- Department of Diagnostic Radiology and Organ Imaging, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong.
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47
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Reeder SB, Desser TS, Weigel RJ, Jeffrey RB. Sonography in primary hyperparathyroidism: review with emphasis on scanning technique. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2002; 21:539-554. [PMID: 12008817 DOI: 10.7863/jum.2002.21.5.539] [Citation(s) in RCA: 65] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
OBJECTIVE To review the sonographic features and focused sonographic scanning techniques that may assist in the preoperative localization of parathyroid adenomas in patients with primary hyperparathyroidism. METHODS The sonographic findings were reviewed in 54 of 58 consecutive patients with pathologically proven parathyroid adenomas. A systematic scanning approach including real-time gray scale, color and power Doppler, and graded compression gray scale imaging was used in all patients. RESULTS Fifty-four (93%) of 58 proven adenomas were correctly identified by sonography. Gray scale imaging alone was sufficient for identifying 26 (100%) of 26 large (> or =1-cm) and 3 (11%) of 25 small (<1-cm) parathyroid adenomas. However, for 25 (89%) of 28 small adenomas, a combination of color and power Doppler and graded compression real-time gray scale imaging was required for sonographic localization and identification. CONCLUSIONS Knowledge of typical locations and characteristic imaging features, as well as a systematic scanning approach, can result in accurate preoperative sonographic localization of parathyroid adenomas.
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Affiliation(s)
- Scott B Reeder
- Department of Radiology, Stanford University Medical Center, California 94304, USA
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