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Awali M, Middleton WD, Daggumati L, Phillips CH, Caserta MP, Fetzer DT, Dahiya N, Chong WK, Wasnik AP, Burgan CM, Morgan T, Itani M. Ultrasound of palpable lesions: a pictorial review. Abdom Radiol (NY) 2024; 49:3574-3598. [PMID: 38763936 DOI: 10.1007/s00261-024-04249-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 02/07/2024] [Accepted: 02/08/2024] [Indexed: 05/21/2024]
Abstract
Ultrasound (US) is the imaging modality of choice for evaluation of superficial palpable lesions. A large proportion of these lesions have characteristic sonographic appearance and can be confidently diagnosed with US without the need for biopsy or other intervention. The Society of Radiologists in Ultrasound (SRU) recently published a Consensus Conference Statement on superficial soft tissue masses. The goal of this manuscript is (a) to serve as a sonographic pictorial review for palpable lesions based on the SRU statement, (b) present the typical sonographic features of palpable lesions that can be confidently diagnosed with US, and (c) provide an overview of other palpable lesions with a framework to interpret the US studies and advise on appropriate further management.
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Affiliation(s)
- Mohamed Awali
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, 510 S Kingshighway Blvd, St. Louis, MO, 63110, USA
| | - William D Middleton
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, 510 S Kingshighway Blvd, St. Louis, MO, 63110, USA
| | - Lasya Daggumati
- University of Missouri Kansas City School of Medicine, 2411 Holmes St, Kansas City, MO, 64108, USA
| | - Catherine H Phillips
- Vanderbilt University Medical Center, 1211 Medical Center Drive, Nashville, TN, 37232, USA
| | - Melanie P Caserta
- Mayo Clinic Florida, 4500 San Pablo Rd, Jacksonville, FL, 32224, USA
| | - David T Fetzer
- UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA
| | - Nirvikar Dahiya
- Mayo Clinic Arizona, 5777 E. Mayo Blvd, Phoenix, AZ, 85054, USA
| | - Wui K Chong
- University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Houston, TX, 77030, USA
| | - Ashish P Wasnik
- University of Michigan-Michigan Medicine, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109, USA
| | - Constantine M Burgan
- University of Alabama at Birmingham, 625 19 Street South JT N338A, Birmingham, AL, 35233, USA
| | - Tara Morgan
- Mayo Clinic Arizona, 5777 E. Mayo Blvd, Phoenix, AZ, 85054, USA
| | - Malak Itani
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, 510 S Kingshighway Blvd, St. Louis, MO, 63110, USA.
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Altinbasak I, Alp Y, Sanyal R, Sanyal A. Theranostic nanogels: multifunctional agents for simultaneous therapeutic delivery and diagnostic imaging. NANOSCALE 2024; 16:14033-14056. [PMID: 38990143 DOI: 10.1039/d4nr01423e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/12/2024]
Abstract
In recent years, there has been a growing interest in multifunctional theranostic agents capable of delivering therapeutic payloads while facilitating simultaneous diagnostic imaging of diseased sites. This approach offers a comprehensive strategy particularly valuable in dynamically evolving diseases like cancer, where combining therapy and diagnostics provides crucial insights for treatment planning. Nanoscale platforms, specifically nanogels, have emerged as promising candidates due to their stability, tunability, and multifunctionality as carriers. As a well-studied subgroup of soft polymeric nanoparticles, nanogels exhibit inherent advantages due to their size and chemical compositions, allowing for passive and active targeting of diseased tissues. Moreover, nanogels loaded with therapeutic and diagnostic agents can be designed to respond to specific stimuli at the disease site, enhancing their efficacy and specificity. This capability enables fine-tuning of theranostic platforms, garnering significant clinical interest as they can be tailored for personalized treatments. The ability to monitor tumor progression in response to treatment facilitates the adaptation of therapies according to individual patient responses, highlighting the importance of designing theranostic platforms to guide clinicians in making informed treatment decisions. Consequently, the integration of therapy and diagnostics using theranostic platforms continues to advance, offering intelligent solutions to address the challenges of complex diseases such as cancer. In this context, nanogels capable of delivering therapeutic payloads and simultaneously armed with diagnostic modalities have emerged as an attractive theranostic platform. This review focuses on advances made toward the fabrication and utilization of theranostic nanogels by highlighting examples from recent literature where their performances through a combination of therapeutic agents and imaging methods have been evaluated.
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Affiliation(s)
- Ismail Altinbasak
- Department of Chemistry, Bogazici University, Bebek, Istanbul 34342, Türkiye.
| | - Yasin Alp
- Department of Chemistry, Bogazici University, Bebek, Istanbul 34342, Türkiye.
| | - Rana Sanyal
- Department of Chemistry, Bogazici University, Bebek, Istanbul 34342, Türkiye.
- Center for Life Sciences and Technologies, Bogazici University, Bebek, Istanbul 34342, Türkiye
| | - Amitav Sanyal
- Department of Chemistry, Bogazici University, Bebek, Istanbul 34342, Türkiye.
- Center for Life Sciences and Technologies, Bogazici University, Bebek, Istanbul 34342, Türkiye
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Jin Q, Heng Y, Zhu X, Xu C, Cai W, Tao L. Patterns of cervical lymph node involvement in mono-focal papillary thyroid carcinoma patients with different capsular status: A multi-center analysis. Am J Otolaryngol 2024; 45:104265. [PMID: 38703608 DOI: 10.1016/j.amjoto.2024.104265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 03/14/2024] [Accepted: 03/17/2024] [Indexed: 05/06/2024]
Abstract
OBJECTIVE The characteristics of cervical lymph node involvement in papillary thyroid carcinoma (PTC) patients with different degree of capsular invasion remains unclear, especially for those with mono-focal lesion who have traditionally been considered as low neck metastasis risk subgroup. STUDY DESIGN Retrospective cohort study. SETTING Three academic teaching hospital. METHODS A total of 1276 mono-focal PTC patients were retrospectively analyzed. RESULTS Mono-focal PTC patients with extrathyroidal extension (ETE) showed significantly higher central lymph node metastasis (CLNM) rate than those without. For patients with no gross ETE (gETE), those with minimal ETE (mETE) also showed more commonly CLNM than those with encapsulated lesions. However, the lateral lymph node metastasis (LLNM) rates of patients with mETE and encapsulated tumors were comparable, both lower than that of patients with gETE. Age ≥40, male, and MTD ≥0.5 cm were identified as independent risk factors of CLNM for those with encapsulated tumors and were enrolled for creating a prediction model. In terms of LLNM, only MTD ≥1.0 cm was confirmed as independent risk factors of LLNM for patients with positive gETE. CONCLUSIONS The presence and degree of ETE may have different effects on the risk of central and lateral lymph node metastasis. gETE demonstrates a strong correlation with both CLNM and LLNM while mETE is only associated with CLNM in mono-focal PTC patients. A comprehensive model is established in the aim of predicting neck involvement according to the capsular status and the corresponding stratified risk factors, which may aid clinical decision-making for the management of neck regions.
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Affiliation(s)
- Qiuyan Jin
- ENT institute and Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, China
| | - Yu Heng
- ENT institute and Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, China
| | - Xiaoke Zhu
- ENT institute and Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, China
| | - Chengzhi Xu
- Department of General Surgery, Ruijin Hospital, Shanghai Jiaotong University School of medicine, China.
| | - Wei Cai
- Department of General Surgery, Ruijin Hospital, Shanghai Jiaotong University School of medicine, China.
| | - Lei Tao
- ENT institute and Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, China.
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Garg HK, Shashi KK, Fisher P, Winant AJ, Hull NC, Lee EY. Pediatric Upper Abdominal Masses: Current Practical Imaging Assessment. Semin Roentgenol 2024; 59:299-311. [PMID: 38997183 DOI: 10.1053/j.ro.2024.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 02/29/2024] [Accepted: 03/04/2024] [Indexed: 07/14/2024]
Affiliation(s)
- Harsha K Garg
- Department of Diagnostic, Molecular and Interventional Radiology and Pediatrics, Kravis Children's Hospital, Icahn School of Medicine at The Mount Sinai Hospital, New York, NY.
| | - Kumar K Shashi
- Department of Radiology, Arkansas Children's Hospital, Little Rock, AR
| | - Paul Fisher
- Department of Diagnostic, Molecular and Interventional Radiology and Pediatrics, Kravis Children's Hospital, Icahn School of Medicine at The Mount Sinai Hospital, New York, NY
| | - Abbey J Winant
- Department of Radiology, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Nathan C Hull
- Department of Radiology, Division of Pediatric Radiology, Mayo Clinic, Rochester, MN
| | - Edward Y Lee
- Department of Radiology, Boston Children's Hospital, Harvard Medical School, Boston, MA
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Ghabisha S, Al-wageeh S, Al-yousofy F, Ahmed F, Al-Mwald T, Altam A, Badheeb M. Utility of perioperative ultrasonography and fine-needle aspiration cytology in differentiation between benign and malignant cervical lymphadenopathy: a retrospective cohort study. Ann Med Surg (Lond) 2024; 86:3294-3302. [PMID: 38846875 PMCID: PMC11152841 DOI: 10.1097/ms9.0000000000002040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 03/31/2024] [Indexed: 06/09/2024] Open
Abstract
Background The preoperative differentiation of benign form malignant cervical lymphadenopathy (CLA) is crucial in determining the need for surgical intervention. This study aims to assess the diagnostic performance of ultrasonography (US), fine-needle aspiration cytology (FNAC), and their combination with the postoperative histopathological diagnoses of CLA. Method In a retrospective study between April 2021 and May 2023, 214 patients with CLA were assessed with preoperative US and FNAC. The morphological parameters, including tissue margins, vascularity, and fatty hilum echogenicity, were collected and analyzed retrospectively. The diagnostic efficacies of US, FNAC, and their combined use were compared to the postoperative histopathological findings. Result In the final histopathological examination, 185 cases (86.4%) were found to be benign, while 29 cases (13.6%) were determined to be malignant. The US features of fatty hilum, echogenicity, and vascularity pattern had the highest diagnostic accuracy in characterizing CLA patterns, with values of 88.3%, 85.5%, and 85.0%, respectively. The receiver operating characteristic (ROC) curve showed a significantly higher area under the curve (AUC) value of 0.883 (95% CI: 0.832-0.923; P<0.0001) for the combined use of all US parameters with better sensitivity (93.10%) and specificity (68.65%) than individual parameters. The overall sensitivity, specificity, and accuracy of FNAC were 97.3%, 82.8%, and 95.3%, respectively. Additionally, US parameters and FNAC together showed a significantly higher AUC value of 0.924 (95% CI: 0.880-0.956; P<0.0001) and achieved a sensitivity of 86.21% and specificity of 88.65%. Conclusions The combined use of US and FNAC provides high sensitivity, specificity, and diagnostic accuracy in characterizing CLA patterns. In limited-resources settings, this approach is feasible, less invasive, and cost-effective, thereby enabling clear management strategies and avoiding additional surgical interventions.
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Affiliation(s)
| | | | - Fayed Al-yousofy
- Department of Pathology, Faculty of Medicine, Taiz University of Medical Sciences, Taiz
| | | | | | - Abdulfattah Altam
- Department of General Surgery, School of Medicine, 21 September University, Sana’a, Yemen
| | - Mohamed Badheeb
- Department of Internal Medicine, Yale New-Haven Health/Bridgeport Hospital, Bridgeport, CT
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Nofi CP, Roberts BK, Kallis MP, Koo D, Glick RD, Rich BS. Management of Persistent Low-Suspicion Cervical Lymphadenopathy in Pediatric Patients. J Surg Res 2024; 298:71-80. [PMID: 38581765 DOI: 10.1016/j.jss.2024.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 01/25/2024] [Accepted: 03/12/2024] [Indexed: 04/08/2024]
Abstract
INTRODUCTION Cervical lymphadenopathy in children is typically self-limited; however, the management of persistent lymphadenopathy remains unclear. This study aimed to evaluate the management and outcomes of patients with persistent cervical lymphadenopathy. METHODS Single-institution, retrospective review of children <18 years undergoing ultrasound (US) for cervical lymphadenopathy from 2013 to 2021 was performed. Patients were stratified into initial biopsy, delayed biopsy, or no biopsy groups. Clinical characteristics and workup were compared, and multivariate analyses were performed to assess predictors of delayed biopsy. RESULTS 568 patients were identified, with 493 patients having no biopsy, 41 patients undergoing initial biopsy, and 34 patients undergoing delayed biopsy. Presenting symptoms differed: no biopsy patients were younger, were more likely to present to the emergency department, and had clinical findings often associated with acute illness. Patients with USs revealing abnormal vascularity or atypical architecture were more likely to be biopsied. History of malignancy, symptoms >1 week but <3 months, and atypical or change in architecture on US was associated with delayed biopsy. Patients with long-term follow-up (LTF) were followed for a median of 99.0 days. Malignancies were identified in 12 patients (2.1%). All malignancies were diagnosed within 14 days of presentation, and no malignancies were identified in LTF. CONCLUSIONS Patients with persistent low suspicion lymphadenopathy are often followed for long durations; however, in this cohort, no malignancies were diagnosed during LTF. We propose an algorithm of forgoing a biopsy and employing primary care surveillance and education, which may be appropriate for these patients in the proper setting.
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Affiliation(s)
- Colleen P Nofi
- Department of Surgery, Donald and Barbara Zucker School of Medicine at Hofstra/ Northwell, Hempstead, New York; Division of Pediatric Surgery, Cohen Children's Medical Center at Hofstra/Northwell, Queens, New York
| | - Bailey K Roberts
- Department of Surgery, Donald and Barbara Zucker School of Medicine at Hofstra/ Northwell, Hempstead, New York; Division of Pediatric Surgery, Cohen Children's Medical Center at Hofstra/Northwell, Queens, New York
| | - Michelle P Kallis
- Department of Surgery, Donald and Barbara Zucker School of Medicine at Hofstra/ Northwell, Hempstead, New York; Division of Pediatric Surgery, Cohen Children's Medical Center at Hofstra/Northwell, Queens, New York
| | - Donna Koo
- Department of Surgery, Donald and Barbara Zucker School of Medicine at Hofstra/ Northwell, Hempstead, New York
| | - Richard D Glick
- Department of Surgery, Donald and Barbara Zucker School of Medicine at Hofstra/ Northwell, Hempstead, New York; Division of Pediatric Surgery, Cohen Children's Medical Center at Hofstra/Northwell, Queens, New York
| | - Barrie S Rich
- Department of Surgery, Donald and Barbara Zucker School of Medicine at Hofstra/ Northwell, Hempstead, New York; Division of Pediatric Surgery, Cohen Children's Medical Center at Hofstra/Northwell, Queens, New York.
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Caliskan E, Paytoncu N, Düzkalır HG, Arifoglu M, Fistikcioglu N, Gunbey HP. The Diagnostic Performance of Magnetic Resonance Imaging in the Categorization of Pediatric Neck Lymph Nodes: Radiologic and Pathologic Correlations. J Pediatr Hematol Oncol 2024; 46:188-196. [PMID: 38573005 DOI: 10.1097/mph.0000000000002835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 01/26/2024] [Indexed: 04/05/2024]
Abstract
BACKGROUND/AIM To present MRI features of neck lymph nodes in benign and malignant conditions in the pediatric population. MATERIALS AND METHODS MRIs of the neck of 51 patients 1 to 18 years old (40 boys, 11 girls [10.08±4.73]) with lymph node biopsy were retrospectively analyzed. Those were grouped as benign including reactive (27 [52.9%]) and lymphadenitis (11 [21.6%]), and malignant (13 [25.5%]). The groups were evaluated multiparametrically in terms of quantitative and qualitative variables. RESULTS The long axis, short axis, area, and apparent diffusion coefficient (ADC) values of the largest lymph node were 21 (17 to 24) mm, 14 (12 to 18) mm, 228.60 (144.79 to 351.82) mm 2 , 2531 (2457 to 2714) mm 2 /s for reactive, 24 (19 to 27) mm, 15 (11 to 20) mm, 271.80 (231.43 to 412.20) mm 2 , 2534 (2425 to 2594) mm 2 /s for lymphadenitis, 27 (23.50 to 31.50) mm, 20 (15 to 22) mm, 377.08 (260.47 to 530.94) mm 2 , 2337 (2254 to 2466) mm 2 /s for malignant, respectively. Statistical analysis of our data suggests that the following parameters are associated with a higher likelihood of malignancy: long axis >22 mm, short axis >16 mm, area >319 cm 2 , ADC value <2367 mm 2 /s, and supraclavicular location. Perinodal and nodal heterogeneity, posterior cervical triangle location are common in lymphadenitis ( P <0.001). Reactive lymph nodes are distributed symmetrically in both neck halves ( P <0.001). CONCLUSION In the MRI-based approach to lymph nodes, not only long axis, short axis, surface area, and ADC, but also location, distribution, perinodal, and nodal heterogeneity should be used.
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Affiliation(s)
| | - Naz Paytoncu
- Radiology, Kartal Dr. Lutfi Kirdar City Hospital, University of Health Sciences, Istanbul, Turkey
| | - Hanife G Düzkalır
- Radiology, Kartal Dr. Lutfi Kirdar City Hospital, University of Health Sciences, Istanbul, Turkey
| | - Meral Arifoglu
- Radiology, Kartal Dr. Lutfi Kirdar City Hospital, University of Health Sciences, Istanbul, Turkey
| | - Neriman Fistikcioglu
- Radiology, Kartal Dr. Lutfi Kirdar City Hospital, University of Health Sciences, Istanbul, Turkey
| | - Hediye P Gunbey
- Radiology, Kartal Dr. Lutfi Kirdar City Hospital, University of Health Sciences, Istanbul, Turkey
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Chudobiński C, Świderski B, Antoniuk I, Kurek J. Enhancements in Radiological Detection of Metastatic Lymph Nodes Utilizing AI-Assisted Ultrasound Imaging Data and the Lymph Node Reporting and Data System Scale. Cancers (Basel) 2024; 16:1564. [PMID: 38672646 PMCID: PMC11048706 DOI: 10.3390/cancers16081564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Revised: 04/11/2024] [Accepted: 04/17/2024] [Indexed: 04/28/2024] Open
Abstract
The paper presents a novel approach for the automatic detection of neoplastic lesions in lymph nodes (LNs). It leverages the latest advances in machine learning (ML) with the LN Reporting and Data System (LN-RADS) scale. By integrating diverse datasets and network structures, the research investigates the effectiveness of ML algorithms in improving diagnostic accuracy and automation potential. Both Multinominal Logistic Regression (MLR)-integrated and fully connected neuron layers are included in the analysis. The methods were trained using three variants of combinations of histopathological data and LN-RADS scale labels to assess their utility. The findings demonstrate that the LN-RADS scale improves prediction accuracy. MLR integration is shown to achieve higher accuracy, while the fully connected neuron approach excels in AUC performance. All of the above suggests a possibility for significant improvement in the early detection and prognosis of cancer using AI techniques. The study underlines the importance of further exploration into combined datasets and network architectures, which could potentially lead to even greater improvements in the diagnostic process.
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Affiliation(s)
- Cezary Chudobiński
- Copernicus Regional Multi-Specialty Oncology and Trauma Centre, 93-513 Lódź, Poland;
| | - Bartosz Świderski
- Department of Artificial Intelligence, Institute of Information Technology, Warsaw University of Life Sciences, 02-776 Warsaw, Poland; (B.Ś.); (I.A.)
| | - Izabella Antoniuk
- Department of Artificial Intelligence, Institute of Information Technology, Warsaw University of Life Sciences, 02-776 Warsaw, Poland; (B.Ś.); (I.A.)
| | - Jarosław Kurek
- Department of Artificial Intelligence, Institute of Information Technology, Warsaw University of Life Sciences, 02-776 Warsaw, Poland; (B.Ś.); (I.A.)
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Morisada MV, Bewley AF, Broadhead K, Assadsangabi R, Paydar A, Birkeland AC, Abouyared M, Qi L, Ivanovic V. CT predictors of sub-centimeter occult lymph node metastases in oral cavity squamous cell carcinoma: A case-control study. Neuroradiol J 2024; 37:214-220. [PMID: 38148295 PMCID: PMC10973826 DOI: 10.1177/19714009231224447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2023] Open
Abstract
BACKGROUND For patients with oral cavity squamous cell carcinoma (OCSCC) without evidence of nodal metastasis (cN0) on pre-operative evaluation, there are no clear guidelines who should undergo elective neck dissection (END) versus clinical surveillance. OBJECTIVE To identify CT imaging characteristics of sub-centimeter lymph nodes that would help predict the likelihood of nodal metastases on pathology. METHODS Retrospective review of cN0 OCSCC patients at a tertiary academic medical center was performed. Inclusion criteria included elective neck dissection, pre-operative CT imaging and presence of metastatic disease within lymph nodes. Control group consisted of patients without nodal metastases on pathology. CT features that were evaluated included asymmetric size, disrupted fatty hilum, asymmetric number, presence of cortical nodule, cortical nodule size, and round/oval shape. We evaluated the associations between CT LN features and the presence of metastases using multi-level mixed-effects logistic regression models. Model evaluation was performed using 5-fold cross-validation. The positive predictive value (PPV) and negative predictive value (NPV) were calculated. RESULTS 26 patients in each study and control groups were included. Three-level mixed-effects logistic regression models indicated round/oval shape (OR = 1.39, p = .01), asymmetric number (OR = 7.20, p = .005), and disrupted fatty hilum (OR = 3.31, p = .04) to be independently predictive in a 3-variable model with sensitivity = 38.0%, specificity = 92.0%, and PPV = 93.8%. CONCLUSIONS In cN0 OCSCC patients undergoing END, round/oval shape, asymmetric number, and disrupted fatty hilum of lymph nodes on pre-operative CT imaging are novel and highly predictive of occult nodal disease.
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Affiliation(s)
- Megan V Morisada
- Department of Otolaryngology, University of California Davis, USA
| | - Arnaud F Bewley
- Department of Otolaryngology, University of California Davis, USA
| | | | - Reza Assadsangabi
- Department of Radiology, Keck School of Medicine, University of Southern California, USA
| | - Alireza Paydar
- Department of Radiology, Cleveland Clinic Foundation, USA
| | | | | | - Lihong Qi
- Department of Public Health Sciences, School of Medicine, University of California Davis, USA
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Zhang X, Wei B, Nong L, Zhang H, Zhang J, Ye J. To diagnose primary and secondary squamous cell carcinoma of the thyroid with ultrasound malignancy risk stratification. Front Endocrinol (Lausanne) 2024; 14:1238775. [PMID: 38495474 PMCID: PMC10940438 DOI: 10.3389/fendo.2023.1238775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 10/17/2023] [Indexed: 03/19/2024] Open
Abstract
Objectives This study aimed to investigate the clinico-ultrasound features of primary squamous cell carcinoma of the thyroid (PSCCT) and secondary SCCT (SSCCT) and evaluate the accuracy of fine needle aspiration (FNA) recommendation for SCCT with American College of Radiology-Thyroid Imaging and Reporting Data System (ACR-TIRADS) and Chinese-TIRADS (C-TIRADS). Materials and methods We retrieved 26 SCCT patients (11 PSCCT, 15 SSCCT) from our hospital's pathology database (5,718 patients with thyroid malignancy) over 23 years. Medical records and ultrasound data of the 26 patients with 27 SCCTs were analyzed retrospectively, and each SCCT focus was categorized based on the two TIRADSs. Results For 26 patients (21 males, 5 females) with an age range of 42-81 years, rapidly enlarging thyroid/neck nodules (18/26, 69.2%), dysphagia (7/26, 26.9%), hoarseness (6/26, 23.1%), dyspnea (5/26, 19.6%), cough (4/26, 15.4%), neck pain (2/26, 7.7%), B symptoms (2/26, 7.7%), and blood in sputum (1/26, 3.8%) were presented at diagnosis. Five asymptomatic patients (5/26, 19.2%) were detected by ultrasound. Hoarseness was more common in PSCCT (5/11, 45.5%) than in SSCCT (1/15, 6.7%) (P=0.032). For 27 SCCTs with a mean size of 3.7 ± 1.3 cm, the ultrasound features consisted of solid (25/27, 92.6%) or almost completely solid composition (2/27, 7.4%), hypoechoic (17/27, 63%) and very hypoechoic echogenicity (10/27, 37%), irregular/lobulated margin with extra-thyroidal extension (27/27, 100%), taller-than-wide shape (13/27, 48.1%), punctate echogenic foci (6/27, 22.2%), hypervascularity (23/27, 85.2%) and involved neck lymph (13/26, 50.0%). A total of 27 SCCTs were evaluated as high malignancy risk stratification (≥TR4 and 4B) by the two TIRADSs and recommended FNA in 96.3-100% (26/27, 27/27). Pathologically, more than half of PSCCTs (7/12, 58.3%) and a quarter of SSCCTs (4/15, 26.7%) were poorly differentiated, while moderately and well-differentiated grades were observed in 5 PSCCTs and 11 SSCCTs (P=0.007). Thirteen patients (50.0%) underwent surgery with radical operation in 5 cases (5/13, 38.5%). Conclusion SCCT is an extremely rare and aggressive malignancy with a male predominance. PSCCT and SSCCT had similar clinical and ultrasound features except for tumor differentiation and the symptom of hoarseness. SCCT showed a high malignancy risk stratification in ACR-TIRADS and C-TIRADS, with a high rate of FNA recommendation.
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Affiliation(s)
- Xiumei Zhang
- Department of Ultrasound, Peking University First Hospital, Beijing, China
| | - Boxiong Wei
- Department of Ultrasound, Peking University First Hospital, Beijing, China
| | - Lin Nong
- Department of Pathology, Peking University First Hospital, Beijing, China
| | - Hong Zhang
- Department of Pathology, Peking University First Hospital, Beijing, China
| | - Jixin Zhang
- Department of Pathology, Peking University First Hospital, Beijing, China
| | - Jingming Ye
- Department of General Surgery, Peking University First Hospital, Beijing, China
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11
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Bagci N, Peker I, Gündüz T. Evaluation of lymph node findings in patients with and without odontogenic infection: A clinical and ultrasonographic study. Med Oral Patol Oral Cir Bucal 2024; 29:e195-e202. [PMID: 37823301 PMCID: PMC10945872 DOI: 10.4317/medoral.26170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 07/10/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND The present study aimed to evaluate the ultrasonographic findings of submandibular and submental lymph nodes in patients with and without odontogenic infection. MATERIAL AND METHODS Systemically healthy patients aged 18-30 years old with or without odontogenic infections were included in this study. Clinical examinations were performed on all patients; those with any odontogenic infection were placed in the study group, and those without were placed in the control group. Ultrasonographic examinations of bilateral submental and submandibular lymph nodes were performed for both groups. The data were statistically analyzed using Pearson's Chi-square test and Student's t-test. RESULTS A total of 150 patients voluntarily participated (female: n=86 (57%), male: n=64 (43%)), 75 in the study group and 75 in the control group. During the ultrasonographic examination, patients in the study group had more than one lymph node the same patient was mostly detected, in the study group (right submandibular: n=42, 56%, and left submandibular: n=43, 57.3%). The long-axis diameter of the submandibular lymph nodes was 9.305.30 mm and 5.505.20 mm in the study and control groups, respectively. CONCLUSIONS Ultrasonography revealed that the presence, number, and long-axis diameter of the submandibular lymph nodes in the patients with and without odontogenic infection were statistically different.
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Affiliation(s)
- N Bagci
- Department of Dentomaxillofacial Radiology Faculty of Dentistry, Gazi University Ankara, Turkey
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12
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Ling B, Xie W, Zhong Y, Feng T, Huang Y, Ge L, Liu A. A Nomogram to Predict Benign/Malignant Mediastinal Lymph Nodes Based on EBUS Sonographic Features. Int J Clin Pract 2024; 2024:3711123. [PMID: 38454935 PMCID: PMC10919979 DOI: 10.1155/2024/3711123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 12/21/2023] [Accepted: 02/12/2024] [Indexed: 03/09/2024] Open
Abstract
Background Endobronchial ultrasound (EBUS) sonographic features help identify benign/malignant lymph nodes while conducting transbronchial needle aspiration (TBNA). This study aims to identify risk factors for malignancy based on EBUS sonographic features and to estimate the risk of malignancy in lymph nodes by constructing a nomogram. Methods 1082 lymph nodes from 625 patients were randomly enrolled in training (n = 760) and validation (n = 322) sets. The subgroup of EBUS-TBNA postoperative negative lymph nodes (n = 317) was randomly enrolled in a training (n = 224) set and a validation (n = 93) set. Logistic regression analysis was used to identify the EBUS features of malignant lymph nodes. A nomogram was formulated using the EBUS features in the training set and later validated in the validation set. Results Multivariate analysis revealed that long-axis, short-axis, echogenicity, fusion, and central hilar structure (CHS) were the independent predictors of malignant lymph nodes. Based on these risk factors, a nomogram was constructed. Both the training and validation sets of 5 EBUS features nomogram showed good discrimination, with area under the curve values of 0.880 (sensitivity = 0.829 and specificity = 0.807) and 0.905 (sensitivity = 0.819 and specificity = 0.857). Subgroup multivariate analysis revealed that long-axis, echogenicity, and CHS were the independent predictors of malignancy outcomes of EBUS-TBNA postoperative negative lymph nodes. Based on these risk factors, a nomogram was constructed. Both the training and validation sets of 3 EBUS features nomogram showed good discrimination, with the area under the curve values of 0.890 (sensitivity = 0.882 and specificity = 0.786) and 0.834 (sensitivity = 0.930 and specificity = 0.636). Conclusions Our novel scoring system based on two nomograms can be utilized to predict malignant lymph nodes.
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Affiliation(s)
- Bingchao Ling
- Department of Endoscopy, Guangxi Medical University Cancer Hospital, Nanning 530021, China
| | - Weishun Xie
- Department of Endoscopy, Guangxi Medical University Cancer Hospital, Nanning 530021, China
| | - Yi Zhong
- Department of Endoscopy, Guangxi Medical University Cancer Hospital, Nanning 530021, China
| | - Taowen Feng
- Department of Endoscopy, Guangxi Medical University Cancer Hospital, Nanning 530021, China
| | - Yueli Huang
- Department of Endoscopy, Guangxi Medical University Cancer Hospital, Nanning 530021, China
| | - Lianying Ge
- Department of Endoscopy, Guangxi Medical University Cancer Hospital, Nanning 530021, China
| | - Aiqun Liu
- Department of Endoscopy, Guangxi Medical University Cancer Hospital, Nanning 530021, China
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Srivastava S, Kak I, Major P, Bonert M. What is your count? An observational study of lymph node counting in 2,028 colorectal cancer resections. PLoS One 2024; 19:e0295209. [PMID: 38329946 PMCID: PMC10852306 DOI: 10.1371/journal.pone.0295209] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 11/15/2023] [Indexed: 02/10/2024] Open
Abstract
BACKGROUND Lymph node status and lymph node count (LNC) are predictors of colorectal cancer outcome. Under-sampling of lymph nodes may lead to clinically relevant stage migration. METHODS Colorectal cancer (CRC) cases with a synoptic report, accessioned 2012-2020 at a regional laboratory, were extracted and retrospectively studied. LNC, positive lymph node count (PLNC), tumour deposits present (TDpos), and 'y' (staging) prefix (YS) were retrieved and tabulated by pathologist using custom software. Statistical analyses were done with R. DATA AND RESULTS The cohort had 2,543 CRC resections. Seventeen pathologists interpreted >50 cases (range: 56-356) each and collectively saw 2,074. After cases with unavailable data were purged, 2,028 cases remained with 43,996 lymph nodes, of which 2,637/43,996 were positive. 368 cases had a 'y' prefix, and 379 had TDpos. The 17 pathologists' median LNC/case was 19.0 (range: 14.0-24.0), and the mean PLNC per case was 1.4 (range: 1.0-2.0). Kruskal-Wallis rank sum tests showed there were differences in LNC (p<0.001) among pathologists; however, PLNC did not show this association (p = 0.2917). T-tests showed that mean LNC (p<0.001) and PLNC (p<0.035) differed between YS. 138 of 2,028 cases had less than the 12 LNC target. Logistic regression revealed a strong association between meeting the LNC target and pathologist (p<0.001) but TDpos was non-predictive (p = 0.4736). CONCLUSIONS Positive lymph node call rate has a good consistency in the laboratory; however, lymph node count varies significantly between pathologists. Standardized counting criteria are needed to improve uniformity and could be aided by synoptic reporting data.
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Affiliation(s)
- Shivali Srivastava
- Pathology and Molecular Medicine, McMaster University, Hamilton, ON, Canada
| | - Ipshita Kak
- Pathology and Molecular Medicine, McMaster University, Hamilton, ON, Canada
| | - Pierre Major
- Medical Oncology, McMaster University, Hamilton, ON, Canada
| | - Michael Bonert
- Pathology and Molecular Medicine, McMaster University, Hamilton, ON, Canada
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Jung HN, Ryoo I, Suh S, Lee YH, Kim E. Evaluating the Elasticity of Metastatic Cervical Lymph Nodes in Head and Neck Squamous Cell Carcinoma Patients Using DWI-based Virtual MR Elastography. Magn Reson Med Sci 2024; 23:49-55. [PMID: 36529497 PMCID: PMC10838712 DOI: 10.2463/mrms.mp.2022-0082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 10/10/2022] [Indexed: 01/05/2024] Open
Abstract
PURPOSE The assessment of metastatic cervical lymph nodes in head and neck squamous cell carcinoma patients is crucial; as such, many studies focusing on non-invasive imaging techniques to evaluate metastatic cervical lymph nodes have been performed. The aim of our study was to assess the usefulness of elasticity values on diffusion weighted imaging (DWI)-based virtual MR elastography in the evaluation of metastatic cervical lymph nodes from head and neck squamous cell carcinoma. METHODS Two head and neck radiologists measured the elasticity values of 16 metastatic cervical lymph nodes from head and neck squamous cell carcinoma and 13 benign cervical lymph nodes on DWI-based virtual MR elastography maps. Mean, minimum, maximum, and median elasticity values were evaluated for lymph nodes between the two groups and interobserver agreement in measuring the elasticity was also evaluated. RESULTS The mean, maximum, and median elasticity values of metastatic cervical lymph nodes were significantly higher than those of benign cervical lymph nodes (P = 0.001, 0.01, and 0.002, respectively). Diagnostic accuracy, sensitivity, and specificity of the mean elasticity were 82.8%, 93.8%, and 69.2%, respectively. Interobserver agreement was excellent for the mean and median elasticity (intraclass correlation coefficients were 0.98 for both). CONCLUSION Estimated elasticity values based on DWI-based virtual MR elastography show significant difference between benign and metastatic cervical lymph nodes from head and neck squamous cell carcinoma. While precise modulation of MR sequences and calibration parameters still needs to be established, elasticity values can be useful in differentiating between these lymph nodes.
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Affiliation(s)
- Hye Na Jung
- Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Inseon Ryoo
- Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Sangil Suh
- Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Young Hen Lee
- Department of Radiology, Korea University Ansan Hospital, Korea University College of Medicine, Seoul, Korea
| | - Eunju Kim
- Philips Healthcare Korea, Seoul, Korea
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Sugai K, Sekine Y, Kawamura T, Yanagihara T, Saeki Y, Kitazawa S, Kobayashi N, Kikuchi S, Goto Y, Ichimura H, Sato Y. Sphericity of lymph nodes using 3D-CT predicts metastasis in lung cancer patients. Cancer Imaging 2023; 23:124. [PMID: 38105231 PMCID: PMC10726577 DOI: 10.1186/s40644-023-00635-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 11/03/2023] [Indexed: 12/19/2023] Open
Abstract
BACKGROUND The presence of mediastinal lymph node metastasis is important because it is related to the treatment and prognosis of lung cancer. Although prevalently used, evaluation of lymph nodes is not always reliable. We introduced sphericity as a criterion for evaluating morphologic differences between metastatic and nonmetastatic nodes. METHODS We reviewed the cases of 66 patients with N2 disease and of 68 patients with N0-1 disease who underwent lobectomy with mediastinal dissection between January 2012 and December 2021. The sphericity of the dissected station lymph nodes, which represents how close the node is to being a true sphere, was evaluated along with the diameter and volume. Each parameter was obtained and evaluated for ability to predict metastasis. RESULTS Metastatic lymph nodes had a larger short-axis diameter (average: 8.2 mm vs. 5.4 mm, p < 0.001) and sphericity (average: 0.72 vs. 0.60, p < 0.001) than those of nonmetastatic lymph nodes. Short-axis diameter ≥ 6 mm and sphericity ≥ 0.60 identified metastasis with 76.2% sensitivity and 70.2% specificity (AUC = 0.78, p < 0.001) and 92.1% sensitivity and 53.9% specificity (AUC = 0.78, p < 0.001), respectively. For lymph nodes with a short-axis diameter ≥ 5 mm, sphericity ≥ 0.60 identified metastasis with 84.1% sensitivity and 89.3% specificity. CONCLUSION By using 3D-CT analysis to examine sphericity, we showed that metastatic lymph nodes became spherical. Our method for predicting lymph node metastasis based on sphericity of lymph nodes with a short-axis diameter ≥ 5 mm could do so with higher sensitivity than the conventional method, and with acceptable specificity.
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Affiliation(s)
- Kazuto Sugai
- Department of Thoracic Surgery, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, 305-8575, Ibaraki, Japan
| | - Yasuharu Sekine
- Department of Thoracic Surgery, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, 305-8575, Ibaraki, Japan
| | - Tomoyuki Kawamura
- Department of Thoracic Surgery, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, 305-8575, Ibaraki, Japan
| | - Takahiro Yanagihara
- Department of Thoracic Surgery, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, 305-8575, Ibaraki, Japan
| | - Yusuke Saeki
- Department of Thoracic Surgery, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, 305-8575, Ibaraki, Japan
| | - Shinsuke Kitazawa
- Department of Thoracic Surgery, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, 305-8575, Ibaraki, Japan
| | - Naohiro Kobayashi
- Department of Thoracic Surgery, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, 305-8575, Ibaraki, Japan
| | - Shinji Kikuchi
- Department of Thoracic Surgery, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, 305-8575, Ibaraki, Japan
- Ibaraki Prefectural Hospital, 6528, Koibuchi, Kasama, 309-1793, Ibaraki, Japan
| | - Yukinobu Goto
- Department of Thoracic Surgery, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, 305-8575, Ibaraki, Japan
| | - Hideo Ichimura
- Department of Thoracic Surgery, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, 305-8575, Ibaraki, Japan
| | - Yukio Sato
- Department of Thoracic Surgery, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, 305-8575, Ibaraki, Japan.
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Zhang R, Xu Y, Gao S, Jing Y, Li W. Observer- and radiomics model-based computed tomography classification of suppurative versus tuberculous lymphadenitis complicated with nodal necrosis of the neck in children. Pediatr Radiol 2023; 53:2586-2596. [PMID: 37806973 DOI: 10.1007/s00247-023-05761-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 08/30/2023] [Accepted: 08/31/2023] [Indexed: 10/10/2023]
Abstract
BACKGROUND Computed tomography (CT) can be used for the early detection of lymphadenitis. Radiomics is able to identify a large amount of hidden information from images. However, few CT-based radiomics studies on cervical lymphadenitis in children have been published. OBJECTIVE This study aimed to investigate the role of visual CT analysis and CT radiomics in differentiating cervical suppurative node necrosis from tuberculous node necrosis in pediatric patients. MATERIALS AND METHODS A total of 101 patients with cervical suppurative lymphadenitis (n=52) or cervical tuberculous lymphadenitis (n=49) were included. Clinical data and CT images were retrieved for analysis. For visual observation, 11 major CT features were identified for univariate and multivariate analyses. For radiomics analysis, image segmentation, feature value extraction, and dimension reduction, feature selection and the construction of radiomics-based models were performed through the RadCloud platform. RESULTS For the visual observation, significant differences were found between the two groups, including the short diameter of the largest necrotic lymph node (P=0.03), sharp border of the node (P=0.02), fusion of nodes (P=0.02), regular silhouette of the necrotic area (P=0.001), multilocular necrotic area (P=0.02), node calcification (P=0.004), and enhancement degree of the nodal nonnecrotic area (P=0.01). No feature was found to be an independent predictor for suppurative or tuberculous lymphadenitis (P>0.05 for all features). Concerning the radiomics analysis, after feature value extraction and dimension reduction, nine related features were selected. The support vector machine classifier achieved high diagnostic performance in distinguishing suppurative from tuberculous lymphadenitis. The area under the curve, accuracy, sensitivity, and specificity of the support vector machine model test set were 0.89 (95% confidence interval: 0.72-1.00), 0.88, 0.78, and 0.90, respectively. CONCLUSION Compared to observer-based CT image analyses, radiomics model-based CT image analyses exhibit better performance in the differential diagnosis of cervical suppurative and tuberculous lymphadenitis complicated with nodal necrosis in children.
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Affiliation(s)
- Rui Zhang
- Department of Radiology, Children's Hospital of Chongqing Medical University, The Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, 136 Zhongshan Er Lu, Yuzhong District, Chongqing, 400000, China
| | - Ye Xu
- Department of Radiology, Children's Hospital of Chongqing Medical University, The Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, 136 Zhongshan Er Lu, Yuzhong District, Chongqing, 400000, China
| | - Sijie Gao
- Department of Radiology, Children's Hospital of Chongqing Medical University, The Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, 136 Zhongshan Er Lu, Yuzhong District, Chongqing, 400000, China
| | - Yang Jing
- Huiying Medical Technology Co., Ltd., Haidian District, Beijing, 100192, China
| | - Wei Li
- Department of Radiology, Children's Hospital of Chongqing Medical University, The Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, 136 Zhongshan Er Lu, Yuzhong District, Chongqing, 400000, China.
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Pérez-Marrero L, Norambuena MF, Whittle C, Fuentealba IM, Spralja B. "Truffle sign". A suspicious malignant pattern of lymphadenopathies in children observed on ultrasound. Preliminary study. J Ultrasound 2023; 26:823-827. [PMID: 37432555 PMCID: PMC10632340 DOI: 10.1007/s40477-023-00798-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 05/06/2023] [Indexed: 07/12/2023] Open
Abstract
BACKGROUND The differential diagnosis of lymphadenopathies in children including benign and malignant conditions is often difficult to identify by ultrasound (US). The lymphadenopathies in children are frequent and mostly benign, therefore it is essential to decide what patients should undergo further studies. OBJECTIVE To describe the potential usefulness of a new suspicious ultrasound sign on pediatric lymphadenopathies that can orient the diagnosis of malignancy. MATERIALS AND METHODS We retrospectively reviewed all pediatric cases with lymphadenopathy suspicious of lymphoma or lymphoproliferative syndrome on soft tissue ultrasound from 2014 to 2021. Two expert ultrasound radiologists reviewed ultrasound images of these patients, associating the internal structure of infiltrated adenopathy with the internal structure of the truffles. RESULTS On ultrasound, twelve cases presented enlarged lymphadenopathy with loss of internal structure, without hilum; mostly hypoechoic parenchyma, with some fine echogenic serpiginous linear surrounding hypoechoic pseudo nodular images, resembling the inner structure of black truffles. This US pattern looked suspicious and histological study was recommended. In 9 cases a lymphomatous infiltrated adenopathy was confirmed on biopsy. CONCLUSION The truffle sign is a new potential suspicious ultrasound sign, that can suggest malignant lymphadenopathy in children. This ultrasound pattern can have some probable usefulness to the radiologist in order to recommend further studies, including histological study, that need to be validated by a larger sample. It is important to recognize easily and early the lymphomatous compromise in a lymph node.
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Affiliation(s)
- L Pérez-Marrero
- Department of Radiology, Facultad de Medicina. Clínica Alemana - Universidad del Desarrollo, Avenida Vitacura 5951,2º Piso Imágenes, Vitacura, Región Metropolitana, 7650568, Santiago, Chile
- Department of Radiology, Hospital Pediátrico Luis Calvo Mackenna, Santiago, Chile
| | - M F Norambuena
- Department of Radiology, Facultad de Medicina. Clínica Alemana - Universidad del Desarrollo, Avenida Vitacura 5951,2º Piso Imágenes, Vitacura, Región Metropolitana, 7650568, Santiago, Chile
| | - C Whittle
- Department of Radiology, Facultad de Medicina. Clínica Alemana - Universidad del Desarrollo, Avenida Vitacura 5951,2º Piso Imágenes, Vitacura, Región Metropolitana, 7650568, Santiago, Chile.
| | - I M Fuentealba
- Department of Radiology, Facultad de Medicina. Clínica Alemana - Universidad del Desarrollo, Avenida Vitacura 5951,2º Piso Imágenes, Vitacura, Región Metropolitana, 7650568, Santiago, Chile
- Department of Radiology, Hospital Pediátrico Luis Calvo Mackenna, Santiago, Chile
| | - B Spralja
- Servicio Anatomía Patológica, Clínica Alemana de Santiago, Santiago, Chile
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Sievert M, Koch M, Iro H, Thimsen V. [Sonography of the neck-aspects of differential diagnosis]. HNO 2023; 71:750-762. [PMID: 37801101 DOI: 10.1007/s00106-023-01375-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/19/2023] [Indexed: 10/07/2023]
Abstract
Sonography is the preferred method for primary diagnosis and acute treatment of pathologies involving the neck's soft tissues. Technological advances, particularly high image resolution and multiparametric ultrasound, have improved diagnostic performance. Clinical interest focuses on examining the cervical lymph nodes, salivary glands, and the thyroid gland, as well as space-occupying and inflammatory processes of the neck. In addition, sonography enables targeted minimally invasive histology acquisition using ultrasound-guided biopsies. In this context, the examiner's comprehensive anatomical knowledge and clinical experience are of utmost importance for the quality of findings. This article provides an overview of the most important findings related to sonography of the neck and highlights the relevance of this imaging modality in the hands of the otorhinolaryngologist.
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Affiliation(s)
- Matti Sievert
- Hals-Nasen-Ohren-Klinik, Kopf- und Halschirurgie, Universität Erlangen, Waldstraße 1, 91054, Erlangen, Deutschland.
| | - Michael Koch
- Hals-Nasen-Ohren-Klinik, Kopf- und Halschirurgie, Universität Erlangen, Waldstraße 1, 91054, Erlangen, Deutschland
| | - Heinrich Iro
- Hals-Nasen-Ohren-Klinik, Kopf- und Halschirurgie, Universität Erlangen, Waldstraße 1, 91054, Erlangen, Deutschland
| | - Vivian Thimsen
- Hals-Nasen-Ohren-Klinik, Kopf- und Halschirurgie, Universität Erlangen, Waldstraße 1, 91054, Erlangen, Deutschland
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Sugawara C, Takahashi A. Orofacial symptoms suggestive of malignant lesions and the role of imaging: literature review and case presentation. Oral Radiol 2023; 39:599-613. [PMID: 37490186 DOI: 10.1007/s11282-023-00701-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 06/09/2023] [Indexed: 07/26/2023]
Abstract
Among the patients seeking dental treatment, some may present with symptoms that cannot be resolved by dental treatment alone. Patients with orofacial symptoms associated with malignant diseases, which require medical treatment, often visit dental clinics for their initial consultation. Delays in making a definitive diagnosis worsen the patient's prognosis. Therefore, dental clinicians should also be aware of the signs and symptoms associated with malignant diseases. The chief complaints of these patients include numb chin syndrome (NCS), painless swelling of the palate and neck, trismus and temporomandibular disorders, and an enlarged tongue. This article aimed to review these orofacial symptoms and related diseases and describe representative cases of these diseases to obtain a definitive diagnosis via imaging. Panoramic radiograph is widely used in general dentistry, and this article reaffirmed the importance of panoramic radiograph anatomical landmarks in diagnosing the cases presented in this paper.
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Affiliation(s)
- Chieko Sugawara
- Department of Dentistry, Oral and Maxillofacial Surgery, Tokushima Prefectural Hospital, 1-10-3, Kuramoto-cho, Tokusihma-shi, Tokushima, 770-8539, Japan.
| | - Akira Takahashi
- Department of Oral and Maxillofacial Surgery, Tokushima University, Tokushima, Japan
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Park H, Ryu HJ, Heo J, Chung MK, Son YI, Kim JH, Hahn SY, Shin JH, Oh YL, Kim SW, Chung JH, Kim JS, Kim TH. Preoperative identification of low-risk medullary thyroid carcinoma: potential application to reduce total thyroidectomy. Sci Rep 2023; 13:15663. [PMID: 37730953 PMCID: PMC10511442 DOI: 10.1038/s41598-023-42907-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 09/15/2023] [Indexed: 09/22/2023] Open
Abstract
Current guidelines recommend total thyroidectomy with central lymph node dissection (CND) for patients with medullary thyroid carcinoma (MTC). This study aimed to identify low-risk MTC patients who may be candidates for lobectomy. We retrospectively reviewed MTC patients who underwent primary surgery at a tertiary referral center from 1998 to 2019. Eighty-five MTC patients were enrolled, excluding patients with primary tumor size > 2.0 cm. Among them, one (1.2%) patient had bilateral tumors. During a median follow-up of 84 months, 12 of the 85 patients experienced structural recurrence. 13 patients had occult lymph node metastasis, and structural recurrence occurred in 2 patients. Factors that significantly affected disease-free survival were clinical N stage (cN0 vs. cN1, log-rank P < 0.001), pathological N stage (pN0 vs. pN1, P < 0.001), and preoperative calcitonin levels (≤ 250 vs. > 250 pg/mL, P = 0.017). After categorizing patients into four groups, patients with preoperative calcitonin levels > 250 pg/mL and cN1 or pN1 had a significantly worse prognosis. Patients with a primary tumor size of 2 cm or less, cN0, and preoperative calcitonin of 250 pg/mL or less can be classified as low-risk MTC patients. We used preoperative clinical information to identify low-risk MTC patients. Lobectomy with prophylactic CND may be a potential therapeutic approach.
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Affiliation(s)
- Hyunju Park
- Department of Internal Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Hyun Jin Ryu
- Division of Endocrinology and Metabolism, Department of Medicine, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, 115 Irwon-Ro, Gangnam-Gu, Seoul, 06355, Korea
| | - Jung Heo
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju-si, Gangwon-do, Korea
| | - Man Ki Chung
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young Ik Son
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jung-Han Kim
- Division of Breast and Endocrine Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-Gu, Seoul, 06351, Korea
| | - Soo Yeon Hahn
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jung Hee Shin
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young Lyun Oh
- Department of Pathology and Translational Genomics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sun Wook Kim
- Division of Endocrinology and Metabolism, Department of Medicine, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, 115 Irwon-Ro, Gangnam-Gu, Seoul, 06355, Korea
| | - Jae Hoon Chung
- Division of Endocrinology and Metabolism, Department of Medicine, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, 115 Irwon-Ro, Gangnam-Gu, Seoul, 06355, Korea
| | - Jee Soo Kim
- Division of Breast and Endocrine Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-Gu, Seoul, 06351, Korea.
| | - Tae Hyuk Kim
- Division of Endocrinology and Metabolism, Department of Medicine, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, 115 Irwon-Ro, Gangnam-Gu, Seoul, 06355, Korea.
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Rinneburger M, Carolus H, Iuga AI, Weisthoff M, Lennartz S, Hokamp NG, Caldeira L, Shahzad R, Maintz D, Laqua FC, Baeßler B, Klinder T, Persigehl T. Automated localization and segmentation of cervical lymph nodes on contrast-enhanced CT using a 3D foveal fully convolutional neural network. Eur Radiol Exp 2023; 7:45. [PMID: 37505296 PMCID: PMC10382409 DOI: 10.1186/s41747-023-00360-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 06/03/2023] [Indexed: 07/29/2023] Open
Abstract
BACKGROUND In the management of cancer patients, determination of TNM status is essential for treatment decision-making and therefore closely linked to clinical outcome and survival. Here, we developed a tool for automatic three-dimensional (3D) localization and segmentation of cervical lymph nodes (LNs) on contrast-enhanced computed tomography (CECT) examinations. METHODS In this IRB-approved retrospective single-center study, 187 CECT examinations of the head and neck region from patients with various primary diseases were collected from our local database, and 3656 LNs (19.5 ± 14.9 LNs/CECT, mean ± standard deviation) with a short-axis diameter (SAD) ≥ 5 mm were segmented manually by expert physicians. With these data, we trained an independent fully convolutional neural network based on 3D foveal patches. Testing was performed on 30 independent CECTs with 925 segmented LNs with an SAD ≥ 5 mm. RESULTS In total, 4,581 LNs were segmented in 217 CECTs. The model achieved an average localization rate (LR), i.e., percentage of localized LNs/CECT, of 78.0% in the validation dataset. In the test dataset, average LR was 81.1% with a mean Dice coefficient of 0.71. For enlarged LNs with a SAD ≥ 10 mm, LR was 96.2%. In the test dataset, the false-positive rate was 2.4 LNs/CECT. CONCLUSIONS Our trained AI model demonstrated a good overall performance in the consistent automatic localization and 3D segmentation of physiological and metastatic cervical LNs with a SAD ≥ 5 mm on CECTs. This could aid clinical localization and automatic 3D segmentation, which can benefit clinical care and radiomics research. RELEVANCE STATEMENT Our AI model is a time-saving tool for 3D segmentation of cervical lymph nodes on contrast-enhanced CT scans and serves as a solid base for N staging in clinical practice and further radiomics research. KEY POINTS • Determination of N status in TNM staging is essential for therapy planning in oncology. • Segmenting cervical lymph nodes manually is highly time-consuming in clinical practice. • Our model provides a robust, automated 3D segmentation of cervical lymph nodes. • It achieves a high accuracy for localization especially of enlarged lymph nodes. • These segmentations should assist clinical care and radiomics research.
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Affiliation(s)
- Miriam Rinneburger
- Institute of Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.
| | | | - Andra-Iza Iuga
- Institute of Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Mathilda Weisthoff
- Institute of Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Simon Lennartz
- Institute of Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Nils Große Hokamp
- Institute of Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Liliana Caldeira
- Institute of Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Rahil Shahzad
- Institute of Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
- Innovative Technologies, Philips Healthcare, Aachen, Germany
| | - David Maintz
- Institute of Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Fabian Christopher Laqua
- Institute of Diagnostic and Interventional Radiology, University Hospital Würzburg, Würzburg, Germany
| | - Bettina Baeßler
- Institute of Diagnostic and Interventional Radiology, University Hospital Würzburg, Würzburg, Germany
| | | | - Thorsten Persigehl
- Institute of Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
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Cheng PC, Chang CM, Liao LJ, Hsieh CH, Shueng PW, Cheng PW, Lo WC. Ultrasound Is Beneficial to Determine Lymphadenopathy in Oral Cancer Patients after Radiotherapy. Diagnostics (Basel) 2023; 13:2409. [PMID: 37510156 PMCID: PMC10378444 DOI: 10.3390/diagnostics13142409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 07/14/2023] [Accepted: 07/17/2023] [Indexed: 07/30/2023] Open
Abstract
The present study aimed to investigate whether the addition of ultrasound (US) +/- fine needle aspiration (FNA) to magnetic resonance imaging (MRI) or computed tomography (CT) improves the diagnostic accuracy in assessing neck lymphadenopathy in oral cancer patients after neck irradiation. We retrospectively reviewed oral cancer patients who had neck lymphadenopathy after radiotherapy (RT) or chemoradiation therapy (CRT) from February 2008 to November 2019. The following diagnostic modalities were assessed: (1) MRI/CT, (2) MRI/CT with a post-RT US predictive model, and (3) MRI/CT with US + FNA. The receiver operating characteristic (ROC) curves were used to assess the diagnostic performance. A total of 104 irradiation-treated oral cancer patients who subsequently had neck lymphadenopathy were recruited and analyzed. Finally, there were 68 (65%) malignant and 36 (35%) benign lymphadenopathies. In terms of the diagnostic performance, the area under the ROC curves (C-statistics) was 0.983, 0.920, and 0.828 for MRI/CT with US + FNA, MRI/CT with a post-RT US predictive model, and MRI/CT, respectively. The addition of US to MRI/CT to evaluate cervical lymphadenopathy could achieve a better diagnostic accuracy than MRI/CT alone in oral cancer patients after neck irradiation.
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Affiliation(s)
- Ping-Chia Cheng
- Department of Otolaryngology Head and Neck Surgery, Far Eastern Memorial Hospital, New Taipei City 22060, Taiwan
- Head and Neck Cancer Surveillance and Research Study Group, Far Eastern Memorial Hospital, New Taipei City 22060, Taiwan
- Department of Communication Engineering, Asia Eastern University of Science and Technology, New Taipei City 22061, Taiwan
- Department of Biomedical Engineering, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan
| | - Chih-Ming Chang
- Department of Otolaryngology Head and Neck Surgery, Far Eastern Memorial Hospital, New Taipei City 22060, Taiwan
- Department of Biomedical Engineering, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan
| | - Li-Jen Liao
- Department of Otolaryngology Head and Neck Surgery, Far Eastern Memorial Hospital, New Taipei City 22060, Taiwan
- Head and Neck Cancer Surveillance and Research Study Group, Far Eastern Memorial Hospital, New Taipei City 22060, Taiwan
- Department of Electrical Engineering, Yuan Ze University, Taoyuan 32003, Taiwan
- Medical Engineering Office, Far Eastern Memorial Hospital, New Taipei City 22060, Taiwan
| | - Chen-Hsi Hsieh
- Head and Neck Cancer Surveillance and Research Study Group, Far Eastern Memorial Hospital, New Taipei City 22060, Taiwan
- Division of Radiation Oncology, Department of Radiology, Far Eastern Memorial Hospital, New Taipei City 22060, Taiwan
- Department of Medicine, School of Medicine, National Yang-Ming University, Taipei 11221, Taiwan
| | - Pei-Wei Shueng
- Head and Neck Cancer Surveillance and Research Study Group, Far Eastern Memorial Hospital, New Taipei City 22060, Taiwan
- Division of Radiation Oncology, Department of Radiology, Far Eastern Memorial Hospital, New Taipei City 22060, Taiwan
- Department of Medicine, School of Medicine, National Yang-Ming University, Taipei 11221, Taiwan
| | - Po-Wen Cheng
- Department of Otolaryngology Head and Neck Surgery, Far Eastern Memorial Hospital, New Taipei City 22060, Taiwan
- Head and Neck Cancer Surveillance and Research Study Group, Far Eastern Memorial Hospital, New Taipei City 22060, Taiwan
| | - Wu-Chia Lo
- Department of Otolaryngology Head and Neck Surgery, Far Eastern Memorial Hospital, New Taipei City 22060, Taiwan
- Head and Neck Cancer Surveillance and Research Study Group, Far Eastern Memorial Hospital, New Taipei City 22060, Taiwan
- Graduate Institute of Medicine, Yuan Ze University, Taoyuan 32003, Taiwan
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23
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Meng S. [Ultrasound of the neck]. RADIOLOGIE (HEIDELBERG, GERMANY) 2023; 63:293-306. [PMID: 36881109 DOI: 10.1007/s00117-023-01131-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/16/2023] [Indexed: 03/08/2023]
Abstract
Ultrasound examination of the neck organs enables an assessment that in many cases is superior to that of magnetic resonance imaging and computed tomography. Ultrasound is therefore not only a first line or point of care imaging modality but can provide imaging for the concluding diagnosis in cases. Because of the good sonographic accessibility of the majority of the structures of the neck, many technical advances, in particular high-resolution ultrasound and signal post-processing have a major influence on the possibilities of ultrasound. Lymph nodes and salivary glands are the main focus in clinical applications, although other diseases and swellings of the neck can also be clarified with ultrasound. Special applications are ultrasound-guided interventions, e.g., biopsies or the sonographic assessment of peripheral nerves. As in any imaging modality, a comprehensive clinical knowledge is necessary for the diagnostic assessment. Because of constant assessment and thus continuous modification of the examination, ultrasound examinations may only be performed adequately with the appropriate clinical knowledge.
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Affiliation(s)
- Stefan Meng
- Radiologie, Hanusch-Krankenhaus, Heinrich-Collin-Straße 30, 1140, Wien, Österreich. .,Zentrum für Anatomie und Zellbiologie, Medizinische Universität Wien, Wien, Österreich.
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24
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Cheng PC, Chang CM, Liao LJ, Hsieh CH, Shueng PW, Cheng PW, Lo WC. Ultrasound examination supporting CT or MRI in the evaluation of cervical lymphadenopathy in patients with irradiation-treated head and neck cancer. Open Med (Wars) 2023; 18:20230682. [PMID: 37069937 PMCID: PMC10105548 DOI: 10.1515/med-2023-0682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 02/11/2023] [Accepted: 03/01/2023] [Indexed: 04/19/2023] Open
Abstract
In this study, we determined the diagnostic performance of adding ultrasound (US) with/without fine-needle aspiration cytology (FNAC) to computed tomography (CT)/magnetic resonance imaging (MRI) in evaluating neck lymphadenopathy (LAP) in patients with head and neck cancer treated with irradiation. We included 269 patients who had neck LAP after radiotherapy (RT) or concurrent chemoradiotherapy (CCRT) resulting from cancers of the head and neck region between October 2008 and September 2018. The diagnostic methods consisted of the following: 1) CT/MRI alone, 2) CT/MRI combined with a post-RT US predictive model, and 3) CT/MRI combined with US + FNAC. We compared their diagnostic performance using receiver operating characteristic (ROC) curves. In total, 141 (52%) malignant and 128 (48%) benign LAPs were observed. Regarding the diagnostic accuracy, the area under the ROC curves was highest for the combined CT/MRI and US + FNAC (0.965), followed by the combined CT/MRI and post-RT US predictive model (0.906) and CT/MRI alone (0.836). Our data suggest that the addition of a US examination to CT/MRI resulted in higher diagnostic performance than CT/MRI alone in terms of diagnosing recurrent or persistent nodal disease during the evaluation of LAP in patients with irradiation-treated head and neck cancer.
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Affiliation(s)
- Ping-Chia Cheng
- Department of Otolaryngology Head and Neck Surgery, Far Eastern Memorial Hospital, New Taipei City 220, Taiwan (R.O.C.)
- Head and Neck Cancer Surveillance and Research Study Group, Far Eastern Memorial Hospital, New Taipei City, Taiwan (R.O.C.)
- Department of Communication Engineering, Asia Eastern University of Science and Technology, New Taipei City, Taiwan (R.O.C.)
| | - Chih-Ming Chang
- Department of Otolaryngology Head and Neck Surgery, Far Eastern Memorial Hospital, New Taipei City 220, Taiwan (R.O.C.)
- Department of Biomedical Engineering, National Yang-Ming University, Taipei, Taiwan (R.O.C.)
| | - Li-Jen Liao
- Department of Otolaryngology Head and Neck Surgery, Far Eastern Memorial Hospital, New Taipei City 220, Taiwan (R.O.C.)
- Head and Neck Cancer Surveillance and Research Study Group, Far Eastern Memorial Hospital, New Taipei City, Taiwan (R.O.C.)
- Department of Electrical Engineering, Yuan Ze University, Taoyuan, Taiwan (R.O.C.)
- Medical Engineering Office, Far Eastern Memorial Hospital, New Taipei City, Taiwan (R.O.C.)
| | - Chen-Hsi Hsieh
- Division of Radiation Oncology, Department of Radiology, Far Eastern Memorial Hospital, Taipei, Taiwan
- Department of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan (R.O.C.)
| | - Pei-Wei Shueng
- Division of Radiation Oncology, Department of Radiology, Far Eastern Memorial Hospital, Taipei, Taiwan
- Department of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan (R.O.C.)
| | - Po-Wen Cheng
- Head and Neck Cancer Surveillance and Research Study Group, Far Eastern Memorial Hospital, New Taipei City, Taiwan (R.O.C.)
| | - Wu-Chia Lo
- Head and Neck Cancer Surveillance and Research Study Group, Far Eastern Memorial Hospital, New Taipei City, Taiwan (R.O.C.)
- Graduate Institute of Medicine, Yuan Ze University, Taoyuan, Taiwan (R.O.C.)
- Department of Otolaryngology Head and Neck Surgery, Far Eastern Memorial Hospital, No. 21, Sec. 2, Nanya S. Rd., Banqiao Dist., New Taipei City 220, Taiwan (R.O.C.)
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25
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Alamdaran SA, Randian A, Rasoulian B, Jafarian AH, Aminzadeh B, Niroumand S. Correlation of Sonographic Classification of Neck Adenopathy (A-RADS) and Malignancy. IRANIAN JOURNAL OF OTORHINOLARYNGOLOGY 2023; 35:39-47. [PMID: 36721411 PMCID: PMC9872261 DOI: 10.22038/ijorl.2022.67255.3299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 12/25/2022] [Indexed: 02/02/2023]
Abstract
Introduction Cervical adenopathy can be involved in various pathological processes. This study aimed to evaluate the ultrasound classification of cervical adenopathy (A-RADS) to choose the appropriate approach. Materials and Methods This cross-sectional study was conducted among 294 patients with cervical adenopathy at Mashhad University of Medical Sciences during 2020-2021. The data of the long axis diameter, short axis diameter, shape, border, vascular pattern, presence of calcification and changes in cyst/necrosis, cortical echogenicity, hilum visibility, and location of involved lymph nodes were extracted. Lymph nodes was classified into four normal, reactive, suspicious & lymphoid disorders, and metastatic groups, based on ultrasound appearance (Adenopathy-reporting and data system). Diagnostic methods included follow-up, core needle biopsy (CNB), and fine needle aspiration (FNA), and surgical results. After determining the final diagnosis, demographic, sonographic, and pathological data were analyzed at a significance level of p<0.05. Results Of 294 patients, 185 were benign, and 109 were malignant. There were no significant differences in the location, long axis diameter, shape, cystic or necrotic changes, calcification, and margins of the lymph nodes between the benign and malignant groups. The enlarged short axis diameter, invisible hilum with isoechoic cortex, and non-hilar vascularity were significantly higher in the malignant group (p<0.001). The malignancy rate was 8.7% in reactive cases, 48.5% in lymphoid disorders, and 90% in metastatic nodes. Conclusion The results of this study shows that cervical lymph nodes can be classified based on short axis diameter, cortex and hilum echo-texture and vascular pattern into normal, reactive, suspicious & lymphoid disorders, and metastatic, which have a high concordance with pathologic results.
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Affiliation(s)
- Seyed Ali Alamdaran
- Department of Radiology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Alieh Randian
- Department of Radiology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.,Corresponding Author: Department of Radiology, Faculty of medicine, Mashhad University of Medical Sciences, Mashhad, Iran. E-mail:
| | - Bashir Rasoulian
- Sinus and Surgical Endoscopic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Amir Hossein Jafarian
- Pathology Cancer Molecular Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Behzad Aminzadeh
- Department of Radiology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Shabnam Niroumand
- Department of Community Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
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26
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Ren Y, Shi Y, Zhou Z, Yang D, Xie J, Zhang Z, Wang J. Ultrasonographic and cytological characterization of ultrasound-guided fine-needle aspiration cytology of cervical lymph nodes for false-negative and false-positive diagnosis. Eur Arch Otorhinolaryngol 2022; 280:2463-2470. [PMID: 36571612 DOI: 10.1007/s00405-022-07802-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 12/14/2022] [Indexed: 12/27/2022]
Abstract
OBJECTIVES The primary goal of this study was to examine the ultrasound and cytological characteristics of inconsistent cases (false negatives and false positives)of ultrasound-guided fine-needle aspiration cytology (US-FNAC) of cervical lymph nodes, to investigate factors influencing the diagnostic accuracy of fine-needle aspiration, and to improve diagnostic efficiency. METHODS The results of US and FNAC of cervical lymph nodes in 562 cases treated at our institution from February 2019 to June 2021 were retrospectively analyzed. FNAC cytology results were compared with the final diagnostic results (242 surgical resections/core-needle biopsy, 320 cases followed up for more than 1 year), and the final diagnostic results were taken as the gold standard, and the ultrasound features and clinicopathology-related features were systematically retrospectively analyzed in cases of inconsistency. RESULTS The overall diagnostic accuracy of US-FNAC for cervical lymph nodes was 94.9%, with a false-negative rate of 6.7% and a false-positive rate of 3.8%. Analyzing the cases, sampling error due to factors associated with ultrasound features, such as larger, more numerous nodes, non-solid, hypoechoic, inhomogeneous, and increased vascularity are the main causes of false-negative diagnosis, while smaller nodules, overlapping cytologic patterns, and overinterpretation by pathologists are associated with false-positive FNAC results. CONCLUSIONS Proper interpretation of cytomorphologic and ultrasound features can improve diagnostic accuracy, and diagnostic misdiagnosis should be carefully observed, the identification of both features should be enhanced to reduce interpretation errors and sampling errors and to reduce the rate of misdiagnosis and missed diagnoses in fine needle aspiration of lymph nodes.
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Affiliation(s)
- Yiqun Ren
- The First Clinical Medical College of Gansu University of Chinese Medicine (Gansu Provincial Hospital), Lanzhou, China
| | - Yucong Shi
- The First Clinical Medical College of Gansu University of Chinese Medicine (Gansu Provincial Hospital), Lanzhou, China
| | - Zubang Zhou
- Department of Ultrasound, Gansu Provincial Hospital, No. 204 West Dong-Gang Road, Lanzhou, Gan su, 730000, China.
| | - Daxiong Yang
- The First Clinical Medical College of Gansu University of Chinese Medicine (Gansu Provincial Hospital), Lanzhou, China
| | - Jinhui Xie
- Department of Ultrasound, Gansu Provincial Hospital, No. 204 West Dong-Gang Road, Lanzhou, Gan su, 730000, China
| | - Zhi Zhang
- The First Clinical Medical College of Gansu University of Chinese Medicine (Gansu Provincial Hospital), Lanzhou, China
| | - Jiao Wang
- Gansu University of Traditional Chinese Medicine, Lanzhou, China
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27
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Malik DG, Dahiya N, Young SW, Heng LXX, Patel MD. Non-Vascular Considerations When Interpreting Extremity Arterial and Venous Examinations. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2022; 41:3145-3158. [PMID: 35984099 DOI: 10.1002/jum.16087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 07/29/2022] [Accepted: 08/02/2022] [Indexed: 06/15/2023]
Abstract
Peripheral arterial and venous examinations are performed regularly in vascular labs and interpreted by physicians of different specialities. Many vascular examinations have nonvascular pathology that is either inadvertently imaged by the sonographer or imaged with intent as it relates to patient's symptoms. It is prudent for every reader of vascular studies to be acquainted with the sonographic appearance of these non-vascular lesions to enable appropriate and optimal interpretation that has a direct bearing on patient's clinical care. Our review includes a discussion of the nonvascular pathologies like lymph nodes, soft tissue edema, soft tissue fluid collections, musculotendinous injuries, soft tissue masses, and joint and bursal pathologies that may be encountered during interpretation of vascular exams. The pictorial essay includes a discussion of their sonographic appearances and pitfalls in interpretation. Multiple illustrative examples and sonographic images of the non-vascular pathologies found during interpretation of vascular studies have been utilized to highlight their appearances.
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Affiliation(s)
- Dania G Malik
- Department of Radiology, Mayo Clinic Arizona, Phoenix, Arizona, USA
| | - Nirvikar Dahiya
- Department of Radiology, Mayo Clinic Arizona, Phoenix, Arizona, USA
| | - Scott W Young
- Department of Radiology, Mayo Clinic Arizona, Phoenix, Arizona, USA
| | | | - Maitray D Patel
- Department of Radiology, Mayo Clinic Arizona, Phoenix, Arizona, USA
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28
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Evaluating Different Quantitative Shear Wave Parameters of Ultrasound Elastography in the Diagnosis of Lymph Node Malignancies: A Systematic Review and Meta-Analysis. Cancers (Basel) 2022; 14:cancers14225568. [PMID: 36428661 PMCID: PMC9688428 DOI: 10.3390/cancers14225568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 11/08/2022] [Accepted: 11/11/2022] [Indexed: 11/16/2022] Open
Abstract
Shear wave elastography (SWE) has shown promise in distinguishing lymph node malignancies. However, the diagnostic accuracies of various SWE parameters that quantify tissue stiffness are yet to be demonstrated. To evaluate the pooled diagnostic accuracy of different SWE parameters for differentiating lymph node malignancies, we conducted a systematic screening of four databases using the PRISMA guidelines. Lymph node biopsy was adopted as the reference standard. Emax (maximum stiffness), Emean (mean stiffness), Emin (minimum stiffness), and Esd (standard deviation) SWE parameters were subjected to separate meta-analyses. A sub-group analysis comparing the use of Emax in cervical (including thyroid) and axillary lymph node malignancies was also conducted. Sixteen studies were included in this meta-analysis. Emax and Esd demonstrated the highest pooled sensitivity (0.78 (95% CI: 0.69-0.87); 0.78 (95% CI: 0.68-0.87)), while Emean demonstrated the highest pooled specificity (0.93 (95% CI: 0.88-0.98)). From the sub-group analysis, the diagnostic performance did not differ significantly in cervical and axillary LN malignancies. In conclusion, SWE is a promising adjunct imaging technique to conventional ultrasonography in the diagnosis of lymph node malignancy. SWE parameters of Emax and Esd have been identified as better choices of parameters for screening clinical purposes.
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29
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Imaging palpable tumors in pediatrics. RADIOLOGIA 2022; 64:552-565. [DOI: 10.1016/j.rxeng.2022.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Accepted: 08/18/2022] [Indexed: 11/18/2022]
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30
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Radiología en las tumoraciones palpables del paciente pediátrico Parte 1. RADIOLOGIA 2022. [DOI: 10.1016/j.rx.2022.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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31
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Prasad KT, Muthu V, Sehgal IS, Dhooria S, Singh N, Gupta N, Aggarwal AN, Agarwal R. Endosonographic characteristics of mediastinal lymph nodes for predicting malignancy in high tuberculosis burden settings: a study of 774 subjects. Expert Rev Respir Med 2022; 16:1011-1015. [PMID: 36031844 DOI: 10.1080/17476348.2022.2118717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Kuruswamy Thurai Prasad
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh
| | - Valliappan Muthu
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh
| | - Inderpaul Singh Sehgal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh
| | - Sahajal Dhooria
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh
| | - Navneet Singh
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh
| | - Nalini Gupta
- Department of Cytology, Postgraduate Institute of Medical Education and Research, Chandigarh
| | - Ashutosh Nath Aggarwal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh
| | - Ritesh Agarwal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh
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32
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Zhu Y, Meng Z, Fan X, Duan Y, Jia Y, Dong T, Wang Y, Song J, Tian J, Wang K, Nie F. Deep learning radiomics of dual-modality ultrasound images for hierarchical diagnosis of unexplained cervical lymphadenopathy. BMC Med 2022; 20:269. [PMID: 36008835 PMCID: PMC9410737 DOI: 10.1186/s12916-022-02469-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 07/07/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Accurate diagnosis of unexplained cervical lymphadenopathy (CLA) using medical images heavily relies on the experience of radiologists, which is even worse for CLA patients in underdeveloped countries and regions, because of lack of expertise and reliable medical history. This study aimed to develop a deep learning (DL) radiomics model based on B-mode and color Doppler ultrasound images for assisting radiologists to improve their diagnoses of the etiology of unexplained CLA. METHODS Patients with unexplained CLA who received ultrasound examinations from three hospitals located in underdeveloped areas of China were retrospectively enrolled. They were all pathologically confirmed with reactive hyperplasia, tuberculous lymphadenitis, lymphoma, or metastatic carcinoma. By mimicking the diagnosis logic of radiologists, three DL sub-models were developed to achieve the primary diagnosis of benign and malignant, the secondary diagnosis of reactive hyperplasia and tuberculous lymphadenitis in benign candidates, and of lymphoma and metastatic carcinoma in malignant candidates, respectively. Then, a CLA hierarchical diagnostic model (CLA-HDM) integrating all sub-models was proposed to classify the specific etiology of each unexplained CLA. The assistant effectiveness of CLA-HDM was assessed by comparing six radiologists between without and with using the DL-based classification and heatmap guidance. RESULTS A total of 763 patients with unexplained CLA were enrolled and were split into the training cohort (n=395), internal testing cohort (n=171), and external testing cohorts 1 (n=105) and 2 (n=92). The CLA-HDM for diagnosing four common etiologies of unexplained CLA achieved AUCs of 0.873 (95% CI: 0.838-0.908), 0.837 (95% CI: 0.789-0.889), and 0.840 (95% CI: 0.789-0.898) in the three testing cohorts, respectively, which was systematically more accurate than all the participating radiologists. With its assistance, the accuracy, sensitivity, and specificity of six radiologists with different levels of experience were generally improved, reducing the false-negative rate of 2.2-10% and the false-positive rate of 0.7-3.1%. CONCLUSIONS Multi-cohort testing demonstrated our DL model integrating dual-modality ultrasound images achieved accurate diagnosis of unexplained CLA. With its assistance, the gap between radiologists with different levels of experience was narrowed, which is potentially of great significance for benefiting CLA patients in underdeveloped countries and regions worldwide.
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Affiliation(s)
- Yangyang Zhu
- Ultrasound Medical Center, Lanzhou University Second Hospital, Lanzhou University, Lanzhou, 730030, China.,CAS Key Laboratory of Molecular Imaging, The State Key Laboratory of Management and Control for Complex Systems, Institute of Automation, Chinese Academy of Sciences, Beijing, 100190, China
| | - Zheling Meng
- CAS Key Laboratory of Molecular Imaging, The State Key Laboratory of Management and Control for Complex Systems, Institute of Automation, Chinese Academy of Sciences, Beijing, 100190, China.,School of Artificial Intelligence, University of Chinese Academy of Sciences, Beijing, China
| | - Xiao Fan
- Ultrasound Medical Center, Lanzhou University Second Hospital, Lanzhou University, Lanzhou, 730030, China
| | - Yin Duan
- Department of Ultrasound, Gansu Provincial Cancer Hospital, Lanzhou, China
| | - Yingying Jia
- Department of Ultrasound, People's Hospital of Ningxia Hui Autonomous Region, Yinchuan, China
| | - Tiantian Dong
- Ultrasound Medical Center, Lanzhou University Second Hospital, Lanzhou University, Lanzhou, 730030, China
| | - Yanfang Wang
- Ultrasound Medical Center, Lanzhou University Second Hospital, Lanzhou University, Lanzhou, 730030, China
| | - Juan Song
- Department of Ultrasound, People's Hospital of Ningxia Hui Autonomous Region, Yinchuan, China
| | - Jie Tian
- CAS Key Laboratory of Molecular Imaging, The State Key Laboratory of Management and Control for Complex Systems, Institute of Automation, Chinese Academy of Sciences, Beijing, 100190, China.,School of Artificial Intelligence, University of Chinese Academy of Sciences, Beijing, China.,Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, School of Medicine and Engineering, Beihang University, Beijing, China
| | - Kun Wang
- CAS Key Laboratory of Molecular Imaging, The State Key Laboratory of Management and Control for Complex Systems, Institute of Automation, Chinese Academy of Sciences, Beijing, 100190, China. .,School of Artificial Intelligence, University of Chinese Academy of Sciences, Beijing, China.
| | - Fang Nie
- Ultrasound Medical Center, Lanzhou University Second Hospital, Lanzhou University, Lanzhou, 730030, China. .,Gansu Province Clinical Research Center for Ultrasonography, Lanzhou, China. .,Gansu Province Medical Engineering Research Center for Intelligence Ultrasound, Lanzhou, China.
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Promise of hypoxia-targeted tracers in metastatic lymph node imaging. Eur J Nucl Med Mol Imaging 2022; 49:4293-4297. [PMID: 35994060 DOI: 10.1007/s00259-022-05938-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Evaluation of different imaging modalities for axillary lymph node staging in breast cancer patients to provide a personalized and optimized therapy algorithm. J Cancer Res Clin Oncol 2022:10.1007/s00432-022-04221-9. [PMID: 35948829 DOI: 10.1007/s00432-022-04221-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 07/18/2022] [Indexed: 10/15/2022]
Abstract
PURPOSE The reliable detection of tumor-infiltrated axillary lymph nodes for breast cancer [BC] patients plays a decisive role in further therapy. We aimed to find out whether cross-sectional imaging techniques could improve sensitivity for pretherapeutic axillary staging in nodal-positive BC patients compared to conventional imaging such as mammography and sonography. METHODS Data for breast cancer patients with tumor-infiltrated axillary lymph nodes having received surgery between 2014 and 2020 were included in this study. All examinations (sonography, mammography, computed tomography [CT] and magnetic resonance imaging [MRI]) were interpreted by board-certified specialists in radiology. The sensitivity of different imaging modalities was calculated, and binary logistic regression analyses were performed to detect variables influencing the detection of positive lymph nodes. RESULTS All included 382 breast cancer patients had received conventional imaging, while 52.61% of the patients had received cross-sectional imaging. The sensitivity of the combination of all imaging modalities was 68.89%. The combination of MRI and CT showed 63.83% and the combination of sonography and mammography showed 36.11% sensitivity. CONCLUSION We could demonstrate that cross-sectional imaging can improve the sensitivity of the detection of tumor-infiltrated axillary lymph nodes in breast cancer patients. Only the safe detection of these lymph nodes at the time of diagnosis enables the evaluation of the response to neoadjuvant therapy, thereby allowing access to prognosis and improving new post-neoadjuvant therapies.
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Lee JY, Yoo RE, Rhim JH, Lee KH, Choi KS, Hwang I, Kang KM, Kim JH. Validation of Ultrasound Risk Stratification Systems for Cervical Lymph Node Metastasis in Patients with Thyroid Cancer. Cancers (Basel) 2022; 14:cancers14092106. [PMID: 35565235 PMCID: PMC9105025 DOI: 10.3390/cancers14092106] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 04/20/2022] [Accepted: 04/21/2022] [Indexed: 12/04/2022] Open
Abstract
Simple Summary Ultrasound (US) malignancy risk stratification systems (RSS) for cervical lymph nodes (LNs) have not been fully established in patients with thyroid cancer. In this study, we assessed the malignancy risks of each US feature and risk category from the Korean Society of Thyroid Radiology (KSThR) and the European Thyroid Association (ETA). Both systems effectively classified malignancy risks; however, 15.1% of LNs were unclassifiable in ETA RSS. Suspicious US features of hyperechogenicity, cystic change, echogenic foci, and abnormal vascularity were independently associated with metastasis. When the primary tumor characteristics were assessed, tumor multiplicity was associated with metastasis in the indeterminate LN group. We refined this system and proposed an RSS based on the KSThR system for cervical LNs in patients with thyroid cancer. Abstract A malignancy risk stratification system (RSS) for cervical lymph nodes (LNs) has not been fully established. This study aimed to validate the current RSS for the diagnosis of cervical LN metastasis in thyroid cancer. In total, 346 LNs from 282 consecutive patients between December 2006 and June 2015 were included. We determined the malignancy risk of each ultrasound (US) feature and performed univariable and multivariable logistic regression analyses. Each risk category from the Korean Society of Thyroid Radiology (KSThR) and the European Thyroid Association (ETA) was applied to calculate malignancy risks. The effects of size, number of suspicious features, and primary tumor characteristics were analyzed to refine the current RSS. Suspicious features including echogenic foci, cystic change, hyperechogenicity, and abnormal vascularity were independently predictive of malignancy (p ≤ 0.045). The malignancy risks of probably benign, indeterminate, and suspicious categories were 2.2–2.5%, 26.8–29.0%, and 85.8–87.4%, respectively, according to the KSThR and ETA criteria. According to the ETA criteria, 15.1% of LNs were unclassifiable. In indeterminate LNs, multiplicity of the primary tumor was significantly associated with malignancy (odds ratio, 6.53; p = 0.004). We refined the KSThR system and proposed a US RSS for LNs in patients with thyroid cancer.
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Affiliation(s)
- Ji Ye Lee
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 03080, Korea; (J.Y.L.); (R.-E.Y.); (K.H.L.); (K.S.C.); (I.H.); (K.M.K.)
| | - Roh-Eul Yoo
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 03080, Korea; (J.Y.L.); (R.-E.Y.); (K.H.L.); (K.S.C.); (I.H.); (K.M.K.)
| | - Jung Hyo Rhim
- Department of Radiology, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul 156707, Korea;
| | - Kyung Hoon Lee
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 03080, Korea; (J.Y.L.); (R.-E.Y.); (K.H.L.); (K.S.C.); (I.H.); (K.M.K.)
| | - Kyu Sung Choi
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 03080, Korea; (J.Y.L.); (R.-E.Y.); (K.H.L.); (K.S.C.); (I.H.); (K.M.K.)
| | - Inpyeong Hwang
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 03080, Korea; (J.Y.L.); (R.-E.Y.); (K.H.L.); (K.S.C.); (I.H.); (K.M.K.)
| | - Koung Mi Kang
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 03080, Korea; (J.Y.L.); (R.-E.Y.); (K.H.L.); (K.S.C.); (I.H.); (K.M.K.)
| | - Ji-hoon Kim
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 03080, Korea; (J.Y.L.); (R.-E.Y.); (K.H.L.); (K.S.C.); (I.H.); (K.M.K.)
- Correspondence: ; Tel.: +82-2-2072-3280
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Dippel E, Assaf C, Becker JC, von Bergwelt-Baildon M, Bernreiter S, Cozzio A, Eich HT, Elsayad K, Follmann M, Grabbe S, Hillen U, Klapper W, Klemke CD, Loquai C, Meiss F, Mitteldorf C, Wehkamp U, Nashan D, Nicolay JP, Oschlies I, Schlaak M, Stranzenbach R, Moritz R, Stoll C, Vag T, Weichenthal M, Wobser M, Stadler R. S2k-Leitlinie - Kutane Lymphome (ICD10 C82-C86): Update 2021. J Dtsch Dermatol Ges 2022; 20:537-555. [PMID: 35446484 DOI: 10.1111/ddg.14706_g] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
| | - Chalid Assaf
- Klinik für Dermatologie und Venerologie, Helios Klinikum Krefeld
| | | | | | | | - Antonio Cozzio
- Klinik für Dermatologie, Venerologie und Allergologie, Kantonsspital St. Gallen
| | - Hans T Eich
- Klinik für Strahlentherapie und Radioonkologie, Universitätsklinikum Münster
| | - Khaled Elsayad
- Klinik für Strahlentherapie und Radioonkologie, Universitätsklinikum Münster
| | | | | | - Uwe Hillen
- Klinik für Dermatologie, Universitätsklinikum Essen
| | - Wolfram Klapper
- Institut für Pathologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel
| | - Claus-Detlev Klemke
- Hautklinik, Städtisches Klinikum Karlsruhe, Akademisches Lehrkrankenhaus der Universität Freiburg, Karlsruhe
| | | | - Frank Meiss
- Klinik für Dermatologie und Venerologie, Universitätsklinik Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg
| | - Christina Mitteldorf
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsmedizin Göttingen
| | - Ulrike Wehkamp
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel
| | | | - Jan P Nicolay
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinik Mannheim
| | - Ilske Oschlies
- Institut für Pathologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel
| | - Max Schlaak
- Klinik für Dermatologie, Venerologie und Allergologie, Charité - Universitätsmedizin Berlin
| | - René Stranzenbach
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum der Ruhr-Universität Bochum
| | - Rose Moritz
- Klinik und Poliklinik für Dermatologie, Universitätsklinikum Halle
| | | | - Tibor Vag
- Nuklearmedizinische Klinik, Klinikum Rechts der Isar, Technische Universität München
| | - Michael Weichenthal
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel
| | - Marion Wobser
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Würzburg
| | - Rudolf Stadler
- Klinik für Dermatologie, Venerologie, Allergologie und Phlebologie, Johannes Wesling Universitätsklinikum Minden, Universitätsklinikum der Ruhr-Universität Bochum
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Dippel E, Assaf C, Becker JC, von Bergwelt‐Baildon M, Bernreiter S, Cozzio A, Eich H
T, Elsayad K, Follmann M, Grabbe S, Hillen U, Klapper W, Klemke C, Loquai C, Meiss F, Mitteldorf C, Wehkamp U, Nashan D, Nicolay JP, Oschlies I, Schlaak M, Stranzenbach R, Moritz R, Stoll C, Vag T, Weichenthal M, Wobser M, Stadler R. S2k-Guidelines - Cutaneous lymphomas (ICD10 C82 - C86): Update 2021. J Dtsch Dermatol Ges 2022; 20:537-554. [PMID: 35446497 PMCID: PMC9325452 DOI: 10.1111/ddg.14706] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Edgar Dippel
- Department of DermatologyHospital LudwigshafenGermany
| | - Chalid Assaf
- Department of Dermatology and VenereologyHelios Hospital KrefeldGermany
| | | | | | | | - Antonio Cozzio
- Department of DermatologyVenereology and AllergologyCanton Hospital St. GallenSwitzerland
| | - Hans
T. Eich
- Department of Radiation Therapy and Radio‐OncologyUniversity Hospital MünsterGermany
| | - Khaled Elsayad
- Department of Radiation Therapy and Radio‐OncologyUniversity Hospital MünsterGermany
| | | | - Stephan Grabbe
- Department of DermatologyUniversity Hospital MainzGermany
| | - Uwe Hillen
- Department of DermatologyUniversity Hospital EssenGermany
| | - Wolfram Klapper
- Institute of PathologyUniversity Hospital Schleswig‐HolsteinCampus KielGermany
| | - Claus‐Detlev Klemke
- Department of DermatologyMunicipal Hospital of KarlsruheAcademic Teaching Hospital for the University of FreiburgKarlsruheGermany
| | - Carmen Loquai
- Department of DermatologyUniversity Hospital MainzGermany
| | - Frank Meiss
- Department of Dermatology and VenereologyUniversity Hospital Freiburgmedical FacultyAlbert‐Ludwigs University FreiburgGermany
| | - Christina Mitteldorf
- Department of DermatologyVenereology and AllergologyUniversity Hospital GöttingenGermany
| | - Ulrike Wehkamp
- Department of DermatologyVenereology and AllergologyUniversity Hospital Schleswig‐HolsteinCampus KielGermany
| | - Dorothee Nashan
- Department of DermatologyDortmund Hospital GmbHDortmundGermany
| | - Jan P. Nicolay
- Department of DermatologyVenereology and AllergologyUniversity Hospital MannheimGermany
| | - Ilske Oschlies
- Institute of PathologyUniversity Hospital Schleswig‐HolsteinCampus KielGermany
| | - Max Schlaak
- Charité
– Universitätsmedizin BerlinDepartment of DermatologyVenereology and AllergologyBerlinGermany
| | - René Stranzenbach
- Department of DermatologyVenereology and AllergologyUniversity Hospital at Ruhr University BochumGermany
| | - Rose Moritz
- Department for DermatologyUniversity Hospital HalleGermany
| | | | - Tibor Vag
- Department of Nuclear MedicineTechnical University of MunichGermany
| | - Michael Weichenthal
- Department of DermatologyVenereology and AllergologyUniversity Hospital Schleswig‐HolsteinCampus KielGermany
| | - Marion Wobser
- Department of DermatologyVenereology and AllergologyUniversity Hospital WürzburgGermany
| | - Rudolf Stadler
- Department of DermatologyVenereologyAllergologyand PhlebologyJohannes Wesling University Hospital MindenUniversity Hospital at Ruhr University BochumGermany
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Imaizumi K, Homma S, Nishida M, Soyama T, Shimura R, Kudo Y, Omotehara S, Yokota I, Takagi R, Matsui H, Miyaoka Y, Ichikawa N, Yoshida T, Takahashi N, Taketomi A. Transabdominal Ultrasonography for Preoperative Diagnosis of Lymph Node Metastasis in Colon Cancer: A Retrospective Cohort Study. CANCER DIAGNOSIS & PROGNOSIS 2022; 2:173-183. [PMID: 35399166 DOI: 10.21873/cdp.10092] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Accepted: 01/31/2022] [Indexed: 02/06/2023]
Abstract
Background/Aim Although computed tomography (CT) is the standard modality for diagnosing lymph node metastasis (LNM), transabdominal ultrasonography (US) can be useful due to its high spatial resolution and use of Doppler signals to precisely analyse lymph nodes. This study aimed to evaluate the accuracy of US for lymph node assessment, establish US-based diagnostic criteria for LNM, and compare the capability of US with that of CT for the diagnosis of LNM. Patients and Methods This retrospective, single-institution, cohort study included patients who underwent radical surgery for clinical stage 0-III colon cancer, between March 2012 and February 2019. Results Overall, 34.9% (66/189) of patients had pathological LNM. The optimal US diagnostic criteria were 1) short axis ≥7 mm and short/long ratio ≥0.75 and 2) at least two of the following: the absence of hilar echoes, expansive appearance, or peripheral/mixed vascularity by the colour Doppler and/or contrast-enhanced method. Compared to CT, US showed a higher diagnostic sensitivity (54.5% vs. 43.9%; p=0.296), higher concordance with the number of pathological LNM (correlation coefficient: US, 0.42; CT, 0.27) and pathological N diagnosis (weighted ĸ: US, 0.35; CT, 0.18), and higher sensitivity for advanced LNM, including multiple LNMs (47.4% vs. 18.4%; p=0.014) and N2 stage (27.8% vs. 5.6%; p=0.177). Conclusion US has higher sensitivity than CT for diagnosing LNM in colon cancer, along with a more accurate preoperative diagnosis of the N stage. Additionally, US may be more helpful than CT alone for preoperatively deciding the appropriateness of neoadjuvant treatment in colon cancer with advanced LNM.
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Affiliation(s)
- Ken Imaizumi
- Department of Gastroenterological Surgery I, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Shigenori Homma
- Department of Gastroenterological Surgery I, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Mutsumi Nishida
- Division of Laboratory and Transfusion Medicine, Diagnostic Center for Sonography, Hokkaido University Hospital, Sapporo, Japan
| | - Takeshi Soyama
- Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, Sapporo, Japan
| | - Ryosuke Shimura
- Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, Sapporo, Japan
| | - Yusuke Kudo
- Division of Laboratory and Transfusion Medicine, Diagnostic Center for Sonography, Hokkaido University Hospital, Sapporo, Japan
| | - Satomi Omotehara
- Division of Laboratory and Transfusion Medicine, Diagnostic Center for Sonography, Hokkaido University Hospital, Sapporo, Japan
| | - Isao Yokota
- Department of Biostatistics, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Ryo Takagi
- Department of Biostatistics, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Hiroki Matsui
- Department of Gastroenterological Surgery I, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Yoichi Miyaoka
- Department of Gastroenterological Surgery I, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Nobuki Ichikawa
- Department of Gastroenterological Surgery I, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Tadashi Yoshida
- Department of Gastroenterological Surgery I, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Norihiko Takahashi
- Department of Gastroenterological Surgery I, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Akinobu Taketomi
- Department of Gastroenterological Surgery I, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
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Wang B, Zhang MK, Zhou MP, Liu Y, Li N, Liu G, Wang ZL. Logistic Regression Analysis of Conventional Ultrasound, and Contrast-Enhanced Ultrasound Characteristics: Is It Helpful in Differentiating Benign and Malignant Superficial Lymph Nodes? JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2022; 41:343-353. [PMID: 33792978 DOI: 10.1002/jum.15711] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 03/07/2021] [Accepted: 03/17/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVES This study aimed to screen the significant sonographic features for differentiation of benign and malignant superficial lymph nodes (LNs) by logistic regression analysis and fit a model to diagnose LNs. METHODS A total of 204 pathological LNs were analyzed retrospectively. All the LNs underwent conventional ultrasound (US) and contrast-enhanced ultrasound (CEUS) examinations. A total of 16 suspicious sonographic features were used to assess LNs. All variables that were statistically related to the diagnosis of LNs were included in the logistic regression analysis in order to ascertain the significant features of diagnosing LNs, and to establish a logistic regression analysis model. RESULTS The significant features in the logistic regression analysis model of diagnosing malignant LNs were absence of echogenic hilus, age, and absence of hilum after enhancement. According to the results of logistic regression analysis, the formula to predict whether LNs were malignant was established. The area under the receiver operating curve (ROC) was 0.908 and the accuracy, sensitivity, and specificity were 85.0%, 92.9%, and 85.3%, respectively. CONCLUSION The logistic regression model for the significant sonographic features of conventional US and CEUS is an effective and accurate diagnostic tool for differentiating malignant and benign LNs.
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Affiliation(s)
- Bo Wang
- Department of Ultrasound, First Medical Center, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Meng Ke Zhang
- Department of Ultrasound, First Medical Center, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Mao Ping Zhou
- Department of Ultrasound, Affiliated Hospital of Qingdao University, Qingdao City, China
| | - Yuan Liu
- Department of Ultrasound, Fifth Medical Center, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Nan Li
- Department of Ultrasound, First Medical Center, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Gang Liu
- Department of Radiology, First Medical Center, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Zhi Li Wang
- Department of Ultrasound, First Medical Center, Chinese People's Liberation Army General Hospital, Beijing, China
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Ni X, Xu S, Zhan W, Zhou W. A Risk Stratification Model for Metastatic Lymph Nodes of Papillary Thyroid Cancer: A Retrospective Study Based on Sonographic Features. Front Endocrinol (Lausanne) 2022; 13:942569. [PMID: 35937798 PMCID: PMC9355421 DOI: 10.3389/fendo.2022.942569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 06/13/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Papillary thyroid carcinoma (PTC) has a high probability of cervical lymph node (LN) metastasis. The aim of the study was to develop an ultrasound risk stratification model to standardize the diagnosis of metastatic LNs of PTC. METHODS Patients with suspicious thyroid nodules who underwent US examination and US guided fine-needle aspiration for cervical LNs were retrospectively collected. Univariate and multivariate logistic regression analyses were performed to assess the independent risk factor of metastatic LNs. According to the OR value of correlated indicators in logistic regression analysis, a risk stratification model was established. RESULTS A total of 653 LNs were included. The independent risk factors of metastatic LNs were long-axis diameter/short-axis ≤ 2 (OR=1.644), absence of hilum (OR=1.894), hyperechogenicity (OR=5.375), calcifications (OR=6.201), cystic change (OR=71.818), and abnormal flow (OR=3.811) (P<0.05 for all). The risk stratification model and malignancy rate were as follows: 0-2 points, malignancy rate of 10.61%, low suspicion; 3-5 points, malignancy rate of 50.49%, intermediate suspicion, ≥6 points, malignancy rate of 84.81%, high suspicion. The area under the receiver operating characteristic curve for the model was 0.827 (95% CI 0.795-0.859). CONCLUSIONS Our established risk stratification model can effectively evaluate metastatic LNs in the patients with suspicious thyroid nodules, and it might provide a new strategy choice for clinical practice.
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Affiliation(s)
- Xiaofeng Ni
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shangyan Xu
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Weiwei Zhan
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- *Correspondence: Wei Zhou, ; Weiwei Zhan,
| | - Wei Zhou
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Ultrasound, RuiJin Hospital/Lu Wan Branch, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- *Correspondence: Wei Zhou, ; Weiwei Zhan,
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Ramesh A, Rohan K, Nagarajan K, Abdulbasith KM, Sureshkumar S, Vijayakumar C, Balamourougan K, Srinivas BH. Evaluation of acoustic radiation force impulse imaging in differentiating benign and malignant cervical lymphadenopathy. J Med Ultrasound 2022; 30:87-93. [PMID: 35832364 PMCID: PMC9272720 DOI: 10.4103/jmu.jmu_10_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 03/21/2021] [Accepted: 06/04/2021] [Indexed: 11/10/2022] Open
Abstract
Background: The aim of this study was to assess the diagnostic role of acoustic radiation force impulse imaging (ARFI) in differentiating benign and malignant cervical nodes. Methods: This was a diagnostic accuracy cross-sectional study. All patients who underwent ultrasound-guided fine-needle aspiration cytology (FNAC) of cervical nodes were included. Patients without FNAC/biopsy and patients in whom cervical nodes were cystic or completely necrotic were excluded. FNAC was used as reference investigation to predict the diagnostic accuracy. In all cases, FNAC was carried out after the B-mode, color Doppler and the ARFI imaging. In patients with multiple cervical lymph nodes, the most suspicious node based on grayscale findings was chosen for ARFI. ARFI included Virtual Touch imaging (VTI), area ratio (AR), and shear wave velocity (SWV) for each node, and the results were compared with FNAC/biopsy. Results: The final analysis included 166 patients. Dark VTI elastograms had sensitivity and specificity of 86.2% and 72.1%, respectively, in identifying malignant nodes. Sensitivity and specificity of AR were 71.3% and 82.3%, respectively, for a cutoff of 1.155. Median SWV of benign and malignant nodes was 1.9 [95% confidence interval (CI), 1.56–2.55] m/s and 6.7 (95% CI, 2.87–9.10) m/s, respectively. SWV >2.68 m/s helped in identifying malignant nodes with 81% specificity, 81.6% sensitivity, and 81.3% accuracy. ARFI was found to be inaccurate in tuberculous and lymphomatous nodes. Conclusion: Malignant nodes had significantly darker elastograms, higher AR and SWV compared to benign nodes, and SWV was the most accurate parameter. ARFI accurately identifies malignant nodes, hence could potentially avoid unwarranted biopsy.
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Identification of secondary splenic lymphoma with contrast-enhanced ultrasound in the pediatric population. A case report. Radiol Case Rep 2021; 17:467-472. [PMID: 34950275 PMCID: PMC8671098 DOI: 10.1016/j.radcr.2021.11.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 11/10/2021] [Accepted: 11/10/2021] [Indexed: 12/02/2022] Open
Abstract
Contrast-enhanced ultrasound scan (CEUS) is the application of ultrasound contrast agents (UCAs) to traditional ultrasound. Our aim is to report the use of CEUS for a prompt assessment of a suspected secondary splenic lymphoma in a child, which, in our experience, has allowed an accurate description of the parenchymal perfusion and vascularization pattern, leading to a confident diagnosis. We suggest that CEUS will replace Magnetic resonance imaging (MRI) or Computed tomography (CT) as standard imaging option for differential diagnosis of spleen lesions in pediatric population. As a result this will lead to decreasing the overall use of ionizing radiation and reducing the time interval to a certain diagnosis.
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Bugter O, Aaboubout Y, Algoe M, de Bruijn HS, Keereweer S, Sewnaik A, Monserez DA, Koljenović S, Hardillo JAU, Robinson DJ, Baatenburg de Jong RJ. Detecting head and neck lymph node metastases with white light reflectance spectroscopy; a pilot study. Oral Oncol 2021; 123:105627. [PMID: 34826688 DOI: 10.1016/j.oraloncology.2021.105627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 09/08/2021] [Accepted: 11/09/2021] [Indexed: 10/19/2022]
Abstract
INTRODUCTION A challenge in the treatment of patients with head and neck cancer is the management of occult cervical lymph node (LN) metastases. Single-fiber reflectance (SFR) spectroscopy has the potential to detect physiological tissue changes that occur in a positive LN. This pilot study aimed to investigate whether SFR spectroscopy could serve as an alternative or additional technique to detect cervical lymph node metastases. MATERIALS AND METHODS We performed intraoperative SFR spectroscopy measurements of LNs with and without malignancies. We analyzed if physiological and scattering parameters were significantly altered in positive LNs. RESULTS Nine patients with a total of nineteen LNs were included. Three parameters, blood volume fraction (BVF), microvascular saturation (StO2), and Rayleigh amplitude, were significantly lower in positive LNs. They were combined into one optical parameter 'delta', using discriminant analysis. Delta was significantly decreased in positive LNs, p = 0,0006. It had a high diagnostic accuracy where the sensitivity, specificity, PPV, and NPV were 90,0%, 88.9%, 90,0%, and 88.9%, respectively. The area under the ROC curve was 96.7% (95% confidence interval 89.7-100.0%). CONCLUSION This proof of principle study is a first step in the development of an SFR spectroscopy technique to detect LN metastases in real time. A next step towards this goal is replicating these results in LNs with smaller metastases and in a larger cohort of patients. This future study will combine SFR spectroscopy with fine-needle aspiration, using the same needle, to perform preoperative in vivo measurements.
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Affiliation(s)
- Oisín Bugter
- Erasmus MC Cancer Institute, University Medical Center Rotterdam, Department of Otorhinolaryngology and Head and Neck Surgery, Rotterdam, the Netherlands; Erasmus MC Cancer Institute, University Medical Center Rotterdam, Center for Optical Diagnostics and Therapy, Rotterdam, the Netherlands
| | - Yassine Aaboubout
- Erasmus MC Cancer Institute, University Medical Center Rotterdam, Department of Otorhinolaryngology and Head and Neck Surgery, Rotterdam, the Netherlands; Erasmus MC Cancer Institute, University Medical Center Rotterdam, Center for Optical Diagnostics and Therapy, Rotterdam, the Netherlands; Erasmus MC Cancer Institute, University Medical Center Rotterdam, Department of Pathology, Rotterdam, the Netherlands
| | - Mahesh Algoe
- Erasmus MC Cancer Institute, University Medical Center Rotterdam, Department of Pathology, Rotterdam, the Netherlands
| | - Henriëtte S de Bruijn
- Erasmus MC Cancer Institute, University Medical Center Rotterdam, Department of Otorhinolaryngology and Head and Neck Surgery, Rotterdam, the Netherlands; Erasmus MC Cancer Institute, University Medical Center Rotterdam, Center for Optical Diagnostics and Therapy, Rotterdam, the Netherlands
| | - Stijn Keereweer
- Erasmus MC Cancer Institute, University Medical Center Rotterdam, Department of Otorhinolaryngology and Head and Neck Surgery, Rotterdam, the Netherlands
| | - Aniel Sewnaik
- Erasmus MC Cancer Institute, University Medical Center Rotterdam, Department of Otorhinolaryngology and Head and Neck Surgery, Rotterdam, the Netherlands
| | - Dominiek A Monserez
- Erasmus MC Cancer Institute, University Medical Center Rotterdam, Department of Otorhinolaryngology and Head and Neck Surgery, Rotterdam, the Netherlands
| | - Senada Koljenović
- Erasmus MC Cancer Institute, University Medical Center Rotterdam, Department of Pathology, Rotterdam, the Netherlands
| | - Jose A U Hardillo
- Erasmus MC Cancer Institute, University Medical Center Rotterdam, Department of Otorhinolaryngology and Head and Neck Surgery, Rotterdam, the Netherlands.
| | - Dominic J Robinson
- Erasmus MC Cancer Institute, University Medical Center Rotterdam, Department of Otorhinolaryngology and Head and Neck Surgery, Rotterdam, the Netherlands; Erasmus MC Cancer Institute, University Medical Center Rotterdam, Center for Optical Diagnostics and Therapy, Rotterdam, the Netherlands
| | - Robert J Baatenburg de Jong
- Erasmus MC Cancer Institute, University Medical Center Rotterdam, Department of Otorhinolaryngology and Head and Neck Surgery, Rotterdam, the Netherlands
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Goyack LE, Heimann MA. Disseminated Kaposi Sarcoma. Clin Pract Cases Emerg Med 2021; 5:491-493. [PMID: 34813455 PMCID: PMC8610452 DOI: 10.5811/cpcem.2021.9.53692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 09/20/2021] [Indexed: 11/18/2022] Open
Abstract
Case Presentation A 28-year-old male with a recent diagnosis of human immunodeficiency virus presented to the emergency department with odynophagia and dysphagia for a month. Physical exam revealed Kaposi sarcoma partially occluding the airway. Point-of-care ultrasound was used to assist with the diagnosis of reactive lymphadenopathy, and computed tomography revealed systemic disease. Otolaryngology was urgently consulted, and the patient was admitted for prompt tracheostomy the following day. Discussion Kaposi sarcoma is a violaceous vascular neoplasm that is an acquired immuno-deficiency syndrome (AIDS)-defining illness. Mucocutaneous membranes should be thoroughly evaluated with patients suspected of AIDS. This case demonstrates the vital evaluation of the patient’s airway to assess patency. Highly active antiretroviral therapy should be initiated promptly, as well as chemotherapy in severe systemic cases.
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Affiliation(s)
- Laura E Goyack
- University of Alabama - Birmingham, Department of Emergency Medicine, Birmingham, Alabama
| | - Matthew A Heimann
- University of Alabama - Birmingham, Department of Emergency Medicine, Birmingham, Alabama
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Tymofieiev OO, Ushko NO, Fesenko II, Tymofieiev OO, Yarifa MO, Cherniak OS. Suppurative mastoid lymphadenitis mimicking mastoiditis: a case report. J Korean Assoc Oral Maxillofac Surg 2021; 47:398-402. [PMID: 34713816 PMCID: PMC8564086 DOI: 10.5125/jkaoms.2021.47.5.398] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 05/02/2020] [Accepted: 05/05/2020] [Indexed: 11/17/2022] Open
Abstract
Mastoid lymph node inflammation is a rare entity. Pathological conditions in the vicinity of the mastoid processes can be challenging for maxillofacial head-neck surgeons to address. We report a case of suppurative mastoid lymphadenitis in an 18-year-old Caucasian male. To our knowledge, there are no publications that highlight the clinical, ultrasonographic, intra-, and postoperative data for any pathologic process that presented as mastoiditis.
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Affiliation(s)
- Oleksii O Tymofieiev
- Department of Maxillofacial Surgery, Shupyk National Healthcare University of Ukraine, Kyiv, Ukraine
| | - Natalia O Ushko
- Department of Maxillofacial Surgery, Shupyk National Healthcare University of Ukraine, Kyiv, Ukraine
| | - Ievgen I Fesenko
- Center of Maxillofacial Surgery, Kyiv Regional Clinical Hospital, Kyiv, Ukraine
| | - Olexander O Tymofieiev
- Department of Dentistry, Shupyk National Healthcare University of Ukraine, Kyiv, Ukraine
| | - Maria O Yarifa
- Department of Oral and Maxillofacial Surgery, Private Higher Educational Establishment "Kyiv Medical University", Kyiv, Ukraine
| | - Olha S Cherniak
- Department of Ultrasound, Regional Diagnostic Center, Kyiv Regional Clinical Hospital, Kyiv, Ukraine
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Value of Assessing Peripheral Vascularization with Micro-Flow Imaging, Resistive Index and Absent Hilum Sign as Predictor for Malignancy in Lymph Nodes in Head and Neck Squamous Cell Carcinoma. Cancers (Basel) 2021; 13:cancers13205071. [PMID: 34680220 PMCID: PMC8534188 DOI: 10.3390/cancers13205071] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 10/04/2021] [Accepted: 10/07/2021] [Indexed: 12/13/2022] Open
Abstract
Simple Summary Ultrasound-guided fine needle aspiration cytology (USgFNAC) is commonly used for N-staging in head and neck squamous cell carcinoma (HNSCC). The specificity of USgFNAC is always in the order of 100% as false positive cytology is rare. The difference in sensitivity is mainly attributable to selection of the lymph nodes to aspirate and aspiration technique. The aim of this study was to improve the selection criteria of lymph nodes to aspirate. Ultrasound features of nodes such as a short axis diameter, S/L ratio, loss of a fatty hilum sign, resistive index, and peripheral or mixed hilar and peripheral vascularization, obtained by Micro-flow imaging (MFI), which is a new technique to obtain micro-vascularization, were evaluated. To calculate the sensitivity and PPV of each feature, data of sonographic findings and cytological results of all aspirated nodes were statistically analyzed. We found that next to size, peripheral vascularisation obtained by MFI and absent hilum sign have a high predictive value for malignancy and should be added as selection criteria for fine needle aspiration in lymph nodes. Abstract Ultrasound-guided fine needle aspiration cytology (USgFNAC) is commonly used for nodal staging in head and neck squamous cell cancer (HNSCC). Peripheral vascularity is a described feature for node metastasis. Micro-flow imaging (MFI) is a new sensitive technique to evaluate micro-vascularization. Our goal is to assess the additional value of MFI to detect malignancy in lymph nodes. A total of 102 patients with HNSCC were included prospectively. USgFNAC was performed with the Philips eL18–4 transducer. Cytological results served as a reference standard to evaluate the prediction of cytological malignancy depending on ultrasound features such as resistive index (RI), absence of fatty hilum sign, and peripheral vascularization. Results were obtained for all US examinations and for the subgroup of clinically node-negative neck (cN0). USgFNAC was performed in 211 nodes. Peripheral vascularization had a positive predictive value (PPV) of 83% (cN0: 50%) and the absence of a fatty hilum had a PPV of 82% (cN0 50%) The combination of peripheral vascularization and absent fatty hilum had a PPV of 94% (cN0: 72%). RI (threshold: 0.705) had a PPV of 61% (cN0: RI-threshold 0.615, PPV 20%), whereas the PPV of short axis diameter (threshold of 6.5mm) was 59% for all patients and 19% in cN0 necks (threshold of 4 mm). Peripheral vascularization assessed by MFI and absent hilum has a high predictive value for cytological malignancy in neck metastases. Next to size, both features should be used as additional selection criteria for USgFNAC.
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Oncologic Imaging of the Lymphatic System: Current Perspective with Multi-Modality Imaging and New Horizon. Cancers (Basel) 2021; 13:cancers13184554. [PMID: 34572781 PMCID: PMC8465736 DOI: 10.3390/cancers13184554] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 09/05/2021] [Accepted: 09/07/2021] [Indexed: 11/17/2022] Open
Abstract
The lymphatic system is an anatomically complex vascular network that is responsible for interstitial fluid homeostasis, transport of large interstitial particles and cells, immunity, and lipid absorption in the gastrointestinal tract. This network of specially adapted vessels and lymphoid tissue provides a major pathway for metastatic spread. Many malignancies produce vascular endothelial factors that induce tumoral and peritumoral lymphangiogenesis, increasing the likelihood for lymphatic spread. Radiologic evaluation for disease staging is the cornerstone of oncologic patient treatment and management. Multiple imaging modalities are available to access both local and distant metastasis. In this manuscript, we review the anatomy, physiology, and imaging of the lymphatic system.
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BAKKAL FK, GÜLHAN N, ERAVCI FC, KIZIL Y, AYDİL U. Head and neck lymphomas from otolaryngology perspective. JOURNAL OF HEALTH SCIENCES AND MEDICINE 2021. [DOI: 10.32322/jhsm.948863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Rennert J, Grosse J, Einspieler I, Bäumler W, Stroszczynski C, Jung EM. Complementary imaging of ultrasound and PET/CT: A new opportunity? Clin Hemorheol Microcirc 2021; 79:39-54. [PMID: 34420945 DOI: 10.3233/ch-219105] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
AIM To evaluate the effectiveness of complementary imaging of high-resolution ultrasound including CEUS with PET/CT for tissue characterization and tumor detection. MATERIAL AND METHODS 100 patients were examined with PET/CT and US/CEUS between January 2018 until February 2020. All patients underwent PET/CT followed by selective US/CEUS within 4 weeks. Comparison regarding concordant or diverging findings in PET/CT and US. Analysis of the differences concerning the lesions number of found by PET/CT and US/CEUS or the possibility of a secured diagnosis following ultrasound causing therapeutic changes. RESULTS Diverging findings regarding the number of liver lesions in PET/CT and CEUS were found in 35 out of 64 patients (54%). Regarding renal lesions, a more definite diagnosis following ultrasound, causing a change of therapeutic approach, was achieved in 89%. Concordant results in PET/CT and US were found in 83% of patients with splenic and nodal findings. In 78% of patients with increased musculoskeletal or soft tissue tracer uptake, US was able to make a secured diagnosis with therapeutic changes. CONCLUSION The present results indicate a strong benefit of complementary imaging of PET/CT and selective, high-resolution ultrasound especially in patients with liver, renal and musculoskeletal or soft tissue findings.
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Affiliation(s)
- Janine Rennert
- Department of Radiology, University Hospital Regensburg, Regensburg, Germany
| | - Jirka Grosse
- Department of Nuclear Medicine, University Hospital Regensburg, Regensburg, Germany
| | - Ingo Einspieler
- Department of Radiology, University Hospital Regensburg, Regensburg, Germany
| | - Wolf Bäumler
- Department of Radiology, University Hospital Regensburg, Regensburg, Germany
| | | | - Ernst Michael Jung
- Department of Radiology, University Hospital Regensburg, Regensburg, Germany
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Kühn JP, Wagner M, Bozzato A, Linxweiler M. Multiple schwannomas of the facial nerve mimicking cervical lymphoma: a case report. J Med Case Rep 2021; 15:436. [PMID: 34412684 PMCID: PMC8377860 DOI: 10.1186/s13256-021-03006-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 07/09/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In this report, we describe the first case in literature of a patient with multiple schwannomas of the marginal mandibular branch of the facial nerve. CASE PRESENTATION A Caucasian patient presented with a sudden onset of left lower facial nerve palsy House-Brackmann score III for 1 month. Computed tomography imaging was performed to exclude a cerebral event and revealed multiple tumors within the left parotid gland. Duplex ultrasound and magnetic resonance imaging scans delineated multiple, hypoechoic tumors, round in shape and well defined without a hilar structure along the left mandible. For histological verification, a left-side partial parotidectomy and extirpation of an intraparotideal node was performed with use of a nerve-integrity monitor. Histomorphological analysis of the resected tissue revealed a benign schwannoma. Facial nerve function remained unchanged since the operation. The size of the nonresected tumors is currently monitored regularly by ultrasonography. Fibromatosis has been excluded. CONCLUSIONS If multiple tumors occur in the parotid gland and the angle of the jaw, schwannomas need to be considered as a differential diagnosis. To plan the right diagnostic surgical intervention and prevent nerve damage, a thorough ultrasound examination is essential in preoperative diagnostic work-up for any suspicious lesion of the parotid gland and jaw region.
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Affiliation(s)
- Jan Philipp Kühn
- Department of Otorhinolaryngology, Head and Neck Surgery, Saarland University Medical Center, Kirrbergerstr. 100, building 6, 66421, Homburg, Germany.
| | - Mathias Wagner
- Department of General and Surgical Pathology, Saarland University Medical Center, 66421, Homburg, Germany
| | - Alessandro Bozzato
- Department of Otorhinolaryngology, Head and Neck Surgery, Saarland University Medical Center, Kirrbergerstr. 100, building 6, 66421, Homburg, Germany
| | - Maximilian Linxweiler
- Department of Otorhinolaryngology, Head and Neck Surgery, Saarland University Medical Center, Kirrbergerstr. 100, building 6, 66421, Homburg, Germany
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