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Zhu Y, Tang Y, Jiang Z, Zhang J, Jia S, Li Y, Luo X, Kato T, Zhang G. Potential diagnostic value of quantitative superb microvascular imaging in premalignant and malignant cervical lesions. Front Oncol 2023; 13:1250842. [PMID: 37692857 PMCID: PMC10492516 DOI: 10.3389/fonc.2023.1250842] [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: 06/30/2023] [Accepted: 08/07/2023] [Indexed: 09/12/2023] Open
Abstract
Objective The purpose of this study was to assess the diagnostic efficacy of the vascular index (VI) on superb microvascular imaging (SMI) in distinguishing normal uterine cervical epithelium, high-grade cervical intraepithelial neoplasia (CIN), and cervical cancer. Methods The retrospective study included women with pathology-confirmed CIN or cervical cancer, who underwent transvaginal ultrasound and SMI between April 2021 and October 2022. The SIM manifestations of normal cervix and cervical lesions were reviewed. SIM were measured and converted into vascular index (VI) which compared between cervical lesions and control groups. We have retrospectively compared ultrasound features of cervical lesions and characteristics of patients. Measurement reliability was evaluated by intra class correlation coefficient (ICC). Results A total of 235 consecutive females were enrolled, comprising 38 with high-grade CIN, 96 with cervical cancer, and 101 with a normal uterine cervix. The microvascular architecture exhibited significant variations between premalignant and malignant cervical lesions. Branch-like patterns were predominantly observed in high-grade CIN, while crab claw-like and fireball-like patterns were more commonly associated with cervical cancer. The median VI of cervical cancer (34.7 ± 10.3) was significantly higher than that of high-grade CIN (17.6 ± 4.2) (P < 0.001). Moreover, the VI values of cervical cancer differed significantly among different FIGO stages and pathological types (P < 0.001 and P = 0.003, respectively). The VI demonstrated superior diagnostic performance for cervical lesions compared to vascular patterns (AUC = 0.974 and 0.969, respectively). Using a cut-off value of 25.5, the VI yielded a sensitivity of 82.3% and a specificity of 99.3% for cervical lesion detection. Conclusions The SMI parameter (VI) exhibited a significantly higher value in cervical cancer compared to high-grade CIN, with a high level of agreement among observers. These findings suggest that quantitative SMI holds promise as an imaging technique for the detection and characterization of cervical lesions.
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Affiliation(s)
- Yi Zhu
- Outpatient Department (Ultrasound), Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China (UESTC), Chengdu, China
- Department of Gynecology, National Cancer Center Hospital, Tokyo, Japan
| | - Yixin Tang
- Department of Ultrasound, Suining Central Hospital, Suining, China
| | - Zhuolin Jiang
- Outpatient Department (Ultrasound), Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China (UESTC), Chengdu, China
- Graduate School, Chengdu Medical College, Chengdu, China
| | - Jie Zhang
- Department Gynecological Oncology, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China (UESTC), Chengdu, China
| | - Shijun Jia
- Department Pathology, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China (UESTC), Chengdu, China
| | - Yanjie Li
- Outpatient Department (Ultrasound), Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China (UESTC), Chengdu, China
- Graduate School, Chengdu Medical College, Chengdu, China
| | - Xinyi Luo
- Outpatient Department (Ultrasound), Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China (UESTC), Chengdu, China
- Graduate School, Chengdu Medical College, Chengdu, China
| | - Tomoyasu Kato
- Department of Gynecology, National Cancer Center Hospital, Tokyo, Japan
| | - Guonan Zhang
- Department Gynecological Oncology, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China (UESTC), Chengdu, China
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Chami L, Giron A, Ezziane M, Leblond V, Charlotte F, Pellot-Barakat C, Lucidarme O. Quantitative and Qualitative Approach for Shear Wave Elastography in Superficial Lymph Nodes. ULTRASOUND IN MEDICINE & BIOLOGY 2021; 47:2117-2127. [PMID: 34059376 DOI: 10.1016/j.ultrasmedbio.2021.04.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 04/01/2021] [Accepted: 04/10/2021] [Indexed: 06/12/2023]
Abstract
The diagnostic contribution of 2-D shear-wave elastography (SWE) in management of superficial lymph nodes (LNs) of any origin was evaluated in 222 patients referred for needle core biopsy. Each patient underwent conventional B-mode/Doppler ultrasound examinations (conventional ultrasound) and SWE. Quantitative SWE parameters and qualitative SWE map features were extracted. Carcinomas were found to be significantly stiffer than benign LNs (29.5 ± 32.3 kPa vs. 6.7 ± 12.3 kPa). Lymphomas exhibited intermediate stiffness (11.4 ± 5.2 kPa). Qualitative SWE analysis provided color patterns specific to histopathology (stiff rim, nodular and undetermined patterns related to malignancy and blue pattern to benignity). Adding SWE to conventional ultrasound improved the sensitivity of LN diagnosis (from 81.1% to 92.0%) but decreased its specificity (from 73.2% to 67.6%) because of the high prevalence of lymphomas compared with carcinomas. Inter-observer agreement for quantitative SWE was good (intra-class correlation coefficient = 0.82) as was inter-observer diagnostic agreement for qualitative SWE (κ = 0.65). LN location and histology type were found to influence the reported diagnostic performance of SWE.
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Affiliation(s)
- Linda Chami
- Department of Radiology, Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France; LIB, INSERM, CNRS, UMR7371-U1146, Sorbonne University, Paris, France
| | - Alain Giron
- LIB, INSERM, CNRS, UMR7371-U1146, Sorbonne University, Paris, France
| | - Malek Ezziane
- Department of Radiology, Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France
| | - Véronique Leblond
- Department of Haematology, Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France
| | - Frédéric Charlotte
- Department of Pathology, Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France
| | - Claire Pellot-Barakat
- BioMaps, University Paris-Saclay, CEA, CNRS, INSERM, Service Hospitalier Frédéric Joliot, Orsay, France.
| | - Olivier Lucidarme
- Department of Radiology, Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France; LIB, INSERM, CNRS, UMR7371-U1146, Sorbonne University, Paris, France
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Rohan K, Ramesh A, Sureshkumar S, Vijayakumar C, Abdulbasith KM, Krishnaraj B. Evaluation of B-Mode and Color Doppler Ultrasound in the Diagnosis of Malignant Cervical Lymphadenopathy. Cureus 2020; 12:e9819. [PMID: 32953329 PMCID: PMC7495950 DOI: 10.7759/cureus.9819] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background B-mode ultrasound (BMUS) and color doppler ultrasound (CDUS) could be valuable in evaluating cervical lymphadenopathy compared to palpation. This study aimed at evaluating the efficacy of BMUS and CDUS in differentiating cervical lymph nodes into benign and malignant nature. Methodology In this cross-sectional analytical study, a total of 166 patients, who were referred for US-guided fine-needle aspiration cytology (FNAC) of cervical nodes, were included. Patients with cystic/ necrotic cervical nodes or without FNAC/biopsy report were excluded. All study patients underwent BMUS and CDUS, followed by the reference investigation of FNAC/biopsy for analysis. In BMUS, short-axis diameter (SAD), short-axis/long-axis diameter ratio (S/L), presence or absence of echogenic hilum and well defined or ill-defined borders were analyzed. In CDUS, the vascular pattern of a cervical node was categorized as hilar, peripheral or mixed. In cases with multiple cervical lymph nodes, the node having the most suspicious features on the greyscale US was chosen. The results were compared with the final FNAC/biopsy reports. Results A total of 166 patients were analyzed in this study. The cut-off point of SAD and S/L ratio for the cervical lymph nodes was 1.28cm and 0.595. The S/L ratio was the best BMUS parameter with a sensitivity of 75%, the specificity of 81%, and an accuracy of 79%. Loss of echogenic hilum was the most sensitive parameter in this study with a sensitivity of 95.4% and an accuracy of 79.5%. The presence of ill-defined margins was significantly higher in the malignant nodes than the benign nodes with a p-value <0.001. The presence of peripheral/mixed vascularity was higher in the malignant nodes than the benign nodes with a p-value <0.001. Conclusions Malignant nodes had significantly higher SAD, higher S/L ratio, loss of echogenic hilum, presence of ill-defined margins and peripheral/mixed vascularity compared to benign nodes. The loss of echogenic hilum was the most accurate and sensitive parameter, while the S/L ratio was found to be the most specific BMUS parameter in the detection of malignant nodes. BMUS and CDUS identify malignant nodes and also helps in guiding FNAC/biopsy.
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Affiliation(s)
- Kamat Rohan
- Radiodiagnosis, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
| | - Ananthakrishnan Ramesh
- Radiodiagnosis, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
| | - Sathasivam Sureshkumar
- Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
| | - Chellappa Vijayakumar
- Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
| | - K M Abdulbasith
- Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
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Enshaei A, Mohammadi A, Moosavi Toomatari SB, Yekta Z, Moosavi Toomatari SE, Ghasemi-Rad M, Shamspour SZ, Sarabi ZK, Sepehrvand N. Diagnostic value of a power Doppler ultrasound-based malignancy index for differentiating malignant and benign solid breast lesions. Indian J Cancer 2020; 57:44-48. [PMID: 31929234 DOI: 10.4103/ijc.ijc_424_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background Power Doppler ultrasound (PDUS) can provide useful information regarding the vascularity of breast lesions. The aim of this study was to investigate the diagnostic performance of a new PDUS-driven malignancy index in differentiating between malignant and benign causes of solid breast lesions. Materials and Methods Patients with solid breast lesions were enrolled consecutively and evaluated first by PDUS and subsequently by histopathologic assessment after undergoing surgical biopsy. A custom-made software was used to extract data from images for calculating malignancy index formula. Results A total of 87 patients with solid breast lesions were enrolled. Histopathologic evaluation identified 49 patients as benign and 38 patients as malignant. Malignancy index was significantly higher in the malignant group as compared to benign tumors (6.31 vs 0.30,P < 0.001). Area under the receiver operating characteristics (ROC) curve (AUC) was 0.98 (95% confidence interval (CI) 0.95-1.00). According to the ROC curve analysis, the cut-off point of 1.23 for malignancy index had a sensitivity and specificity of 94.7% (95% CI 82.2-99.3) and 94.0% (95% CI 83.1-98.7), respectively. Conclusion Comparing with the histopathologic evaluation as the gold standard for diagnosing breast lesions, PDUS-driven malignancy index was shown to have a high discriminative performance in identifying malignant lesions with high sensitivity, specificity, and diagnostic accuracy. The noninvasive nature of PDUS is an important advantage that could prevent unnecessary biopsies.
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Affiliation(s)
- Ali Enshaei
- Department of Surgery, Urmia University of Medical Sciences, Urmia, Iran
| | - Afshin Mohammadi
- Department of Radiology, Urmia University of Medical Sciences, Urmia, Iran
| | | | - Zahra Yekta
- Department of Community Medicine, Urmia University of Medical Sciences, Urmia, Iran
| | | | | | | | - Zahra Karimi Sarabi
- Department of Anesthesiology, Urmia University of Medical Sciences, Urmia, Iran
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Hong YR, Luo ZY, Mo GQ, Wang P, Ye Q, Huang PT. Role of Contrast-Enhanced Ultrasound in the Pre-operative Diagnosis of Cervical Lymph Node Metastasis in Patients with Papillary Thyroid Carcinoma. ULTRASOUND IN MEDICINE & BIOLOGY 2017; 43:2567-2575. [PMID: 28807450 DOI: 10.1016/j.ultrasmedbio.2017.07.010] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Revised: 07/04/2017] [Accepted: 07/11/2017] [Indexed: 06/07/2023]
Abstract
The objective of this study was to prospectively evaluate the diagnostic accuracy of contrast-enhanced ultrasonography (CEUS) in differentiating between benign and metastatic cervical lymph nodes in patients with papillary thyroid cancer (PTC). Three hundred nineteen cervical lymph nodes (162 metastatic from PTC and 157 benign) were evaluated using conventional ultrasonography (US) and CEUS before biopsy or surgery. Metastatic lymph nodes more often manifested centripetal or asynchronous perfusion, hyper-enhancement, heterogeneous enhancement, perfusion defects and ring-enhancing margins than benign lymph nodes at pre-operative CEUS (all p values < 0.001). The area under the receiver operating characteristic curve (AUC) for the combination of conventional US and CEUS (0.983, 95% confidence interval [CI]: 0.971-0.994) was higher than that of conventional US alone (0.929, 95% CI: 0.899-0.958) and CEUS (0.911, 95% CI: 0.876-0.947). In conclusion, CEUS is a promising tool in conjunction with conventional US for the pre-operative prediction of metastatic cervical lymph nodes in patients with PTC.
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Affiliation(s)
- Yu-Rong Hong
- Department of Ultrasound, Second Affiliated Hospital, Zhejiang University College of Medicine, Hangzhou City, Zhejiang Province, China
| | - Zhi-Yan Luo
- Department of Ultrasound, Second Affiliated Hospital, Zhejiang University College of Medicine, Hangzhou City, Zhejiang Province, China
| | - Guo-Qiang Mo
- Department of Ultrasound, Second Affiliated Hospital, Zhejiang University College of Medicine, Hangzhou City, Zhejiang Province, China
| | - Ping Wang
- Department of Surgery, Second Affiliated Hospital, Zhejiang University College of Medicine, Hangzhou City, Zhejiang Province, China
| | - Qin Ye
- Department of Pathology, Second Affiliated Hospital, Zhejiang University College of Medicine, Hangzhou City, Zhejiang Province, China
| | - Pin-Tong Huang
- Department of Ultrasound, Second Affiliated Hospital, Zhejiang University College of Medicine, Hangzhou City, Zhejiang Province, China.
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Lo WC, Cheng PW, Shueng PW, Hsieh CH, Chang YL, Liao LJ. A real-time prediction model for post-irradiation malignant cervical lymph nodes. Clin Otolaryngol 2017; 43:477-482. [PMID: 28981204 DOI: 10.1111/coa.12998] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/10/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To establish a real-time predictive scoring model based on sonographic characteristics for identifying malignant cervical lymph nodes (LNs) in cancer patients after neck irradiation. METHODS One-hundred forty-four irradiation-treated patients underwent ultrasonography and ultrasound-guided fine-needle aspirations (USgFNAs), and the resultant data were used to construct a real-time and computerised predictive scoring model. This scoring system was further compared with our previously proposed prediction model. RESULTS A predictive scoring model, 1.35 × (L axis) + 2.03 × (S axis) + 2.27 × (margin) + 1.48 × (echogenic hilum) + 3.7, was generated by stepwise multivariate logistic regression analysis. Neck LNs were considered to be malignant when the score was ≥ 7, corresponding to a sensitivity of 85.5%, specificity of 79.4%, positive predictive value (PPV) of 82.3%, negative predictive value (NPV) of 83.1%, and overall accuracy of 82.6%. When this new model and the original model were compared, the areas under the receiver operating characteristic curve (c-statistic) were 0.89 and 0.81, respectively (P < .05). CONCLUSIONS A real-time sonographic predictive scoring model was constructed to provide prompt and reliable guidance for USgFNA biopsies to manage cervical LNs after neck irradiation.
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Affiliation(s)
- W-C Lo
- Graduate Institute of Pathology, National Taiwan University College of Medicine, Taipei, Taiwan.,Department of Otolaryngology, Far Eastern Memorial Hospital, Taipei, Taiwan
| | - P-W Cheng
- Department of Otolaryngology, Far Eastern Memorial Hospital, Taipei, Taiwan
| | - P-W 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
| | - C-H 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
| | - Y-L Chang
- Graduate Institute of Pathology, National Taiwan University College of Medicine, Taipei, Taiwan.,Department of Pathology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - L-J Liao
- Department of Otolaryngology, Far Eastern Memorial Hospital, Taipei, Taiwan
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González-Arriagada WA, Santos-Silva AR, Vargas PA, Lopes MA. Diagnostic approach to intramasseteric nodules. Oral Surg Oral Med Oral Pathol Oral Radiol 2017; 123:e16-e21. [DOI: 10.1016/j.oooo.2016.10.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2016] [Revised: 09/30/2016] [Accepted: 10/08/2016] [Indexed: 10/20/2022]
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Manzo A, Benaglio F, Vitolo B, Bortolotto C, Zibera F, Todoerti M, Alpini C, Bugatti S, Caporali R, Calliada F, Montecucco C. Power Doppler ultrasonographic assessment of the joint-draining lymph node complex in rheumatoid arthritis: a prospective, proof-of-concept study on treatment with tumor necrosis factor inhibitors. Arthritis Res Ther 2016; 18:242. [PMID: 27770827 PMCID: PMC5075165 DOI: 10.1186/s13075-016-1142-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2016] [Accepted: 09/30/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Emerging research on the mechanisms of disease chronicity in experimental arthritis has included a new focus on the draining lymph node (LN). Here, we combined clinical-serological analyses and power Doppler ultrasound (PDUS) imaging to delineate noninvasively the reciprocal relationship in vivo between the joint and the draining LN in patients with rheumatoid arthritis (RA). METHODS Forty consecutive patients refractory to conventional synthetic disease-modifying anti-rheumatic drugs were examined through parallel PDUS of the hand-wrist joints and axillary LNs and compared with 20 healthy subjects. A semiquantitative score for LN gray-scale (GS) parameters (nodal hypertrophy and cortical structure) and LN PD signal was developed. A 6-month follow-up study with serial sonographic assessments was then performed on initiation of tumor necrosis factor (TNF) inhibitors. RESULTS PDUS analysis of RA axillary LNs revealed the existence of marked inter-individual heterogeneity and of quantitative differences compared with healthy individuals in both GS and PD characteristics. RA LN changes were plastic, responsive to anti-TNF treatment, and displayed a degree of concordance with synovitis activity in peripheral joints. However, low LN PD signal at baseline despite active arthritis was strongly associated with a poor clinical response to TNF blockade. CONCLUSIONS PDUS analysis of the draining LN in RA allows capture of measurable inter-individual differences and dynamic changes linked to the underlying pathologic process. LN and joint sonographic assessments are nonredundant approaches that may provide independent perspectives on peripheral disease and its evolution over time.
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Affiliation(s)
- Antonio Manzo
- Rheumatology and Translational Immunology Research Laboratories (LaRIT) and Biologic Therapy Unit, Division of Rheumatology, IRCCS Policlinico San Matteo Foundation/University of Pavia, P.le Golgi 19, 27100, Pavia, Italy.
| | - Francesca Benaglio
- Rheumatology and Translational Immunology Research Laboratories (LaRIT) and Biologic Therapy Unit, Division of Rheumatology, IRCCS Policlinico San Matteo Foundation/University of Pavia, P.le Golgi 19, 27100, Pavia, Italy
| | - Barbara Vitolo
- Rheumatology and Translational Immunology Research Laboratories (LaRIT) and Biologic Therapy Unit, Division of Rheumatology, IRCCS Policlinico San Matteo Foundation/University of Pavia, P.le Golgi 19, 27100, Pavia, Italy
| | - Chandra Bortolotto
- Division of Radiology, IRCCS Policlinico San Matteo Foundation/University of Pavia, Pavia, Italy
| | - Francesca Zibera
- Division of Radiology, IRCCS Policlinico San Matteo Foundation/University of Pavia, Pavia, Italy
| | - Monica Todoerti
- Rheumatology and Translational Immunology Research Laboratories (LaRIT) and Biologic Therapy Unit, Division of Rheumatology, IRCCS Policlinico San Matteo Foundation/University of Pavia, P.le Golgi 19, 27100, Pavia, Italy
| | - Claudia Alpini
- Laboratory of Biochemical-Clinical Analyses, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Serena Bugatti
- Rheumatology and Translational Immunology Research Laboratories (LaRIT) and Biologic Therapy Unit, Division of Rheumatology, IRCCS Policlinico San Matteo Foundation/University of Pavia, P.le Golgi 19, 27100, Pavia, Italy
| | - Roberto Caporali
- Rheumatology and Translational Immunology Research Laboratories (LaRIT) and Biologic Therapy Unit, Division of Rheumatology, IRCCS Policlinico San Matteo Foundation/University of Pavia, P.le Golgi 19, 27100, Pavia, Italy
| | - Fabrizio Calliada
- Division of Radiology, IRCCS Policlinico San Matteo Foundation/University of Pavia, Pavia, Italy
| | - Carlomaurizio Montecucco
- Rheumatology and Translational Immunology Research Laboratories (LaRIT) and Biologic Therapy Unit, Division of Rheumatology, IRCCS Policlinico San Matteo Foundation/University of Pavia, P.le Golgi 19, 27100, Pavia, Italy
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Ryoo I, Suh S, You SH, Seol HY. Usefulness of Microvascular Ultrasonography in Differentiating Metastatic Lymphadenopathy from Tuberculous Lymphadenitis. ULTRASOUND IN MEDICINE & BIOLOGY 2016; 42:2189-2195. [PMID: 27353493 DOI: 10.1016/j.ultrasmedbio.2016.05.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 03/22/2016] [Accepted: 05/16/2016] [Indexed: 06/06/2023]
Abstract
This study was undertaken to evaluate the usefulness of vascular pattern analysis on microvascular ultrasonography in distinguishing metastatic lymphadenopathy from tuberculous lymphadenitis, compared with conventional power Doppler ultrasonography, and to evaluate inter-observer agreement for microvascular ultrasonography. Thirty-four patients with metastatic lymphadenopathy and 27 patients with tuberculous lymphadenitis were included. The level of inter-observer agreement was excellent or good for all aspects of vascular pattern analysis on both ultrasonographic examinations. Vascular distribution, internal vascularity and internal vascular features of lymph nodes on microvascular ultrasonography differed significantly different (p ≤ 0.002) between metastatic lymphadenopathy and tuberculous lymphadenitis. A central vascular pattern with displacement was prevalent in metastasis, and an avascular pattern was more frequent in tuberculosis. Internal vascularity of metastasis was higher than that of tuberculosis. Vascular patterns on power Doppler ultrasonography did not differ significantly. Vascular pattern analysis using microvascular ultrasonography can be helpful in differentiating metastatic lymphadenopathy from tuberculous lymphadenitis with good inter-observer agreement.
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Affiliation(s)
- Inseon Ryoo
- Department of Radiology, Korea University Guro Hospital, College of Medicine, Seoul, Korea
| | - Sangil Suh
- Department of Radiology, Korea University Guro Hospital, College of Medicine, Seoul, Korea.
| | - Sung-Hye You
- Department of Radiology, Korea University Anam Hospital, College of Medicine, Seoul, Korea
| | - Hae Young Seol
- Department of Radiology, Korea University Guro Hospital, College of Medicine, Seoul, Korea
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Ying M, Cheng SCH, Ahuja AT. Diagnostic Accuracy of Computer-Aided Assessment of Intranodal Vascularity in Distinguishing Different Causes of Cervical Lymphadenopathy. ULTRASOUND IN MEDICINE & BIOLOGY 2016; 42:2010-2016. [PMID: 27131839 DOI: 10.1016/j.ultrasmedbio.2016.03.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Revised: 03/10/2016] [Accepted: 03/20/2016] [Indexed: 06/05/2023]
Abstract
Ultrasound is useful in assessing cervical lymphadenopathy. Advancement of computer science technology allows accurate and reliable assessment of medical images. The aim of the study described here was to evaluate the diagnostic accuracy of computer-aided assessment of the intranodal vascularity index (VI) in differentiating the various common causes of cervical lymphadenopathy. Power Doppler sonograms of 347 patients (155 with metastasis, 23 with lymphoma, 44 with tuberculous lymphadenitis, 125 reactive) with palpable cervical lymph nodes were reviewed. Ultrasound images of cervical nodes were evaluated, and the intranodal VI was quantified using a customized computer program. The diagnostic accuracy of using the intranodal VI to distinguish different disease groups was evaluated and compared. Metastatic and lymphomatous lymph nodes tend to be more vascular than tuberculous and reactive lymph nodes. The intranodal VI had the highest diagnostic accuracy in distinguishing metastatic and tuberculous nodes with a sensitivity of 80%, specificity of 73%, positive predictive value of 91%, negative predictive value of 51% and overall accuracy of 68% when a cutoff VI of 22% was used. Computer-aided assessment provides an objective and quantitative way to evaluate intranodal vascularity. The intranodal VI is a useful parameter in distinguishing certain causes of cervical lymphadenopathy and is particularly useful in differentiating metastatic and tuberculous lymph nodes. However, it has limited value in distinguishing lymphomatous nodes from metastatic and reactive nodes.
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Affiliation(s)
- Michael Ying
- Department of Health Technology and Informatics, Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong, China
| | - Sammy C H Cheng
- Department of Health Technology and Informatics, Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong, China
| | - Anil T Ahuja
- Department of Imaging and Interventional Radiology, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong, China.
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Transcutaneous Ultrasound: Elastographic Lymph Node Evaluation. Current Clinical Applications and Literature Review. ULTRASOUND IN MEDICINE & BIOLOGY 2015; 42:16-30. [PMID: 26489365 DOI: 10.1016/j.ultrasmedbio.2015.09.005] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Revised: 08/12/2015] [Accepted: 09/04/2015] [Indexed: 12/11/2022]
Abstract
Distinguishing malignant versus benign lymphadenopathies is a major diagnostic dilemma in clinical medicine. Metastatic deposits in normal-sized lymph nodes (LNs) can be smaller than a millimeter, thus presenting a diagnostic challenge. In most clinical settings, however, enlarged LNs detected on imaging need to be classified as malignant or benign. Ultrasound seems to be a very reliable method for LN characterization because of the high resolution, especially in the subcutaneous areas. However, B-mode and Doppler-ultrasound criteria for characterization of a lymphadenopathy as benign or malignant are lacking specificity. Newer methods such as elastography seem to be valuable for identifying metastatic deposits within LNs and may help discriminate malignant and benign LNs. This review summarizes the different elastographic methods available and provides an overview of the relevant publications. According to the literature, elastography can be used for identifying metastatic deposits, to guide fine needle aspiration and to non-invasively choose the most suspicious LN of a group of enlarged LNs for targeted biopsy.
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Ghafoori M, Azizian A, Pourrajabi Z, Vaseghi H. Sonographic Evaluation of Cervical Lymphadenopathy; Comparison of Metastatic and Reactive Lymph Nodes in Patients With Head and Neck Squamous Cell Carcinoma Using Gray Scale and Doppler Techniques. IRANIAN JOURNAL OF RADIOLOGY 2015; 12:e11044. [PMID: 26528381 PMCID: PMC4623781 DOI: 10.5812/iranjradiol.11044] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/07/2013] [Revised: 04/20/2013] [Accepted: 03/17/2014] [Indexed: 12/16/2022]
Abstract
Background: Cervical lymphadenopathy could be seen in several pathologic processes. An accurate differentiation between these conditions is of utmost importance to select an appropriate therapy and assess the prognosis. Gray scale and Doppler are appropriate sonographic techniques for evaluating internal and external features of lymph nodes. Although, various criteria have been proposed to differentiate metastatic lymph nodes from benign ones, the most valuable and specific sonographic features are still under dispute. Objectives: The present study was designed to determine valuable sonographic features for differentiating metastasis from benign nodes using gray scale and Doppler sonography. Patients and Methods: A prospective diagnostic study was performed on 63 patients with head and neck squamous cell carcinoma (SCC) treated and referred to surgery clinic of Hazrat Rasoul Akram hospital from November 2010 to June 2012 with complaint of palpable cervical lymph node. All patients’ necks were scanned multidirectionally by gray-scale and Doppler techniques. After sonography, lymph nodes were biopsied and investigated to find out whether they were metastatic or reactive. Finally, demographic, sonographic and pathologic data were statistically analyzed by SPSS ver. 16 software using t-test, a nonparametric test and ROC analysis. Ninety five percent confidence interval was considered for all parameters. Results: The study included 41 males and 22 females with a mean age of 57.56 ± 13.79 years. The number of metastatic lymph nodes was 47, while the remaining 16 were reactive. There were significant differences in length (P = 0.037), width (P = 0.001), resistance index (P < 0.001), pulsatility index (P < 0.001) and systolic velocity (P < 0.001) of metastatic and reactive lymph nodes. Cut points for resistive and pulsatility indexes and systolic velocity were calculated as 0.695, 1.35 and 16.5, respectively. The most valuable factor for defining a lymph node as metastatic was circulation pattern with accuracy, sensitivity and specificity of 94%, 85% and 93%, respectively. Conclusion: Gray scale sonography in combination with Doppler sonography could be a trustworthy technique in differentiating metastatic lymph nodes from reactive ones. Although, circulation pattern had a higher diagnostic accuracy in the present study, combination of sonographic characteristics could be more beneficial in differentiating metastatic cervical nodes from reactive ones.
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Affiliation(s)
- Mahyar Ghafoori
- Department of Radiology, Hazrat Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Amin Azizian
- Department of Radiology, Hazrat Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
- Corresponding author: Amin Azizian, Department of Radiology, Hazrat Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran. Tel: +98-2166509775, E-mail:
| | - Zahra Pourrajabi
- Hazrat Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Hamed Vaseghi
- Medical Student Research Committee (MSRC), Iran University of Medical Sciences, Tehran, Iran
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Lo WC, Liao LJ. Comparison of Two Elasticity Scoring Systems in the Assessment of the Cervical Lymph Nodes. J Med Ultrasound 2014. [DOI: 10.1016/j.jmu.2014.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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15
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Diagnosis of solid breast tumors using vessel analysis in three-dimensional power Doppler ultrasound images. J Digit Imaging 2014; 26:731-9. [PMID: 23296913 DOI: 10.1007/s10278-012-9556-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
This study aims to evaluate whether the distribution of vessels inside and adjacent to tumor region at three-dimensional (3-D) power Doppler ultrasonography (US) can be used for the differentiation of benign and malignant breast tumors. 3-D power Doppler US images of 113 solid breast masses (60 benign and 53 malignant) were used in this study. Blood vessels within and adjacent to tumor were estimated individually in 3-D power Doppler US images for differential diagnosis. Six features including volume of vessels, vascularity index, volume of tumor, vascularity index in tumor, vascularity index in normal tissue, and vascularity index in surrounding region of tumor within 2 cm were evaluated. Neural network was then used to classify tumors by using these vascular features. The receiver operating characteristic (ROC) curve analysis and Student's t test were used to estimate the performance. All the six proposed vascular features are statistically significant (p < 0.001) for classifying the breast tumors as benign or malignant. The A Z (area under ROC curve) values for the classification result were 0.9138. Accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of the diagnosis performance based on all six proposed features were 82.30 (93/113), 86.79 (46/53), 78.33 (47/60), 77.97 (46/59), and 87.04 % (47/54), respectively. The p value of A Z values between the proposed method and conventional vascularity index method using z test was 0.04.
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Fu X, Guo L, Lv K, Wang L, Ran W, Tan Q, Wang J, Liu X. Sonographic appearance of cervical lymphadenopathy due to infectious mononucleosis in children and young adults. Clin Radiol 2014; 69:239-45. [DOI: 10.1016/j.crad.2013.09.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2013] [Revised: 07/20/2013] [Accepted: 09/18/2013] [Indexed: 10/26/2022]
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Lai YS, Kuo CY, Chen MK, Chen HC. Three-dimensional doppler ultrasonography in assessing nodal metastases and staging head and neck cancer. Laryngoscope 2013; 123:3037-42. [DOI: 10.1002/lary.24219] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2013] [Revised: 05/01/2013] [Accepted: 05/01/2013] [Indexed: 11/10/2022]
Affiliation(s)
- Yu-Shih Lai
- Department of Otorhinolaryngology; Head and Neck Surgery, Changhua Christian Hospital, Changhua; Taiwan
| | - Chun-Ying Kuo
- Department of Otorhinolaryngology; Head and Neck Surgery, Changhua Christian Hospital, Changhua; Taiwan
| | - Mu-Kuan Chen
- Department of Otorhinolaryngology; Head and Neck Surgery, Changhua Christian Hospital, Changhua; Taiwan
- Mingdao University; Changhua Taiwan
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Real-time ultrasound elastography: an assessment of enlarged cervical lymph nodes. Eur Radiol 2013; 23:2351-7. [DOI: 10.1007/s00330-013-2861-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2013] [Revised: 03/13/2013] [Accepted: 03/25/2013] [Indexed: 02/07/2023]
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Teng DK, Wang H, Lin YQ, Sui GQ, Guo F, Sun LN. Value of ultrasound elastography in assessment of enlarged cervical lymph nodes. Asian Pac J Cancer Prev 2013; 13:2081-5. [PMID: 22901174 DOI: 10.7314/apjcp.2012.13.5.2081] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To investigate the value of ultrasound elastography (UE) in the differentiation between benign and malignant enlarged cervical lymph nodes (LNs). METHODS B-mode ultrasound, power Doppler imaging and UE were examined to determine LN characteristics. Two kinds of methods, 4 scores of elastographic classification and a strain ratio (SR) were used to evaluate the ultrasound elastograms. RESULTS The cutoff point of SR had high utility in differential diagnosis of benign and malignant of cervical lymph nodes, with good sensitivity, specificity and accuracy. CONCLUSION UE is an important aid in differential diagnosis of benign and malignant cervical LNs.
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Affiliation(s)
- Deng-Ke Teng
- Department of Ultrasonography, The 208th Hospital of PLA, Jilin University, Changchun, China
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Efficacy of colour Doppler ultrasound in diagnosis of cervical lymphadenopathy. J Maxillofac Oral Surg 2012; 12:123-9. [PMID: 24431828 DOI: 10.1007/s12663-012-0395-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2011] [Accepted: 05/28/2012] [Indexed: 10/28/2022] Open
Abstract
OBJECTIVES The purpose of the study was to evaluate the efficacy of colour doppler ultrasound (CDUS) in diagnosis of cervical lymphadenopathy. MATERIALS AND METHODS The study group consisted of 30 patients with clinical evidence of cervical lymphadenopathy (19 patients with clinically suspected reactive/benign cervical lymphadenopathy and 11 patients with clinically suspected malignant/metastatic cervical lymphadenopathy). CDUS examinations were carried out for one lymph node (LN) in each patient and fine needle aspiration cytology of the same LN was obtained. To evaluate the efficacy of CDUS, comparison between clinical features, CDUS features and cytological features of enlarged cervical LNs were then done. RESULTS Clinical examination evaluated 54 cervical LNs. CDUS evaluation discovered an additional 55 LNs (54 + 55 = 109). Accuracy of the CDUS examination was higher than clinical evaluation. Patterns of colour doppler flow signals when correlated with cytological diagnosis showed central flow for benign nodes and peripheral flow for malignant nodes. The mean pulsatility index (PI) was 1.977 ± 0.669 in LNs involved with metastases and 0.839 ± 0.135in LNs affected by benign processes. LNs involved with metastases showed a characteristic high resistive index (RI) and a high pulsatility index than the lymph nodes affected by benign processes. The RI and PI were significantly different between LNs affected by benign versus malignant disease. CONCLUSION Nodal vascularity of the LNs can be used to differentiate benign from malignant lymphadenopathy. CDUS can be trusted upon as a reliable marker for the diagnosis of cervical lymphadenopathy.
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Yen CH, Chiou HJ, Chou YH, Chiou SY, Chen WM, Chen W, Wang HK, Chang CY, Huo Teng MM. Application of 3D Power Doppler Ultrasonography in Soft Tissue Neoplasms. J Med Ultrasound 2011. [DOI: 10.1016/j.jmu.2011.03.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Chiou HJ, Chou YH, Chen WM, Chen W, Wang HK, Chang CY. Soft-tissue tumor differentiation using 3D power Doppler ultrasonography with echo-contrast medium injection. J Chin Med Assoc 2010; 73:628-33. [PMID: 21145510 DOI: 10.1016/s1726-4901(10)70137-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2010] [Accepted: 08/04/2010] [Indexed: 10/18/2022] Open
Abstract
BACKGROUND We aimed to evaluate the ability of 3-dimensional power Doppler ultrasonography to differentiate soft-tissue masses from blood flow and vascularization with contrast medium. METHODS Twenty-five patients (mean age, 44.1 years; range, 12-77 years) with a palpable mass were enrolled in this study. Volume data were acquired using linear and convex 3-dimensional probes and contrast medium injected manually by bolus. Data were stored and traced slice by slice for 12 slices. All patients were scanned by the same senior sonologist. The vascular index (VI), flow index (FI), and vascular-flow index (VFI) were automatically calculated after the tumor was completely traced. All tumors were later confirmed by pathology. RESULTS The study included 8 benign (mean, 36.5 mL; range, 2.4-124 mL) and 17 malignant (mean, 319.4 mL; range, 9.9-1,179.6 mL) tumors. Before contrast medium injection, mean VI, FI and VFI were, respectively, 3.22, 32.26 and 1.07 in benign tumors, and 1.97, 29.33 and 0.67 in malignant tumors. After contrast medium injection, they were, respectively, 20.85, 37.33 and 8.52 in benign tumors, and 40.12, 41.21 and 17.77 in malignant tumors. The mean differences between with and without contrast injection for VI, FI and VFI were, respectively, 17.63, 5.07 and 7.45 in benign tumors, and 38.15, 11.88 and 16.55 in malignant tumors. Tumor volume, VI, FI and VFI were not significantly different between benign and malignant tumors before and after echo-contrast medium injection. However, VI, FI and VFI under self-differentiation (differences between with and without contrast injection) were significantly different between malignant and benign tumors. CONCLUSION Three-dimensional power Doppler ultrasound is a valuable tool for differential diagnosis of soft-tissue tumors, especially with the injection of an echo-contrast medium.
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Affiliation(s)
- Hong-Jen Chiou
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C.
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Liao LJ, Wang CT, Young YH, Cheng PW. Real-time and computerized sonographic scoring system for predicting malignant cervical lymphadenopathy. Head Neck 2010; 32:594-8. [PMID: 19693943 DOI: 10.1002/hed.21225] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND To identify malignant cervical lymphadenopathy, we established a real-time, computerized scoring system based on sonographic findings and demographic data. METHODS One hundred eight patients with neck lymphadenopathy, receiving ultrasonography and ultrasound-guided fine-needle aspiration (US-FNA), were used to construct a predictive model. This model was validated by another independent patient cohort. RESULTS A predictive scoring scale was proposed by multivariate logistic regression analysis: 0.06 x (age) + 4.76 x (S/L ratio) + 2.15 x (internal echo) + 1.80 x (vascular pattern). Cervical lymphadenopathy was regarded as malignant with a score >or=7. The formula was programmed into a synchronized, computerized sonographic reporting system. Prospective validation of this predictive tool showed excellent sensitivity (100%), specificity (88.0%), and overall accuracy (90.1%). CONCLUSION A real-time and practical sonographic scoring system was built and validated to provide the physician prompt and reliable probability guidance for performing US-FNA cytology in managing cervical lymphadenopathy.
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Affiliation(s)
- Li-Jen Liao
- Department of Otolaryngology, Far Eastern Memorial Hospital, Taipei, Taiwan
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Tan R, Xiao Y, He Q. Ultrasound elastography: Its potential role in assessment of cervical lymphadenopathy. Acad Radiol 2010; 17:849-55. [PMID: 20540909 DOI: 10.1016/j.acra.2010.03.014] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2010] [Revised: 03/17/2010] [Accepted: 03/18/2010] [Indexed: 12/25/2022]
Abstract
RATIONALE AND OBJECTIVES The aims of this study were to investigate the value of ultrasound elastography (UE) in the diagnosis of lymphadenopathy and to explore whether UE could improve the differentiation between benign and malignant cervical lymph nodes (LNs). MATERIALS AND METHODS B-mode ultrasound, power Doppler imaging, and UE were performed in 107 consecutive patients with 128 cervical LNs. Only LNs that unequivocally matched between sonography and pathology were analyzed. The results of B-mode ultrasound, power Doppler imaging, and UE were interpreted separately to assess cervical LNs, using histopathologic analysis as the reference standard. RESULTS A marked difference (P = .000) was found in the strain ratio between 70 malignant LNs (median, 2.71; range, 1.36-36.09) and 58 benign LNs (median, 1.44; range, 0.62-3.90). Receiver-operating characteristic curves showed that a strain ratio > 1.5 had high utility in enlarged cervical LN classification, with 92.5% sensitivity, 53.4% specificity, and a Youden's index of 0.463. These results were significantly better than those obtained using the best grayscale criterion, a ratio of long-axis to short-axis diameter > 2, which yielded 58.6% sensitivity, 70% specificity, and a Youden's index of 0.286. The kappa values for interobserver agreement were highest using UE, at 0.881 (observer 1 vs observer 2), 0.828 (observer 1 vs observer 3), and 0.946 (observer 2 vs observer 3). CONCLUSIONS UE as an adjunct ultrasound modality holds some promise in screening and monitoring lymphadenopathy.
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Ouyang Q, Chen L, Zhao H, Xu R, Lin Q. Detecting metastasis of lymph nodes and predicting aggressiveness in patients with breast carcinomas. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2010; 29:343-352. [PMID: 20194931 DOI: 10.7863/jum.2010.29.3.343] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVE The purpose of this study was to evaluate the contrast-enhanced ultrasonographic (CEUS) characteristics of metastatic lymph nodes (LNs) and to determine the correlation of CEUS parameters with the tumor aggressiveness in patients with breast cancer. METHODS Real-time gray scale CEUS of axillary LNs was preoperatively performed in 51 consecutive patients with breast carcinoma who were scheduled for axillary lymph node dissection. The CEUS characteristics assessed by a direct visualization method and quantification software were compared with pathologic findings. Expression of human epidermal growth factor receptor 2 (HER-2/neu) in the primary tumor was detected by immunohistochemical analysis. Correlation analysis of CEUS parameters with HER-2/neu expression and the LN stage was performed. RESULTS Of the LNs examined, 27 were metastatic, and 25 were diagnosed as reactive hyperplasia. Lymph nodes with metastasis were characterized by centripetal progress (66.7%) and a heterogeneous pattern (55.6%) or no or scarce perfusion (25.9%). However, LNs with nonmetastases were characterized by with centrifugal enhancement (56.0%) and a homogeneous pattern (80.0%). The difference between the hyperintense and hypointense regions was higher in metastatic LNs than nonmetastatic ones (P < .001). No significant differences were found in the arrival time, time to peak intensity, and peak intensity between the two groups. A histopathologic diagnosis could be predicted with sensitivity, specificity, and accuracy of 92.6%, 76.0%, and 84.6% respectively, by a standardized difference between maximum and minimum signal intensity (SI(max)-SI(min)) value of 28. Human epidermal growth factor receptor 2 expression and the LN histopathologic stage were significantly associated with the SI(max)-SI(min). In metastatic LNs, the relationship between the diagnostic sensitivity of CEUS and the transverse diameter of LNs remained statistically significant (P < .05). CONCLUSIONS Noninvasive CEUS can play a role in discriminating metastatic from nonmetastatic LNs and predicting the aggressiveness in patients with breast cancer.
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Affiliation(s)
- Qiufang Ouyang
- Department of Ultrasonography, Second Affiliated People's Hospital of Fujian Traditional Chinese Medicine, Fuzhou, China
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26
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Chen CN, Lin JJ, Lee H, Cheng YM, Chang KJ, Hsieh FJ, Lai HS, Chang CC, Lee PH. Association between color doppler vascularity index, angiogenesis-related molecules, and clinical outcomes in gastric cancer. J Surg Oncol 2009; 99:402-8. [DOI: 10.1002/jso.21193] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Dangore-Khasbage S, Degwekar SS, Bhowate RR, Banode PJ, Bhake A, Choudhary MS, Lohe VK. Utility of color Doppler ultrasound in evaluating the status of cervical lymph nodes in oral cancer. ACTA ACUST UNITED AC 2009; 108:255-63. [PMID: 19272807 DOI: 10.1016/j.tripleo.2009.01.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2008] [Revised: 12/17/2008] [Accepted: 01/05/2009] [Indexed: 10/21/2022]
Abstract
OBJECTIVE The aim was to study the utility of color Doppler ultrasound (CDUS) in diagnosis of cervical lymphadenopathy in oral cancer patients. STUDY DESIGN In a prospective study, 70 cervical lymph nodes in 30 known primary oral cancer patients were evaluated with CDUS during a period of 8 months. The intranodal perfusion sites and vascular resistance were the key CDUS features used to differentiate between reactive and metastatic cervical lymph nodes. Histopathologic confirmations were obtained by excisional biopsy of the lymph nodes. The results of preoperative clinical palpation of cervical lymph nodes and CDUS evaluation were compared with histopathologic outcome. RESULTS Clinical evaluation suspected 61 cervical lymph nodes to be malignant. According to the CDUS, out of 70 nodes, 49 lymph nodes showed features of benign lymphadenopathy and 21 lymph nodes showed features of malignant lymphadenopathy, whereas histopathologic evaluations were in favor of reactive for 57 (81.42%) and for malignant lymphadenopathy in 13 (18.57%). CONCLUSION The CDUS evaluation was found to be highly significant with a sensitivity of 92.90% and a specificity of 84.21%, after comparing the CDUS findings with histopathologic findings.
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Dangore SB, Degwekar SS, Bhowate RR. Evaluation of the efficacy of colour Doppler ultrasound in diagnosis of cervical lymphadenopathy. Dentomaxillofac Radiol 2008; 37:205-12. [PMID: 18460573 DOI: 10.1259/dmfr/57023901] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES The purpose of the study was to evaluate the efficacy of colour Doppler ultrasound (CDUS) to differentiate between benign and malignant cervical lymph nodes. METHODS During a period of 12 months, 100 untreated patients with clinical evidence of cervical lymphadenopathy (50 patients with clinically suspected malignant/metastatic cervical lymphadenopathy and 50 patients with clinically suspected reactive/benign cervical lymphadenopathy) were prospectively evaluated with CDUS. CDUS was performed for 168 cervical lymph nodes in these 100 patients. Histopathological confirmations were obtained by fine needle aspiration biopsy and/or excisional biopsy. To evaluate the efficacy of CDUS, comparison between clinical features, CDUS features and cytological/histological features of enlarged cervical lymph nodes was then done. RESULTS Initially, clinical examination evaluated 143 cervical lymph nodes. CDUS evaluation discovered additional 25 lymph nodes (143+25 = 168). Correlation of patterns of colour Doppler flow signals with pathological diagnosis showed that central flow for benign nodes and peripheral flow for malignant nodes were highly significant parameters (P < 0.01). CDUS has a higher specificity than clinical evaluation, being 94.28% and 58.76%, respectively. Accuracy of the CDUS examination was also definitely higher than clinical evaluation at 92.85% and 63.67%, respectively. CONCLUSIONS Nodal vascularity can be used to differentiate benign from malignant lymphadenopathy. Proper judicious CDUS examination provides an opportunity to eliminate the need for biopsy/FNAC in reactive nodes.
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Affiliation(s)
- S B Dangore
- Department of Oral Medicine and Radiology, DMIMS, Sawangi (M), Wardha, Maharashtra 442004, India.
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Kuo WH, Chen CN, Hsieh FJ, Shyu MK, Chang LY, Lee PH, Liu LYD, Cheng CH, Wang J, Chang KJ. Vascularity change and tumor response to neoadjuvant chemotherapy for advanced breast cancer. ULTRASOUND IN MEDICINE & BIOLOGY 2008; 34:857-866. [PMID: 18374468 DOI: 10.1016/j.ultrasmedbio.2007.11.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2007] [Revised: 11/01/2007] [Accepted: 11/09/2007] [Indexed: 05/26/2023]
Abstract
For advanced breast cancer with severe local disease (ABC) (stage III/IV), neoadjuvant chemotherapy improves local control and surgical outcome. However, about approximately 20 to 30% of advanced cancers show either no or poor response to chemotherapy. To prevent unnecessary treatment, a capability of predicting clinical response to neoadjuvant chemotherapy of ABC is highly desirable. Vascularity index (VI) of breast cancers was derived from the quantification results in 30 ABC patients by using power Doppler sonography. Power Doppler sonography evaluation was performed every one to two weeks during chemotherapy. The overall response rate for 30 advanced patients tested was 70%, when 50% or more reduction in tumor size was the objective clinical response. Chemotherapy response was unrelated to the original tumor size (p = 0.563) or chemotherapy agents used (p = 0.657). The median VI for all 30 patients was 4.99%. The response rates for hypervascular tumors vs. hypovascular tumors, based on initial median value, were 86.7% and 53.3%, respectively (p = 0.109). The average VIs in responders and nonresponders were 7.67 +/- 4.77% and 4.01 +/- 3.82% (p = 0.052). There was a tendency for responders who have a relatively high initial vascularity. The VI change in responder group shows a pattern of initial increasing in vascularity followed by decreasing in vascularity. All patients (17/17) with a VI increment of >5% during chemotherapy had good chemotherapy response, whereas in patients with a VI increment of <5%, the response rate was 30.8% (4/13) (p < 0.001). For patients with a peak VI of >10% during chemotherapy, the response rate was 94.1% (16/17). However, in patients with a peak VI of <10%, the response rate was 38.5% (5/13) (p = 0.001). This prediction was made mostly within one month (25.47 +/- 12.96 d for VI increments >5% and 25.44 +/- 12.41 d for VI increased to >10%). In the meantime, the differences in size reduction shown in B-mode sonography were insignificant between responders and nonresponders (patient group with VI increment >5%, p = 0.308; patient group with peak VI >10%, p = 0.396). In conclusion, we propose that VI as determined by using power Doppler sonography is a good and inexpensive clinical tool for monitoring vascularity changes during neoadjuvant chemotherapy in ABC patients. Two parameters--VI increment >5% and peak VI >10%--are potential early predictors for good responses to neoadjuvant chemotherapy within one month in patients with ABC.
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Affiliation(s)
- Wen-Hung Kuo
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
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Huang SF, Chang RF, Moon WK, Lee YH, Chen DR, Suri JS. Analysis of tumor vascularity using three-dimensional power Doppler ultrasound images. IEEE TRANSACTIONS ON MEDICAL IMAGING 2008; 27:320-30. [PMID: 18334428 DOI: 10.1109/tmi.2007.904665] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Tumor vascularity is an important factor that has been shown to correlate with tumor malignancy and was demonstrated as a prognostic indicator for a wide range of cancers. Three-dimensional (3-D) power Doppler ultrasound (PDUS) offers a convenient tool for investigators to inspect the signals of blood flow and vascular structures in breast cancer. In this paper, a new computer-aided diagnosis (CAD) system for quantifying Doppler ultrasound images based on 3-D thinning algorithm and neural network is proposed. We extracted the skeleton of blood vessels from 3-D PDUS data to facilitate the capturing of morphological changes. Nine features including vessel-to-volume ratio, number of vascular trees, length of vessels, number of branching, mean of radius, number of cycles, and three tortuosity measures, were extracted from the thinning result. Benign and malignant tumors can therefore be differentiated by a score computed by a multilayered perceptron (MLP) neural network using these features as parameters. The proposed system was tested on 221 breast tumors, including 110 benign and 111 malignant lesions. The accuracy, sensitivity, specificity, and positive and negative predictive values were 88.69% (196/221), 91.89% (102/111), 85.45% (94/110), 86.44% (102/118), and 91.26% (94/103), respectively. The Az value of the ROC curve was 0.94. The results demonstrate a correlation between the morphology of blood vessels and tumor malignancy, indicating that the newly proposed method can retrieves a high accuracy in the classification of benign and malignant breast tumors.
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Affiliation(s)
- Sheng-Fang Huang
- Department of Medical Informatics, Tzu Chi University, Hualien, Taiwan 970, ROC.
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Nyman HT, Lee MH, McEvoy FJ, Nielsen OL, Martinussen T, Kristensen AT. Comparison of B-mode and Doppler ultrasonographic findings with histologic features of benign and malignant superficial lymph nodes in dogs. Am J Vet Res 2006; 67:978-84. [PMID: 16740090 DOI: 10.2460/ajvr.67.6.978] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To compare and correlate B-mode and color Doppler ultrasonographic characteristics with histopathologic findings of benign and malignant superficial lymph nodes in dogs. STUDY POPULATION 50 superficial lymph nodes that were normal, abnormally large on physical examination, or represented regional lymph nodes draining an area of suspected primary malignancy in 30 dogs. PROCEDURES Before excision, lymph nodes were evaluated via B-mode and color Doppler ultrasonography to assess size, echogenicity, presence of a hilus, acoustic transmission, and vascular flow. Formalin-fixed, paraffin-embedded tissue sections of excised lymph nodes were stained with H&E and examined for the presence and extent of necrosis, fibrosis, fat, metastases, and tissue heterogeneity. To assess vascularity, the number and distribution of vessels stained by the Verhoeff van Gieson technique were recorded. RESULTS In superficial lymph nodes, a varied echogenicity corresponded to tissue heterogeneity. The ultrasonographic detection of a hilus was associated with the presence of fibrous tissue, fat, or both in the hilar region. Acoustic enhancement corresponded to presence of areas of intranodal necrosis. There was significant correlation between both the distribution and the number of vessels detected via ultrasonography and that detected by histopathology. The amount of flow estimated via ultrasonography was typically higher than that estimated via histologic examination. CONCLUSIONS AND CLINICAL RELEVANCE Results indicated that histopathologic changes in canine lymph nodes have associated ultrasonographic changes and suggest that lymph node ultrasonography has an important role in the evaluation of lymph nodes in dogs in general and in dogs with neoplastic disease in particular.
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Affiliation(s)
- Helena T Nyman
- Department of Small Animal Clinical Sciences, The Royal Veterinary and Agricultural University, 1870 Frederiksberg, Denmark
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Alzahrani AS, Alsuhaibani H, Salam SA, Al Sifri SN, Mohamed G, Al Sobhi S, Sulaiman O, Akhtar M. Diagnostic accuracy of high-resolution neck ultrasonography in the follow-up of differentiated thyroid cancer: a prospective study. Endocr Pract 2005; 11:165-71. [PMID: 16239202 DOI: 10.4158/ep.11.3.165] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To conduct a prospective study of the diagnostic value of features of cervical lymph nodes (large size, central location, abnormal shape, cystic changes, calcifications, and loss of echogenic hilum), assessed by neck ultrasonography (US), in patients scheduled for surgical treatment of persistent or recurrent differentiated thyroid cancer. METHODS We studied 152 US abnormalities in 42 patients (median age, 38.5 years) who had undergone one or more neck operations, with or without radioiodine therapy, but continued to have persistent or recurrent disease, which was confirmed by fine-needle aspiration. Another surgical procedure was planned for these patients. On the day of operation, patients underwent a detailed US neck examination by an experienced radiologist. US abnormalities were plotted on a standard diagram of the neck and given specific numbers to help track them during surgical intervention and histopathologic examinations. The US features were compared with the final histopathologic diagnosis. RESULTS Of 152 US abnormalities, 127 involved cervical lymph nodes and 25 involved other types of tissue. In univariate analysis, size, absent echogenic hilum, cystic changes, calcifications, and central location (medial to the sternomastoid muscle) of cervical lymph nodes were significantly associated with the presence of metastatic involvement. In multivariate analysis, only central location (odds ratio, 4.07; 95% confidence interval [CI], 1.64 to 10.10) and size (odds ratio, 5.14; 95% CI, 1.64 to 16.06) remained significant. The receiver operating characteristic curve for the size of lymph nodes showed a large area under the curve of 0.77 (95% CI, 0.68 to 0.85), and a size of 7.5 mm showed the highest sensitivity and specificity. CONCLUSION Size and central location of cervical lymph nodes assessed by US during follow-up of patients with differentiated thyroid cancer were the most important predictors of presence of metastatic disease.
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Affiliation(s)
- Ali S Alzahrani
- Department of Medicine, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
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Nyman HT, Kristensen AT, Skovgaard IM, McEvoy FJ. CHARACTERIZATION OF NORMAL AND ABNORMAL CANINE SUPERFICIAL LYMPH NODES USING GRAY-SCALE B-MODE, COLOR FLOW MAPPING, POWER, AND SPECTRAL DOPPLER ULTRASONOGRAPHY: A MULTIVARIATE STUDY. Vet Radiol Ultrasound 2005; 46:404-10. [PMID: 16250399 DOI: 10.1111/j.1740-8261.2005.00074.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
The objective of this study was to characterize the ultrasonographic patterns of normal superficial lymph nodes and to evaluate whether ultrasonography can help discriminate between different lymphadenopathies (reactive, lymphoma, and metastases) in dogs. Three hundred and eighteen superficial lymph nodes in 142 dogs were studied by B-mode, color flow mapping, power, and spectral Doppler ultrasonography. Size, echogenicity, nodal border definition, presence of a nodal hilus, acoustic enhancement and distribution of vascular flow, as well as perfusion indices were measured. Multivariate statistics using discriminant analysis was used to determine which parameters can be used to predict the diagnosis of the lymph node. The size of the lymph node, distribution of vascular flow within the lymph node, and pulsatility index (PI) in combination gave a classification error of 23% for the four groups of lymph nodes. This was improved to 11% if the nodes were divided into two groups: benign and malignant. There was a significant difference in resistive index (RI) and PI between benign and malignant nodes. Cut-off values were determined using receiver operator curves, 0.68 RI and 1.49 PI.
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Affiliation(s)
- Helena T Nyman
- Department of Small Animal Clinical Sciences, The Royal Veterinary and Agricultural University, Copenhagen, Denmark.
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Zenk J, Bozzato A, Steinhart H, Greess H, Iro H. Metastatic and inflammatory cervical lymph nodes as analyzed by contrast-enhanced color-coded Doppler ultrasonography: quantitative dynamic perfusion patterns and histopathologic correlation. Ann Otol Rhinol Laryngol 2005; 114:43-7. [PMID: 15697161 DOI: 10.1177/000348940511400108] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Use of contrast-enhanced color-coded Doppler (ultra)sonography (CCDS) in evaluating enlarged lymph nodes has been subject to numerous attempts to define criteria for differentiation between benign and malignant lesions. Evaluation of dynamic perfusion patterns with contrast-enhanced CCDS in cervical lymph nodes offers new possibilities of differential diagnosis. A total of 28 patients with clinically enlarged lymph nodes were included in this study. Contrast-enhanced CCDS was performed on each patient. The color signals from nodes <15 mm in diameter were analyzed with a specialized computer program. Each node was later examined through immunohistochemical staining. Vascularization as shown by unenhanced CCDS was significantly greater in metastatic lymph nodes than in reactively enlarged lymph nodes (8.66% versus 2.81%; p = .01). The maximum vascularization area after contrast injection did not show any significant change (26.61% versus 28.63%; p = .75). Comparison of values obtained before and after contrast enhancement showed the largest relative increase in vascularization in inflammatory lymph nodes, from a factor of 19.55 to a factor of 10.03 (p = .025). Dynamic values such as contrast enhancement, behavior of dynamic values referred to time, and the evaluated vascularized area did not show any significant difference. The metastatic lymph nodes (5.46 versus 3.33; p = .007) predominantly consisted of large blood vessels. The increased vascularization in the unenhanced CCDS examination of metastatic lymph nodes seems to be associated with the increased number of large blood vessels. An increased vessel density, due to a greater number of total vessels, is related to an inflammatory process. Color Doppler mapping has been proven to depict useful aspects distinguishing benign from malignant lymph nodes of the neck; however, a definitive differentiation between lymph nodes involved with malignancy and inflammatory changes remains difficult.
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Affiliation(s)
- Johannes Zenk
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Erlangen-Nuremberg, Erlangen, Germany
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Nyman HT, Kristensen AT, Flagstad A, McEvoy FJ. A review of the sonographic assessment of tumor metastases in liver and superficial lymph nodes. Vet Radiol Ultrasound 2004; 45:438-48. [PMID: 15487569 DOI: 10.1111/j.1740-8261.2004.04077.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Diagnostic imaging techniques are an important part of the diagnostic workup and staging of cancer patients. Ultrasound is of particular interest in this respect. In so far as tumor metastases are concerned, ultrasonography of regional lymph nodes and of the liver can provide valuable information. In humans many criteria, some of them objective, have been evaluated as indicators of malignancy. The most diagnostically helpful of these include the short/long axis ratio of the lymph node, the pattern of distribution of the blood vessels within the lymph node, and to some extent the calculated values for resistive and pulsatility indices. Putative objective criteria to improve the specificity of ultrasound for metastases detection in the liver have also been evaluated. These include perfusion indices, primarily using analysis of Doppler frequencies (Doppler perfusion index) and hepatic venography using an ultrasound contrast agent. Contrast-enhanced ultrasonography is a new and promising area to help the initial diagnosis and characterization of malignancy, particularly for focal lesions in the liver. This review discusses the use of ultrasound for detection of metastases and presents material from four veterinary cases.
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Affiliation(s)
- Helena T Nyman
- Department of Small Animal Clinical Sciences, The Royal Veterinary and Agricultural University, The Small Animal Hospital, Dyrlaegevej 16, 1870 Frederikksberg C, Copenhagen, Denmark.
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Picardi M, Gennarelli N, Ciancia R, De Renzo A, Gargiulo G, Ciancia G, Sparano L, Zeppa P, Martinelli V, Pettinato G, Lobello R, Pane F, Rotoli B. Randomized Comparison of Power Doppler Ultrasound-Directed Excisional Biopsy With Standard Excisional Biopsy for the Characterization of Lymphadenopathies in Patients With Suspected Lymphoma. J Clin Oncol 2004; 22:3733-40. [PMID: 15365070 DOI: 10.1200/jco.2004.02.171] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose The sensitivity of lymph node excisional biopsy requires validation. Power Doppler ultrasound (US) helps predict the malignant status of lymphadenopathies. We used power Doppler US to select for biopsy the lymph node most suspected of malignancy. Patients and Methods One hundred fifty-two patients having lymphadenopathies with clinical suspicion of lymphoma were divided into two well-matched groups and randomly assigned to undergo either standard or power Doppler US-directed lymph node excisional biopsy. Results Histology showed a malignancy in 64% of patients in the standard group (lymphoma, 49 patients; carcinoma, two patients) and in 87% of patients in the US-assisted group (lymphoma, 62 patients; carcinoma, one patient). There were significantly fewer biopsy-related complications in the assisted group than in the standard group. During the follow-up of the patients with lymph nodes reported as being reactive, 14 of 29 patients in the standard group were rebiopsied and were found to have lymphoma (13 patients) or carcinoma at the subsequent lymph node histology, whereas none of the patients in the assisted group (nine patients) required a second biopsy. Thus, biopsy provided false-negative results for malignancy in 21% of patients affected by lymphoma in the standard group and never in the assisted group (P < .01). Conclusion Power Doppler US is an accurate tool for screening lymphadenopathies to be removed by excisional biopsy in patients with suspected lymphoma.
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Affiliation(s)
- Marco Picardi
- Department of Clinical and Experimental Medicine, CEINGE-Biotecnologie Avanzate, Federico II University Medical School, Naples, Italy
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Chen CA, Cheng WF, Lee CN, Su YN, Hsieh CY, Hsieh FJ. Power Doppler vascularity index for predicting the response of neoadjuvant chemotherapy in cervical carcinoma. Acta Obstet Gynecol Scand 2004; 83:591-7. [PMID: 15144343 DOI: 10.1111/j.0001-6349.2004.00522.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND To evaluate whether the power Doppler vascularity index (PDVI) can predict the response to neoadjuvant chemotherapy (NACT) in cervical carcinoma. METHODS Twenty-five women with bulky early stage cervical carcinoma treated by NACT followed by surgery were enrolled. Their response to NACT was evaluated. Clinical characteristics and pathologic data were recorded. Transvaginal power Doppler was performed before, during and after NACT. PDVI was detected using power Doppler and a quantitative image processing system. Factors that can potentially correlate with the response to NACT were analyzed. RESULTS Twelve (48%) patients showed a response (responders) to NACT and 13 (52%) were unchanged or had progressive disease (nonresponders) after NACT. Higher PDVI values were noted in tumors with lymphovascular emboli and pelvic lymph node metastasis both before and after NACT. The mean values of the PDVI of the nonresponders before (19.27 +/- 6.01 vs. 12.28 +/- 7.06, p = 0.014), during (20.2 +/- 1.5 vs. 12.9 +/- 2.1, p = 0.009) and after NACT (18.1 +/- 6.0 vs. 9.3 +/- 5.4, p = 0.001) were significantly higher than those of the responders. When the cutoff point for predicting nonresponders to NACT was set at a PDVI value of 15%, the sensitivity was 92.3% and the specificity 66.7%. CONCLUSIONS The power Doppler vascularity index can predict the response to neoadjuvant chemotherapy in cervical cancer, and might be useful for the evaluation of response to chemotherapy in cancer patients in the future.
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Affiliation(s)
- Chi-An Chen
- Department of Obstetrics and Gynecology, College of Medicine, National Taiwan University, Taipei, Taiwan
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Ying M, Ahuja A, Brook F. Accuracy of sonographic vascular features in differentiating different causes of cervical lymphadenopathy. ULTRASOUND IN MEDICINE & BIOLOGY 2004; 30:441-447. [PMID: 15121245 DOI: 10.1016/j.ultrasmedbio.2003.12.009] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2003] [Revised: 12/01/2003] [Accepted: 12/20/2003] [Indexed: 05/24/2023]
Abstract
This study was undertaken to evaluate the accuracy of the power Doppler sonographic features in differentiating cervical lymphadenopathy in different diseases. We reviewed power Doppler sonograms of 270 patients with palpable neck nodes (metastases n = 101, lymphoma n = 21, tuberculosis n = 76, reactive n = 72). Confirmed diagnosis was either made by fine-needle aspiration cytology on the largest node or by excision biopsy. In each patient, the largest node was included in the study. The node was evaluated using the vascular pattern, displacement of vascularity and vascular resistance (resistance index, RI, and pulsatility index, PI). Individual groups were compared and the optimum vascular feature in the differential diagnosis was determined. Vascular pattern was more useful in differentiating reactive nodes from malignant nodes, with a sensitivity of 88% for metastases and 67% for lymphoma, and a specificity of 100%. RI with a cut-off value of 0.8 was more accurate in distinguishing metastases (RI > 0.8) from lymphoma (RI < 0.8), with an accuracy of 65% and 75%, respectively. Displacement of vascularity was helpful to differentiate tuberculous nodes (accuracy: 67%) from reactive and lymphomatous nodes (accuracy: 100% and 95%, respectively), whereas PI with a cut-off of 1.5 helped the differentiation between tuberculosis (PI < 1.5) and metastases (PI > 1.5), with an accuracy of 77% in both diseases. When appropriate criteria are used, power Doppler sonography is a valuable adjunct in the sonographic evaluation of cervical lymphadenopathy.
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Affiliation(s)
- Michael Ying
- Department of Optometry and Radiography, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong, China.
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Ahuja A, Ying M. Sonographic evaluation of cervical lymphadenopathy: is power Doppler sonography routinely indicated? ULTRASOUND IN MEDICINE & BIOLOGY 2003; 29:353-359. [PMID: 12706185 DOI: 10.1016/s0301-5629(02)00759-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Routine sonographic examination of neck nodes now includes both grey-scale and Doppler sonography. Although the addition of Doppler sonography to the well-established practice of grey-scale sonography increases the amount of information obtained by sonography, it also increases the examination time, particularly if spectral Doppler and estimation of vascular resistance is performed. This study was, therefore, undertaken to evaluate whether Doppler sonography is routinely indicated in every case or its use should be limited to those cases where grey-scale sonography is equivocal. We evaluated the grey-scale and power Doppler sonograms of 101 fine-needle aspiration cytology (FNAC)-proven metastatic nodes and 72 FNAC-proven nonmetastatic nodes. All lymph nodes were evaluated with grey-scale and power Doppler sonography. The shape, echogenicity, internal architecture, vascular distribution and vascular resistance of the lymph nodes were evaluated. Grey-scale sonographic features evaluated in this study had a high sensitivity (95%) and specificity (83%) in classifying metastatic and nonmetastatic nodes. Metastatic and nonmetastatic lymph nodes that could not be classified by grey-scale sonography demonstrated Doppler features that helped in their correct identification. Power Doppler sonography is not necessary for every case in routine clinical practice, but is essential and useful in patients where grey-scale sonography is equivocal. In this study, power Doppler sonography aided in the diagnosis in 5% and 17% of patients with metastatic and nonmetastatic nodes, respectively.
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Affiliation(s)
- Anil Ahuja
- Department of Diagnostic Radiology and Organ Imaging, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, NT, Hong Kong.
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Epstein E, Skoog L, Isberg PE, De Smet F, De Moor B, Olofsson PA, Gudmundsson S, Valentin L. An algorithm including results of gray-scale and power Doppler ultrasound examination to predict endometrial malignancy in women with postmenopausal bleeding. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2002; 20:370-376. [PMID: 12383320 DOI: 10.1046/j.1469-0705.2002.00800.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
OBJECTIVE To determine if power Doppler ultrasound examination of the endometrium can contribute to a correct diagnosis of endometrial malignancy in women with postmenopausal bleeding and endometrium > or = 5 mm. METHODS Eighty-three women with postmenopausal bleeding and endometrium > or = 5 mm underwent gray-scale and power Doppler ultrasound examination using predetermined, standardized settings. Suspicion of endometrial malignancy at gray-scale ultrasound examination (endometrial morphology) was noted, and the color content of the endometrium at power Doppler examination was estimated subjectively (endometrial color score). Computer analysis of the most vascularized area of the endometrium was done off-line in a standardized manner. Stepwise multivariate logistic regression analysis was carried out to determine which subjective and objective ultrasound and power Doppler variables satisfied the criteria to be included in a model to calculate the probability of endometrial malignancy. RESULTS Endometrial thickness, vascularity index (vascularized area/endometrial area), and use of hormone replacement therapy (HRT) satisfied the criteria to be included in the model used to calculate the 'objective probability of endometrial malignancy'. Endometrial morphology, endometrial color score and HRT use satisfied the criteria to be included in the model to calculate the 'subjective probability of malignancy'. Endometrial thickness > or = 10.5 mm had a sensitivity with regard to endometrial cancer of 0.88 and a specificity of 0.61. At a fixed sensitivity of 0.88, the specificity of the 'objective probability of malignancy' (0.81) was superior to all other ultrasound and power Doppler variables (P = 0.001-0.02). The 'objective probability of malignancy' detected more malignancies at endometrium 5-15 mm than endometrial morphology (5/7 vs. 1/7, i.e. 0.71 vs. 0.14; P = 0.125) with a similar specificity (49/57 vs. 51/57, i.e. 0.86 vs. 0.89). CONCLUSION Power Doppler ultrasound can contribute to a correct diagnosis of endometrial malignancy, especially if the endometrium measures 5-15 mm. The use of regression models including power Doppler results to estimate the risk of endometrial cancer deserves further development.
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Affiliation(s)
- E Epstein
- Department of Obstetrics and Gynecology, Malmö University Hospital, Lund University, Sweden.
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Voit C, Schoengen A, Schwürzer-Voit M, Weber L, Ulrich J, Sterry W, Proebstle TM. The role of ultrasound in detection and management of regional disease in melanoma patients. Semin Oncol 2002; 29:353-60. [PMID: 12170438 DOI: 10.1053/sonc.2002.34113] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Melanoma follow-up programs are directed towards early detection of tumor recurrence. Because the majority of first relapses occur in the regional lymph node area, special focus is placed on this region using various techniques in addition to physical examination. During the last several years, particularly ultrasound B-scan has evolved as a technique of major importance for detection of such regional melanoma recurrences. The technique shows high sensitivity and specificity, discriminating regional or subcutaneous melanoma metastases from nonspecific nodes. Furthermore, suspicious findings can be evaluated quickly and reliably by the minimally invasive technique of ultrasound-guided fine-needle aspiration cytology (FNAC). For regional metastases located deeply or close to vulnerable structures, the new method of ultrasound-guided anchor-wire-marking facilitates subsequent surgery. In summary, ultrasound B-scan has become an essential technique in the follow-up of melanoma patients.
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Affiliation(s)
- Christiane Voit
- Department of Dermatology, Charité, Humboldt University of Berlin, Germany
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Ying M, Ahuja A, Brook F. Repeatability of power Doppler sonography of cervical lymph nodes. ULTRASOUND IN MEDICINE & BIOLOGY 2002; 28:737-744. [PMID: 12113786 DOI: 10.1016/s0301-5629(02)00523-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
This study was undertaken to investigate the repeatability (intraobserver variability) of power Doppler sonography in assessment of cervical lymph nodes. Power Doppler sonography was performed twice in 20 healthy subjects to evaluate the repeatability of measurement of size, blood flow velocity (peak systolic velocity, PSV, and end diastolic velocity, EDV) and vascular resistance (resistance index, RI, and pulsatility index, PI) of cervical nodes. A total of 70 power Doppler sonograms were reviewed to evaluate the repeatability of assessment of vascular pattern, degree of vascularity and displacement of vessels of cervical lymphadenopathy. In the 20 subjects, 139 normal cervical nodes were detected in the first scan and they were re-scanned in the second scan. One node was detected in the second scan, but not in the first scan. Of the total, 50 cervical nodes showed arterial flow in both scans, and blood flow velocity and vascularity resistance were measured. The mean value of PSV, EDV, RI and PI have a higher repeatability than their highest and lowest values. There is a high repeatability in the measurement of maximum transverse diameter (97%), mean PSV (95%), mean EDV (96%), mean RI (86%) and mean PI (87%). The repeatability in evaluation of vascular pattern (85%), degree of vascularity (95%) and displacement of vessels (88%) are also high. Results suggest that power Doppler sonography is a reliable method in assessment of the vasculature of cervical lymph nodes.
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Affiliation(s)
- Michael Ying
- Department of Optometry and Radiography, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong, China.
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Di Martino E, Krombach GA, Nowak B, Sellhaus B, Schmitz-Rode T, Hausmann R, Westhofen M. Color duplex sonography in post-therapeutic neck evaluation. Am J Otolaryngol 2002; 23:153-9. [PMID: 12019484 DOI: 10.1053/ajot.2002.123459] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE Assessment of the clinical utility of color duplex sonography for post-therapeutic evaluation of the neck. PATIENTS AND METHODS Eighty neck sides were evaluated in a prospective nonrandomized study during the post-therapeutic course. Of these, 74 previously had undergone surgery, and 60 subsequently had additional radiotherapy. The diagnostic procedures applied were clinical examination, computed tomography, positron emission tomography, and color duplex sonography. The mean observation period was 18.6 months. RESULTS Seven of 80 (8.75%) neck sides exhibited recurrent disease, and 76.2% of the lymph nodes resected during the postoperative observation period showed malignancy. Color duplex echography could detect all lymph nodes. Sensitivity was 100%, and the specificity was 95.8%. The sensitivity and specificity of computed tomography and positron emission tomography were found to be 85.7% and 97.2%, respectively. Palpation had a sufficient specificity (95.8%) but only a very poor 14.2% sensitivity in the post-therapeutic neck. CONCLUSION In complex tissue alterations of the post-therapeutic neck, color duplex echography is a highly sensitive and easily applied diagnostic procedure for the detection of recurrent disease. It allows a high-resolution depiction of intranodal vascularization and adjacent structures. Problems may occur in the evaluation of vessels in nodes with a diameter of 6 millimeters and below. This may impair specificity in some cases.
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Affiliation(s)
- Ercole Di Martino
- Department of ENT Diseases and Plastic Head and Neck Surgery, University of Aachen, Aachen, Germany
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Giovagnorio F, Galluzzo M, Andreoli C, De CML, David V. Color Doppler sonography in the evaluation of superficial lymphomatous lymph nodes. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2002; 21:403-408. [PMID: 11934097 DOI: 10.7863/jum.2002.21.4.403] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
OBJECTIVE We performed a retrospective study to document the sonographic and color Doppler characteristics of lymphomatous superficial lymph nodes. METHODS We selected 130 individuals who underwent sonography, color Doppler imaging, fine-needle aspiration biopsy, and surgical removal of the nodes with the final diagnosis of lymphoma (87) and chronic adenitis (43). During sonography, for each node we considered the longitudinal and axial diameters, long/short axis ratio, visibility of the hilum, and the internal echogenicity of the node. During the color and power Doppler examination, we classified the nodes into 3 patterns: type I, "hilar normal"; type II, "hilar activated"; and type III, "peripheral." RESULTS Sonographic evidence was not significant. With color Doppler sonography, 97% of nodes affected by non-Hodgkin lymphoma, 94% of nodes affected by Hodgkin lymphoma, and 100% of non-neoplastic nodes showed hilar vascularity. Type I seemed more frequently associated with inflammation, and type II was more frequently associated with lymphoma. CONCLUSIONS The presence of peripheric subcapsular vessels, which is typical of metastasis, is definitely rare in lymphoma (with the possible exception of the uncommon subtypes of high-grade lymphomas). The differential diagnosis between lymphoma and lymphadenitis is frequently impossible on the basis of sonographic and color Doppler patterns alone; therefore, clinical evaluation and biopsy are generally mandatory.
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Chen CN, Cheng YM, Lin MT, Hsieh FJ, Lee PH, Chang KJ. Association of color Doppler vascularity index and microvessel density with survival in patients with gastric cancer. Ann Surg 2002; 235:512-8. [PMID: 11923607 PMCID: PMC1422466 DOI: 10.1097/00000658-200204000-00009] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE The purpose of this study was to investigate the clinical usefulness of microvessel density (MVD) and an in vivo angiogenesis parameter, color Doppler vascularity index (CDVI), in patients with gastric cancer. SUMMARY BACKGROUND DATA Many studies have reported a significant association between the degree of MVD-evaluated angiogenesis with the clinicopathologic factors and prognosis of patients with various solid tumors. All these studies were accomplished on tissue sections retrospectively obtained from surgical specimens. However, an in vivo method to assess tumor angiogenesis for human malignancies is highly desirable for diagnostic purpose, treatment planning, and follow-up. The CDVI is a new ultrasound parameter for evaluating in vivo angiogenesis, has a good correlation with status of lymph node metastasis in cervical carcinoma, and can predict distant metastasis and survival in colon cancer patients. Therefore, the CDVI may also be useful to assess in vivo angiogenesis in human gastric cancer. METHODS A total of 79 patients with gastric cancer were enrolled in this study, and microvessel density was evaluated by using immunohistochemical staining of surgical specimens with anti-CD-34 antibody. Tumors were sonographically visible in 31 patients. The CDVI of each tumor was determined using transabdominal color Doppler ultrasound. The CDVI was defined as the ratio of the number of the colored pixels within a tumor section to the number of total pixels in that specific tumor section, and was calculated by using Encomate software (Electronic Business Machine Co. Ltd., Taipei, Taiwan). Correlation between MVD, CDVI and clinicopathologic factors and patient survival was studied. RESULTS The MVD was significantly correlated with vascular invasion by multiple linear regression analysis. Although the survival of patients with high MVD (> 32) was significantly worse than those with low MVD (< 32) by univariate analysis, vascular invasion was an independent prognostic factor by Cox proportional hazard model. There was a linear correlation between CDVI and MVD (r =.495, P =.005). Moreover, in patients with a high CDVI (> 11%), the survival rate was significantly lower than that in those with low CDVI (< or = 11%, P =.005). None of the patients with high CDVI (> 11%) survived 2 years after curative resection. In addition to vascular invasion, the CDVI was another independent prognostic factor in the patients with stage III gastric cancer. CONCLUSIONS Vascular invasion was an important prognostic indicator in gastric cancer. The high CDVI was a good preoperative indicator of early death in stage III gastric cancer patients. Thus, the CDVI may be helpful in selecting patients with gastric cancer for neoadjuvant chemotherapy and/or anti-angiogenic therapy.
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Affiliation(s)
- Chiung-Nien Chen
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
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Ying M, Ahuja A, Brook F. Gray scale and power Doppler sonography of normal cervical lymph nodes: comparison between Chinese and white subjects. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2002; 21:59-65. [PMID: 11794404 DOI: 10.7863/jum.2002.21.1.59] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
OBJECTIVE To investigate the racial difference in gray scale and power Doppler sonography of cervical lymph nodes between white and Chinese subjects. METHODS Twenty healthy white subjects and 20 healthy Chinese subjects had sonographic examination of the neck. They were age and sex matched. Lymph nodes were evaluated for their number, size, site, echogenic hilus, vascular pattern, degree of vascularity, blood flow velocity, and vascular resistance. RESULTS A total of 184 lymph nodes were detected in the 20 white subjects, and 196 lymph nodes were found in the 20 Chinese subjects. There were no significant differences in the number, size, and distribution of the lymph nodes between the 2 populations. One hundred ninety-six region- and size-matched lymph nodes were selected from the 2 groups of subjects (98 nodes from each group) for evaluation of echogenic hilus, vascular pattern, degree of vascularity, blood flow velocity, and vascular resistance. There was no significant difference in the gray scale and vascular features of cervical nodes between white and Chinese subjects. CONCLUSIONS There is no significant racial difference in the gray scale appearance of cervical lymph nodes. Unlike some other body regions, there is no significant vascular difference between white and Chinese populations. Results on power Doppler and gray scale sonographic assessment of cervical lymphadenopathy reported in previous studies may be applicable in both populations.
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Affiliation(s)
- Michael Ying
- Department of Optometry and Radiography, The Hong Kong Polytechnic University, Kowloon, China
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Ying M, Ahuja A, Brook F, Metreweli C. Vascularity and grey-scale sonographic features of normal cervical lymph nodes: variations with nodal size. Clin Radiol 2001; 56:416-9. [PMID: 11384142 DOI: 10.1053/crad.2000.0680] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
AIM This study was undertaken to investigate variations in the vascularity and grey-scale sonographic features of cervical lymph nodes with their size. MATERIALS AND METHODS High resolution grey-scale sonography and power Doppler sonography were performed in 1133 cervical nodes in 109 volunteers who had a sonographic examination of the neck. Standardized parameters were used in power Doppler sonography. RESULTS About 90% of lymph nodes with a maximum transverse diameter greater than 5 mm showed vascularity and an echogenic hilus. Smaller nodes were less likely to show vascularity and an echogenic hilus. As the size of the lymph nodes increased, the intranodal blood flow velocity increased significantly (P < 0.05), whereas there was no significant variation in the vascular resistance(P> 0.05). CONCLUSIONS The findings provide a baseline for grey-scale and power Doppler sonography of normal cervical lymph nodes. Sonologists will find varying vascularity and grey-scale appearances when encountering nodes of different sizes.Ying, M.et al. (2001). Clinical Radiology, 56, 416-419.
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Affiliation(s)
- M Ying
- Department of Optometry and Radiography, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong.
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Shimizu T, Hino K, Tauchi K, Ansai Y, Tsukada K. Predication of axillary lymph node metastasis by intravenous digital subtraction angiography in breast cancer, its correlation with microvascular density. Breast Cancer Res Treat 2000; 61:261-9. [PMID: 10966002 DOI: 10.1023/a:1006449619475] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Accurate predication of axillary node status by non-invasive diagnostic method would be of great value in cases of breast cancer. There have been few reports advocating digital subtraction angiography (DSA) as specifically advantageous for the detection of lymph node metastasis. IV (intravenous)-DSA was carried out on 42 patients with breast carcinoma using a DSA system with a matrix of 1024 x 1024 pixels. When a mass became stained in the axilla, it was considered to be metastatic. An immunohistochemical technique with JC70 antibody to platelet/endothelial cell adhesion molecules was used to evaluate the microvascular density (MVD) of the axillary lymph nodes. IV-DSA achieved a 76.2% sensitivity, 85.7% specificity, and 81.0% accuracy. The average MVD with JC70 antibody was 97.7 +/- 44.4 in metastatic and 62.9 +/- 23.6 in nonmetastatic nodes. MVD was significantly higher in the cancerous than in the noncancerous regions within lymph nodes. The MVD was 105 +/- 38.4 in DSA-N(+) cases and was 57.8 +/- 21.9 in DSA-N(-) cases, and the difference was statistically significant. In conclusion, IV-DSA is a useful diagnostic modality for detection of axillary lymph node metastasis. This new modality predicts lymph node status by assessing the neovascularization of the lymph node.
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Affiliation(s)
- T Shimizu
- Second Department of Surgery, Faculty of Medicine, Toyama Medical and Pharmaceutical University, Sugitani, Japan.
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Rizzatto G. Superficial structures. ULTRASOUND IN MEDICINE & BIOLOGY 2000; 26 Suppl 1:S116-S122. [PMID: 10794893 DOI: 10.1016/s0301-5629(00)00182-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Affiliation(s)
- G Rizzatto
- Department of Diagnostic Imaging, Ospedale Vittorio Emanuele III, Gorizia, Italy
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Abang Mohammed DK, Uberoi R, de B Lopes A, Monaghan JM. Inguinal node status by ultrasound in vulva cancer. Gynecol Oncol 2000; 77:93-6. [PMID: 10739696 DOI: 10.1006/gyno.1999.5702] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The objective of this study was to determine the value of ultrasound in preoperative assessment of groin node status in vulva cancer. MATERIALS AND METHODS Women with clinically uninvolved groins who were undergoing groin node dissection for vulva cancer in our department over an 18-month period were recruited into the study. A preoperative scan of each groin to be dissected was performed to identify any suspicious lymph nodes containing metastases. Suspicious nodes were defined by two sonographic criteria: short axis diameter (>8 mm) and a long axis/short axis ratio (L/S </= 2). Each suspicious node was sampled by ultrasound-guided fine-needle aspiration (FNA). RESULTS Twenty women, with an average age of 70 years, consented to the study. Seventeen had bilateral groin node dissection and three had unilateral groin node dissection. Six (16%) of the seventeen dissected groins contained metastases. Short axis had a better overall accuracy (89%) but failed to detect a singular micrometastasis. The L/S ratio identified all positive groins but had a high false-positive rate (62%) and an overall accuracy of 67%. The combination of both criteria did not improve the overall accuracy when compared with the individual criterion. FNA was not diagnostic in three, representative in two, and falsely negative in one. CONCLUSION Although L/S ratio has a lower overall accuracy, it correctly identified all groins with metastases. This has a great impact on treatment and prognosis. Its high false-positive rate may be improved by more diagnostic FNA. These sonographic criteria show good potential for segregating those with groin metastases requiring surgical treatment from those with uninvolved nodes. This experience has to be expanded to prove its clinical effectiveness.
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Affiliation(s)
- D K Abang Mohammed
- Gynaecological Oncology Centre/Radiology Department, Queen Elizabeth Hospital, Gateshead, NE9 6SX, United Kingdom
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