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Weng H, Hu H, Zhao Y, Xu Y, Chen P, Huang P. Clinical diagnostic model for predicting indolent or aggressive lymphoma based on clinical information and ultrasound features of superficial lymph nodes. Eur J Radiol 2024; 181:111738. [PMID: 39293239 DOI: 10.1016/j.ejrad.2024.111738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Revised: 08/17/2024] [Accepted: 09/14/2024] [Indexed: 09/20/2024]
Abstract
PURPOSE The aim of this study was to develop a diagnostic model for predicting indolent lymphoma or aggressive lymphoma using clinical information and ultrasound characteristics of superficial lymph nodes. METHOD Patients with confirmed pathological lymphoma subtypes who had undergone ultrasound and contrast-enhanced ultrasound examinations were enrolled. Clinical and ultrasound imaging features were retrospectively analysed and compared to the pathological results, which were considered the gold standard for diagnosis. Two diagnostic models were developed: a clinical model (Model-C) using clinical data only, and a combined model (Model-US) integrating ultrasound features into the clinical model. The efficacy of these models in differentiating between indolent and aggressive lymphoma was compared. RESULTS In total, 236 consecutive patients were enrolled, including 78 patients with indolent lymphomas and 158 patients with aggressive lymphomas. Receiver operating characteristic (ROC) curve analysis revealed that the areas under the curves of Model-C and Model-US were 0.78 (95 % confidence interval: 0.72-0.84) and 0.87 (95 % confidence interval: 0.82-0.92), respectively (p < 0.001). Model-US was further evaluated for calibration and is presented as a nomogram. CONCLUSIONS The diagnostic model incorporated clinical and ultrasound characteristics and offered a noninvasive method for assessing lymphoma with good discrimination and calibration.
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Affiliation(s)
- Huifang Weng
- Department of Ultrasound in Medicine, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China
| | - Huisen Hu
- Department of Ultrasound in Medicine, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China; Department of Ultrasound in Medicine, Lanxi People's Hospital, Jinhua, Zhejiang 321100, China
| | - Yanan Zhao
- Department of Ultrasound in Medicine, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China
| | - Yongyuan Xu
- Department of Ultrasound in Medicine, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China
| | - Panpan Chen
- Department of Haematology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China
| | - Pintong Huang
- Department of Ultrasound in Medicine, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China; Research Center for Life Science and Human Health, Binjiang Institute of Zhejiang University, Hangzhou 310053, China.
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Ni T, Feng N, Zhang X. Ultrasonographic and elastographic features of Rosai-Dorfman disease: A case report (with video). Asian J Surg 2024; 47:4215-4217. [PMID: 38806356 DOI: 10.1016/j.asjsur.2024.05.073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Accepted: 05/10/2024] [Indexed: 05/30/2024] Open
Affiliation(s)
- Tu Ni
- Department of Ultrasonography, Hangzhou Red Cross Hospital, Hangzhou, Zhejiang Province, China
| | - Na Feng
- Department of Ultrasonography, Hangzhou Red Cross Hospital, Hangzhou, Zhejiang Province, China
| | - Xu Zhang
- Department of Ultrasonography, Hangzhou Red Cross Hospital, Hangzhou, Zhejiang Province, China.
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Işık P, Belen Apak FB, Demir TA. Evaluation of Peripheral Lymphadenopathies in Children in a Single Center: Predictive Factors for Malignancy. KLINISCHE PADIATRIE 2024; 236:173-179. [PMID: 38729128 DOI: 10.1055/a-2266-0722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2024]
Abstract
BACKGROUND Lymphadenopathy (LAP) is a common finding in pediatric patients. It was aimed to determine predictive factors in distinguishing cases with malignant or benign lymphadenopathy in this study. SUBJECTS AND METHODS Between January 2022 and January 2023, 101 patients (1-16 years old) with lymphadenopathy were retrospectively examined. RESULTS LAP was localized in 80.2% (n=81) cases and generalized in 19.8% (n=20) cases. In 60 cases (59.4%), lymph node sizes were found to be greater than 20×20 mm in width and length. The most common infectious causative agent was Epstein Barr Virus (EBV). Seven (6.9%) patients underwent biopsy and all were diagnosed with malignancy. When the benign and malignant groups were compared, age, lymph node length, and width on physical examination, anteroposterior and longitudinal diameter of the lymph node on ultrasonography (USG) were statistically significantly higher in the malignant group (p<0.05). The presence of supraclavicular lymphadenopathy was found to be an important factor in differentiating the malignant group (p<0.003). The most important factors in distinguishing the groups are respectively were the anteroposterior diameter of the lymph node on ultrasonography and the presence supraclavicular lymph node in multivariate logistic regression analysis. CONCLUSION It is not always easy to distinguish benign and malignant etiologies in patients with lymphadenopathy. A detailed history, a careful physical examination, laboratory studies, and excisional biopsy are guiding.
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Affiliation(s)
- Pamir Işık
- Pediatric hematology, Başkent Üniversitesi, Ankara, Turkey
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Kuznetsov NS, Skibitskaya MV, Vaynshtok AP, Vashchenko EA. [Prediction of papillary thyroid cancer recurrence according to preoperative data]. Khirurgiia (Mosk) 2024:76-85. [PMID: 39268739 DOI: 10.17116/hirurgia202409176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/15/2024]
Abstract
OBJECTIVE To create a formalized method for predicting papillary thyroid cancer recurrence after hemithyroidectomy based on preoperative data. MATERIAL AND METHODS At this stage of the study, we selected 101 patients with papillary thyroid cancer who underwent surgical treatment in 2017-2023. Recurrence was observed in in 47 patients. Fifty-four patients had no recurrence within 5 years after surgical treatment, i.e. these patients underwent surgery in 2017-2018. To find prediction rules, we used original classification method based on searching for subsets of variables and piecewise linear rules separating classes in pairs with subsequent voting of such rules to make a decision. RESULTS The exam was carried out using a training sample (101 cases) and sliding control method (10 tests on 10 random cases). On the training sample, sensitivity of predictive algorithm was 91%, specificity 78% and error rate 13%. The aggregated result of 10 trials using sliding control method revealed sensitivity of predictive algorithm 86%, specificity 75% and error rate 15%. This result is close to overall sample and confirms the effectiveness of this method for predicting recurrence. CONCLUSION The pilot experiments revealed the patterns in data for potential prediction of recurrence based on preoperative indicators. Further study of this problem may be valuable for decision-making and adjustments in the management of patients with papillary thyroid cancer.
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Affiliation(s)
| | | | - A P Vaynshtok
- Kharkevich Institute for Information Transmission Problems, Moscow, Russia
| | - E A Vashchenko
- Kharkevich Institute for Information Transmission Problems, Moscow, Russia
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Meng S. [Ultrasound of the neck]. RADIOLOGIE (HEIDELBERG, GERMANY) 2023; 63:293-306. [PMID: 36881109 DOI: 10.1007/s00117-023-01131-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/16/2023] [Indexed: 03/08/2023]
Abstract
Ultrasound examination of the neck organs enables an assessment that in many cases is superior to that of magnetic resonance imaging and computed tomography. Ultrasound is therefore not only a first line or point of care imaging modality but can provide imaging for the concluding diagnosis in cases. Because of the good sonographic accessibility of the majority of the structures of the neck, many technical advances, in particular high-resolution ultrasound and signal post-processing have a major influence on the possibilities of ultrasound. Lymph nodes and salivary glands are the main focus in clinical applications, although other diseases and swellings of the neck can also be clarified with ultrasound. Special applications are ultrasound-guided interventions, e.g., biopsies or the sonographic assessment of peripheral nerves. As in any imaging modality, a comprehensive clinical knowledge is necessary for the diagnostic assessment. Because of constant assessment and thus continuous modification of the examination, ultrasound examinations may only be performed adequately with the appropriate clinical knowledge.
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Affiliation(s)
- Stefan Meng
- Radiologie, Hanusch-Krankenhaus, Heinrich-Collin-Straße 30, 1140, Wien, Österreich. .,Zentrum für Anatomie und Zellbiologie, Medizinische Universität Wien, Wien, Österreich.
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Li Z, Huang S, He Y, van Wijnbergen JW, Zhang Y, Cottrell RD, Smith SG, Hammond PT, Chen DZ, Padera TP, Belcher AM. A new label-free optical imaging method for the lymphatic system enhanced by deep learning. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.01.13.523938. [PMID: 36711668 PMCID: PMC9882203 DOI: 10.1101/2023.01.13.523938] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Our understanding of the lymphatic vascular system lags far behind that of the blood vascular system, limited by available imaging technologies. We present a label-free optical imaging method that visualizes the lymphatic system with high contrast. We developed an orthogonal polarization imaging (OPI) in the shortwave infrared range (SWIR) and imaged both lymph nodes and lymphatic vessels of mice and rats in vivo through intact skin, as well as human mesenteric lymph nodes in colectomy specimens. By integrating SWIR-OPI with U-Net, a deep learning image segmentation algorithm, we automated the lymph node size measurement process. Changes in lymph nodes in response to cancer progression were monitored in two separate mouse cancer models, through which we obtained insights into pre-metastatic niches and correlation between lymph node masses and many important biomarkers. In a human pilot study, we demonstrated the effectiveness of SWIR-OPI to detect human lymph nodes in real time with clinical colectomy specimens. One Sentence Summary We develop a real-time high contrast optical technique for imaging the lymphatic system, and apply it to anatomical pathology gross examination in a clinical setting, as well as real-time monitoring of tumor microenvironment in animal studies.
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Wang T, Xu M, Xu C, Wu Y, Dong X. Comparison of microvascular flow imaging and contrast-enhanced ultrasound for blood flow analysis of cervical lymph node lesions. Clin Hemorheol Microcirc 2023; 85:249-259. [PMID: 37694358 DOI: 10.3233/ch-231860] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Abstract
OBJECTIVE To compare the diagnostic value of microvascular flow imaging (MVFI) with that of contrast-enhanced ultrasound (CEUS) for the analysis of blood flow in benign and malignant cervical lymph nodes. MATERIAL AND METHODS As a prospective study, 95 cervical enlarged lymph nodes (43 benign and 52 malignant) were observed in 95 patients using conventional ultrasonography (including gray and Color Doppler Flow Imaging), CEUS, and MVFI. Two researchers evaluated vascular parameters of MVFI (vascular distribution, internal vascular features, vascular index) and CEUS (enhancement mode, enhancement type) and compared the diagnostic effects of MVFI and CEUS.All results were compared with pathological findings. RESULTS There were significant differences in the vascular distribution and internal vascular features of benign and malignant lymph nodes on MVFI (P < 0.05). The vascular distribution of benign lymph nodes was mainly of the central and avascular types, the internal blood vessels were mostly normal, the vascular distribution of malignant lymph nodes was mainly mixed, the internal vessels were mainly tortuous and displaced. The optimal cut-off value of the benign and malignant lymph node vascular index (VI) was 15.55%, and the area under the receiver operating characteristic curve (AUC) of the VI was 0.876. There were also significant differences in the enhancement mode and types of benign and malignant lymph nodes in CEUS (P < 0.05). The benign lymph nodes showed centrifugal perfusion, and the enhancement types were mostly type I and type II. Most malignant lymph nodes showed centripetal or mixed perfusion, and the enhancement types were usually type III and type IV. The accuracy, sensitivity, and specificity of CEUS in the diagnosis of lymph node lesions were 84.2%, 84.6% and 83.7%, respectively, and the AUC was 0.845. The accuracy, sensitivity, and specificity of MVFI in the diagnosis of lymph node lesions were 85.3%, 84.6%, and 86.0%, respectively, and the AUC was 0.886. CONCLUSION Both CEUS and MVFI are valuable in differentiating benign and malignant lesions of lymph nodes and have a similar diagnostic performance; however, MVFI is less invasive and simpler than CEUS. Therefore it is preferred for auxiliary examination of enlarged lymph nodes that are difficult to diagnose by conventional ultrasound.
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Affiliation(s)
- Tianqi Wang
- Department of Medical Ultrasound, The Fourth Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Mingda Xu
- Department of Medical Ultrasound, The Fourth Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Changyu Xu
- Department of Medical Ultrasound, The Fourth Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Yuqing Wu
- Department of Medical Ultrasound, The Fourth Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Xiaoqiu Dong
- Department of Medical Ultrasound, The Fourth Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
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Fakhry S, Abdel Rahman RW, Saied HM, Saif El-nasr SI. Can computed tomography predict nodal metastasis in breast cancer patients? THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2022. [DOI: 10.1186/s43055-022-00819-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Axillary lymph node metastasis is considered one of the main prognostic factors clinically used for the evaluation of breast cancer patient. Also, an accurate diagnosis of axillary lymph node metastasis has a significant effect on the tumor staging and treatment planning. Ultrasonography is a noninvasive, available imaging modality that is capable of giving a real-time evaluation of axillary lymph nodes in breast cancer cases. On the other hand, multi-detector-row computed tomography is increasingly preferred by clinicians to preoperatively evaluate regional lymph node status in many cancers. The aim of this study was to compare the diagnostic performance of computed tomography against ultrasound in detecting axillary lymph node status in breast cancer patients.
Results
One hundred and fifty breast cancer patients were included in this prospective study. According to the final pathological results, 79/150 (52.7%) lymph nodes were metastatic, while 71/150 (47.3%) lymph nodes were benign with no evidence of metastases. Ultrasound examination has achieved a sensitivity of 76.4% and a specificity of 60.8% with overall diagnostic accuracy of 68.7%. Computed tomography (CT) examination has achieved a much higher sensitivity of 98.6%, a much lower specificity of 35.4%, and overall diagnostic accuracy of 65.3%. In our study, CT examination was superior on ultrasound in the determination of the level of lymph node affection, and this may be attributed to the dependency of ultrasound examination on the operator’s experience.
Conclusions
CT is not routinely used in the assessment of nodal stage. However, if used in proper clinical setting, it may increase our confidence in excluding nodal metastasis owing to its high sensitivity. Despite its low specificity, it may act as road map for the surgeon, providing the ability to assess all groups of lymph nodes as well as the number of the suspicious lymph nodes.
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Jung HK, Lim YJ. Sonographic Features of Palpable Breast and Axillary Lesions in Adult Male Patients: A Pictorial Essay. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2022; 83:830-845. [PMID: 36238906 PMCID: PMC9514573 DOI: 10.3348/jksr.2021.0122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 07/28/2021] [Accepted: 10/15/2021] [Indexed: 11/15/2022]
Abstract
The male breast is a non-functional and rudimentary organ, but similarly to the female breast, it can be affected by various diseases. In contrast to female breast cancer, male breast cancer has a low incidence, and there is no established breast cancer screening program for male patients. Therefore, the diagnostic evaluation is usually performed in male patients with symptoms such as palpability or pain in the breasts. Furthermore, most adult male patients who visit breast clinics sometimes present with not only breast symptoms but also axillary symptoms, and both the breast and axilla are usually examined during breast ultrasonography in daily clinical practice. The purpose of this pictorial essay was to present the sonographic features of various palpable breast and axillary lesions in adult male patients.
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Chu J, Zhang Y, Zhang W, Zhao D, Xu J, Yu T, Yang G. The value of multimodal ultrasonography in differential diagnosis of tuberculous and non-tuberculous superficial lymphadenitis. BMC Surg 2021; 21:416. [PMID: 34906107 PMCID: PMC8670034 DOI: 10.1186/s12893-021-01418-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 12/01/2021] [Indexed: 12/21/2022] Open
Abstract
Background To investigate the value of multimodal ultrasonography in differentiating tuberculosis from other lymphadenopathy. Methods Sixty consecutive patients with superficial lymphadenopathy treated at our hospital from January 2017 to December 2018 were categorized into four types based on the color Doppler ultrasound, five types based on contrast-enhanced ultrasound, and five types based on elastography. Sensitivity and specificity were calculated of all the three imaging, including color Doppler examination, contrast-enhanced ultrasound and one individual multimodal method, for detecting lymph nodes. Results A total of 60 patients were included in the final analysis. Of those, Mycobacterium tuberculosis was positive in 38 patients and negative in 22 patients. Among the 38 patients who were positive for Mycobacterium tuberculosis, of which 23 had a history of pulmonary tuberculosis, accounting for 60.53% of the positive cases, and the remaining patients did not combine lesions of other organs. Among the 60 superficial lymph nodes, 63.3% presented with tuberculous lymphadenitis. The sensitivity, specificity, and accuracy of the color Doppler examination were 73.68%, 68.18%, and 71.67%, respectively. The sensitivity, specificity and accuracy of contrast-enhanced ultrasound were 89.47%, 63.64% and 80.00%, respectively. The sensitivity, specificity and accuracy of the elastography were 63.16%, 63.64% and 63.33%, respectively. The sensitivity, specificity and accuracy of one individual multimodal method were 42.11%, 95.45% and 61.67%, respectively. The sensitivity, specificity and accuracy of all modes combined were 100.00%, 27.27% and 73.33%, respectively. Conclusion Multimodal ultrasonography has high predictive value for the differential diagnosis of superficial tuberculous lymphadenitis.
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Affiliation(s)
- Jie Chu
- Department of Ultrasound, Zhejiang Hospital of Integrated Traditional Chinese and Western Medicine, 208 Huancheng East Road, Downtown District, Hangzhou, 310003, Zhejiang, China
| | - Ying Zhang
- Department of Ultrasound, Zhejiang Hospital of Integrated Traditional Chinese and Western Medicine, 208 Huancheng East Road, Downtown District, Hangzhou, 310003, Zhejiang, China
| | - Wenzhi Zhang
- Department of Ultrasound, Zhejiang Hospital of Integrated Traditional Chinese and Western Medicine, 208 Huancheng East Road, Downtown District, Hangzhou, 310003, Zhejiang, China
| | - Dan Zhao
- Department of Ultrasound, Zhejiang Hospital of Integrated Traditional Chinese and Western Medicine, 208 Huancheng East Road, Downtown District, Hangzhou, 310003, Zhejiang, China
| | - Jianping Xu
- Department of Ultrasound, Zhejiang Hospital of Integrated Traditional Chinese and Western Medicine, 208 Huancheng East Road, Downtown District, Hangzhou, 310003, Zhejiang, China
| | - Tianzhuo Yu
- Department of Ultrasound, Zhejiang Hospital of Integrated Traditional Chinese and Western Medicine, 208 Huancheng East Road, Downtown District, Hangzhou, 310003, Zhejiang, China
| | - Gaoyi Yang
- Department of Ultrasound, Zhejiang Hospital of Integrated Traditional Chinese and Western Medicine, 208 Huancheng East Road, Downtown District, Hangzhou, 310003, Zhejiang, China.
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Garganese G, Bove S, Fragomeni S, Moro F, Triumbari EKA, Collarino A, Verri D, Gentileschi S, Sperduti I, Scambia G, Rufini V, Testa AC. Real-time ultrasound virtual navigation in 3D PET/CT volumes for superficial lymph-node evaluation: innovative fusion examination. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2021; 58:766-772. [PMID: 33587289 DOI: 10.1002/uog.23613] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 01/11/2021] [Accepted: 02/05/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To evaluate the feasibility and clinical application of fusion imaging with virtual navigation, combining 18 F-fluorodeoxyglucose (18 F-FDG) positron emission tomography/computed tomography (PET/CT) with real-time ultrasound imaging, in assessing superficial lymph nodes in breast-cancer and gynecological-cancer patients. METHODS This was a pilot study of breast- and gynecological-cancer patients with abnormal uptake of 18 F-FDG by axillary or groin lymph nodes on PET/CT scan, examined at our institution between January 2017 and May 2019. Fusion imaging was performed, uploading preacquired PET/CT DICOM images onto the ultrasound machine and synchronizing them with real-time ultrasound scanning performed at the lymph-node site. In the first phase, we assessed the feasibility and reliability of fusion imaging in a series of 10 patients with suspicious lymph nodes on both PET/CT and ultrasound, and with full correspondence between both techniques in terms of size, shape and morphology of the lymph nodes (Group A). In the second phase, we included 20 patients with non-corresponding findings between PET/CT and ultrasound: 10 patients with lymph nodes that were suspicious or pathological on PET/CT scan but not suspicious on ultrasound assessment (Group B), and 10 patients with suspicious or pathological lymph nodes on both PET/CT and ultrasound but with no correspondence between the two techniques in terms of number of affected lymph nodes (Group C). RESULTS In the 30 selected patients, fusion imaging was assessed at 30 lymph-node sites (22 inguinal and eight axillary nodes). In the first phase (Group A), the fusion technique was shown to be feasible in all 10 lymph-node sites evaluated. In the second phase, fusion imaging was completed successfully in nine of 10 cases in Group B and in all 10 cases in Group C. In all groups, fusion imaging was able to identify the target lymph node, guiding the examiner to perform a core-needle aspiration biopsy or to inject radiotracer for selective surgical nodal excision, according to the radio-guided occult lesion localization technique. CONCLUSION Fusion imaging with virtual navigation, combining PET/CT and real-time ultrasound imaging, is technically feasible and able to detect target lymph nodes even when PET/CT and ultrasound findings are inconsistent. Fusion imaging can also be used to guide the performance of core-needle aspiration biopsy, avoiding further surgical diagnostic procedures, or the injection of radiotracer for selective surgical nodal excision, enabling more sparing, selective surgery. This innovative technique could open up multiple diagnostic and therapeutic opportunities in breast and gynecological oncology. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- G Garganese
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Gynecology and Breast Care Center, Mater Olbia Hospital, Olbia, Italy
| | - S Bove
- Gynecology and Breast Care Center, Mater Olbia Hospital, Olbia, Italy
| | - S Fragomeni
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - F Moro
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - E K A Triumbari
- Istituto di Medicina Nucleare, Università Cattolica del Sacro Cuore, Rome, Italy
| | - A Collarino
- UOC di Medicina Nucleare, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - D Verri
- Gynecology and Breast Care Center, Mater Olbia Hospital, Olbia, Italy
| | - S Gentileschi
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Istituto di Clinica Chirurgica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - I Sperduti
- Department of Biostatistics, Regina Elena National Cancer Institute, IRCCS, Rome, Italy
| | - G Scambia
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Dipartimento Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - V Rufini
- Istituto di Medicina Nucleare, Università Cattolica del Sacro Cuore, Rome, Italy
- UOC di Medicina Nucleare, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - A C Testa
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Dipartimento Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, Rome, Italy
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A Prospective Observational Study to Determine the Correlation of Clinical, Ultrasonography, and Pathological Examination of Cervical Lymph Nodal Staging in Oral Squamous Cell Carcinoma. Indian J Surg Oncol 2021; 12:512-516. [PMID: 34658578 DOI: 10.1007/s13193-021-01383-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Accepted: 07/05/2021] [Indexed: 10/20/2022] Open
Abstract
Oral cancer is one of the most common cancers in our population. These cancers are drained by the nodes located in the cervical region which are easily accessible for clinical examination. However, these cervical nodes may also be enlarged due to various other nonmalignant causes. Hence, accuracy of clinical examination and ultrasound screening for cervical lymph nodes is invaluable. The aims of this study are (1) to correlate the clinical, radiological, and pathological results of cervical lymph nodes in patients with oral malignancy and (2) to calculate the accuracy of clinical and radiological methods in detecting malignant cervical lymph nodes. A prospective observational study was undertaken from January 2016 to December 2016 amounting to a total of 76 patients. All patients diagnosed with squamous cell carcinoma of the oral cavity and having a palpable neck node(s), who were planned for surgery were included. Clinical examination, ultrasonographic (USG) screening of the neck, and the final histopathology reports were noted. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for radiological screening by ultrasound were 90.5%, 90.9%, 79.2%, and 96.2%, respectively, and that for clinical examination were 61.9%, 69.1%, 43.3%, and 82.6%, respectively. Area under the curve (AUC) for ultrasound screening was 0.907, and the AUC for clinical examination was 0.655. Ultrasonography is a reliable, cost-effective imaging method in the assessment of malignant cervical nodes in patients with oral cancer, which is to be used along with clinical palpation for improving the accuracy of clinical staging and surgical planning preoperatively.
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Qiu Y, Xing Z, Yang Q, Luo Y. Diagnostic value of supersonic shear impulse elastography for malignant cervical lymph nodes: a Bayesian analysis. Ultrasonography 2021; 41:279-290. [PMID: 34696539 PMCID: PMC8942728 DOI: 10.14366/usg.21107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 07/31/2021] [Indexed: 02/05/2023] Open
Abstract
Purpose This study aimed to assess the diagnostic performance of supersonic impulse (SSI) elastography in differentiating malignant and benign cervical lymph nodes. Methods The Medline, Embase, and Cochrane Central databases were searched until December 1, 2020. Two different reviewers checked the studies and extracted the data. The diagnostic yields were quantitatively synthesized using a Bayesian bivariate model with an integrated nested Laplace approximation in R. Results In total, 590 patients with 892 cervical lymph nodes who underwent SSI elastography were included. The total prevalence of malignancy was 33.7% (301/892), and the four elastic modulus values (mean, maximum, minimum, and standard deviation) were significantly different between malignant and benign lymph nodes. For the mean elastic modulus, the summary estimates for sensitivity and specificity were 0.720 (95% credible interval [CrI], 0.592 to 0.824) and 0.877 (95% CrI, 0.727 to 0.969), respectively. The estimated area under the curve (AUC) was 0.845 (95% CrI, 0.672 to 0.914). For the maximum elastic modulus, the sensitivity and specificity were estimated to be 0.809 (95% CrI, 0.698 to 0.899) and 0.816 (95% CrI, 0.643 to 0.924), respectively. The estimated AUC was 0.834 (95% CrI, 0.579 to 0.938). The minimum and standard deviation of the elastic modulus and the outcomes of the positive and negative likelihood ratio, diagnostic odds ratio, and risk difference were also calculated. Conclusion SSI elastography is an acceptable imaging technique for diagnosing malignant cervical lymph nodes, and it can play a complementary role today. Both maximum and mean elastic modulus values should be taken into consideration to make a clinical judgment.
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Affiliation(s)
- Yuxuan Qiu
- Department of Ultrasound, Sichuan University West China Hospital, Chengdu, China.,Center of Thyroid & Parathyroid Surgery, Sichuan University West China Hospital, Chengdu, China
| | - Zhichao Xing
- Center of Thyroid & Parathyroid Surgery, Sichuan University West China Hospital, Chengdu, China
| | - Qianru Yang
- Department of Ultrasound, Sichuan University West China Hospital, Chengdu, China
| | - Yan Luo
- Department of Ultrasound, Sichuan University West China Hospital, Chengdu, China
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14
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Fischerova D, Garganese G, Reina H, Fragomeni SM, Cibula D, Nanka O, Rettenbacher T, Testa AC, Epstein E, Guiggi I, Frühauf F, Manegold G, Scambia G, Valentin L. Terms, definitions and measurements to describe sonographic features of lymph nodes: consensus opinion from the Vulvar International Tumor Analysis (VITA) group. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2021; 57:861-879. [PMID: 34077608 DOI: 10.1002/uog.23617] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 11/29/2020] [Accepted: 02/08/2021] [Indexed: 06/12/2023]
Abstract
In centers with access to high-end ultrasound machines and expert sonologists, ultrasound is used to detect metastases in regional lymph nodes from melanoma, breast cancer and vulvar cancer. There is, as yet, no international consensus on ultrasound assessment of lymph nodes in any disease or medical condition. The lack of standardized ultrasound nomenclature to describe lymph nodes makes it difficult to compare results from different ultrasound studies and to find reliable ultrasound features for distinguishing non-infiltrated lymph nodes from lymph nodes infiltrated by cancer or lymphoma cells. The Vulvar International Tumor Analysis (VITA) collaborative group consists of gynecologists, gynecologic oncologists and radiologists with expertise in gynecologic cancer, particularly in the ultrasound staging and treatment of vulvar cancer. The work herein is a consensus opinion on terms, definitions and measurements which may be used to describe inguinal lymph nodes on grayscale and color/power Doppler ultrasound. The proposed nomenclature need not be limited to the description of inguinal lymph nodes as part of vulvar cancer staging; it can be used to describe peripheral lymph nodes in general, as well as non-peripheral (i.e. parietal or visceral) lymph nodes if these can be visualized clearly. The association between the ultrasound features described here and histopathological diagnosis has not yet been established. VITA terms and definitions lay the foundations for prospective studies aiming to identify ultrasound features typical of metastases and other pathology in lymph nodes and studies to elucidate the role of ultrasound in staging of vulvar and other malignancies. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- D Fischerova
- Department of Obstetrics and Gynecology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - G Garganese
- Gynecology and Breast Care Center, Mater Olbia Hospital, Olbia, Italy
- Dipartimento Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - H Reina
- Department of Gynecological Ultrasound and Prenatal Diagnostics, Women's Hospital, University Hospital of Basel, Basel, Switzerland
| | - S M Fragomeni
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | - D Cibula
- Department of Obstetrics and Gynecology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - O Nanka
- Institute of Anatomy, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - T Rettenbacher
- Department Radiologie, Universitäts Klinik für Radiologie II, Innsbruck, Austria
| | - A C Testa
- Dipartimento Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, Rome, Italy
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | - E Epstein
- Department of Clinical Science and Education, Karolinska Institute, Sodersjukhuset, Stockholm, Sweden
- Department of Obstetrics and Gynecology, Sodersjukhuset, Stockholm, Sweden
| | - I Guiggi
- Department of Obstetrics and Gynecology, North West Tuscany Hospital, Livorno, Italy
| | - F Frühauf
- Department of Obstetrics and Gynecology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - G Manegold
- Department of Gynecological Ultrasound and Prenatal Diagnostics, Women's Hospital, University Hospital of Basel, Basel, Switzerland
| | - G Scambia
- Dipartimento Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, Rome, Italy
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | - L Valentin
- Department of Obstetrics and Gynecology, Skåne University Hospital, Malmö, Sweden
- Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
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15
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Application of multimodal ultrasonography for differentiating benign and malignant cervical lymphadenopathy. Jpn J Radiol 2021; 39:938-945. [PMID: 33970452 DOI: 10.1007/s11604-021-01131-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 05/01/2021] [Indexed: 12/16/2022]
Abstract
OBJECTIVES The purpose of this study was to evaluate the diagnostic value of multimodal ultrasonography, including SWE and CEUS, for the differentiation of benign and malignant cervical lymphadenopathy. METHODS A total of 103 patients with 109 enlarged neck lymph nodes underwent SWE and CEUS. There were 25 hyperplastic lymph nodes, 66 metastatic lymph nodes, and 18 cases of lymphoma. RESULTS Using 31.6 kPa as the Emax cutoff, the sensitivity, specificity and accuracy of measurements on both benign and malignant cervical lymph nodes were 55.95%, 96%, and 65.2%, respectively. CEUS showed that lymph nodes with reactive hyperplasia mainly exhibited uniform perfusion via the lymphatic hilum (18/25; 72%; P < 0.01). The main manifestation of lymphoma was uniform perfusion through the lymphatic hila (10/18; 55.6%; P < 0.01). Metastatic lymph nodes mainly exhibited uneven perfusion (57/66; 86.4%; P < 0.01). The sensitivity, specificity, and accuracy of multimodal ultrasonography for the diagnosis of benign and malignant cervical lymphadenopathies were 90.5%, 72%, and 86.2%, respectively. CONCLUSIONS Our findings suggest that multimodal ultrasonography can detect the stiffness (elasticity), perfusion pattern, and characteristics of lymph nodes and is a valuable tool for differentiating between benign and malignant lymphadenopathies.
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16
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Yu TZ, Zhang Y, Zhang WZ, Yang GY. Role of ultrasound in the diagnosis of cervical tuberculous lymphadenitis in children. World J Pediatr 2021; 17:544-550. [PMID: 34472036 PMCID: PMC8523381 DOI: 10.1007/s12519-021-00453-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 08/11/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND To describe sonographic characteristics of cervical tuberculous lymphadenitis (CTBL) in children, clinical information, and sonograms of 348 lymph nodes (LNs) from 57 children with CTBL were retrospectively analyzed in this study. METHODS We retrospectively reviewed the clinical data and sonograms of 348 LNs from 31 boys and 26 girls with CTBL, who were confirmed by pathology or laboratory examination, at the Hangzhou Red Cross Hospital between June 2014 and December 2020. The age of the children ranged from 1 to 14 years (average 7.1 ± 2.9 years). RESULTS Night sweats, fatigue and loss of appetite were the most common clinical symptoms observed in children with CTBL. Unilateral LN involvements were common. Occasionally, CTBL was found in healthy children with no symptoms. On sonography, the hilus was absent or unclear in all LNs. The short-to-long axis (S/L) ratio was ≥ 0.5, and the edges were unclear in most LNs. Other accompanying findings included necrosis (47.4%), an echogenic thin layer (36.8%), surrounding soft-tissue edema (38.5%), multiple intra-nodal strong echo (28.2%), sinus (22.7%) and abscess formation (6.9%). The Doppler ultrasound showed that the majority of vascularity patterns of CTBL were capsular or peripheral (33.3%). CONCLUSIONS Ultrasound is a recommended examination method for children from different age groups with cervical lymphadenitis. The ultrasonic signs of hilus absence, S/L ratio ≥ 0.5, unclear edge, necrosis, echogenic thin layer, strong echoes and capsular or peripheral vascularity may aid in the diagnosis of cervical tuberculous lymphadenitis.
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Affiliation(s)
- Tian-Zhuo Yu
- Department of Ultrasonography, Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine, Chinese and Western Hospital of Zhejiang Province (Hangzhou Red Cross Hospital), No. 208 Huancheng East Road, Hangzhou, 310003, China
| | - Ying Zhang
- Department of Ultrasonography, Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine, Chinese and Western Hospital of Zhejiang Province (Hangzhou Red Cross Hospital), No. 208 Huancheng East Road, Hangzhou, 310003, China
| | - Wen-Zhi Zhang
- Department of Ultrasonography, Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine, Chinese and Western Hospital of Zhejiang Province (Hangzhou Red Cross Hospital), No. 208 Huancheng East Road, Hangzhou, 310003, China
| | - Gao-Yi Yang
- Department of Ultrasonography, Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine, Chinese and Western Hospital of Zhejiang Province (Hangzhou Red Cross Hospital), No. 208 Huancheng East Road, Hangzhou, 310003, China.
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17
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Garda AE, Navin PJ, Merrell KW, Martenson JA, Neben Wittich MA, Haddock MG, Sio TT, Rule WG, Ashman JB, Sheedy SP, Hallemeier CL. Patterns of inguinal lymph node metastases in anal canal cancer and recommendations for elective clinical target volume (CTV) delineation. Radiother Oncol 2020; 149:128-133. [DOI: 10.1016/j.radonc.2020.05.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 04/02/2020] [Accepted: 05/11/2020] [Indexed: 10/24/2022]
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18
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Zheng F, Li P, Bachawal SV, Wang H, Li C, Yuan W, Huang B, Paulmurugan R. Assessment of Metastatic and Reactive Sentinel Lymph Nodes with B7-H3-Targeted Ultrasound Molecular Imaging: A Longitudinal Study in Mouse Models. Mol Imaging Biol 2020; 22:1003-1011. [PMID: 32034623 PMCID: PMC11162558 DOI: 10.1007/s11307-020-01478-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
PURPOSE To explore the potential of B7-H3-targeted ultrasound molecular imaging (USMI) for longitudinal assessment and differentiation of metastatic and reactive sentinel lymph nodes (SLNs) in mouse models. PROCEDURES Metastatic and reactive SLN models were established by injection of 4T1 breast cancer cells and complete Freund's adjuvant (CFA) respectively to the 4th mammary fat pad of female BALB/c mice. At day 21, 28, and 35 after inoculation, USMI was performed following intravenous injection of B7-H3-targeted microbubbles (MBB7-H3) or IgG-control microbubbles (MBcontrol). All SLNs were histopathologically examined after the last imaging session. RESULTS A total of 20 SLNs from tumor-bearing mice (T-SLNs) and five SLNs from CFA-injected mice (C-SLNs) were examined by USMI. Nine T-SLNs were histopathologically positive for metastasis (MT-SLNs). From day 21 to 35, T-SLNs showed a rising trend in MBB7-H3 signal with a steep increase in MT-SLNs at day 35 (213.5 ± 80.8 a.u.) as compared to day 28 (87.6 ± 77.2 a.u., P = 0.002) and day 21 (55.7 ± 35.5 a.u., P < 0.001). At day 35, MT-SLNs had significantly higher MBB7-H3 signal than non-metastatic T-SLNs (NMT-SLNs) (101.9 ± 48.0 a.u., P = 0.001) and C-SLNs (38.5 ± 34.0 a.u., P = 0.001); MBB7-H3 signal was significantly higher than MBcontrol in MT-SLNs (P = 0.001), but not in NMT-SLNs or C-SLNs (both P > 0.05). A significant correlation was detected between MBB7-H3 signal and volume fraction of metastasis in MT-SLNs (r = 0.76, P = 0.017). CONCLUSIONS B7-H3-targeted USMI allows differentiation of MT-SLNs from NMT-SLNs and C-SLNs in mouse models and has great potential to evaluate tumor burden in SLNs of breast cancer.
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Affiliation(s)
- Fengyang Zheng
- Department of Radiology, Molecular Imaging Program at Stanford (MIPS), Stanford University School of Medicine, 3155 Porter Drive, Palo Alto, CA, 94305, USA
- Department of Ultrasound, Zhongshan Hospital, Fudan University, 180 Fenglin Rd, Shanghai, 200032, People's Republic of China
- Shanghai Institute of Medical Imaging, Shanghai, 200032, People's Republic of China
| | - Pan Li
- Department of Radiology, Molecular Imaging Program at Stanford (MIPS), Stanford University School of Medicine, 3155 Porter Drive, Palo Alto, CA, 94305, USA
- Institute of Ultrasound Imaging of Chongqing Medical University, Chongqing, 400010, People's Republic of China
- Department of Ultrasound, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, People's Republic of China
| | - Sunitha V Bachawal
- Department of Radiology, Molecular Imaging Program at Stanford (MIPS), Stanford University School of Medicine, 3155 Porter Drive, Palo Alto, CA, 94305, USA
| | - Huaijun Wang
- Department of Radiology, Molecular Imaging Program at Stanford (MIPS), Stanford University School of Medicine, 3155 Porter Drive, Palo Alto, CA, 94305, USA
| | - Chaolun Li
- Department of Ultrasound, Zhongshan Hospital, Fudan University, 180 Fenglin Rd, Shanghai, 200032, People's Republic of China
- Shanghai Institute of Medical Imaging, Shanghai, 200032, People's Republic of China
| | - Wei Yuan
- Department of pathology, Zhongshan Hospital, Fudan University, 180 Fenglin Rd, Shanghai, 200032, People's Republic of China
| | - Beijian Huang
- Department of Ultrasound, Zhongshan Hospital, Fudan University, 180 Fenglin Rd, Shanghai, 200032, People's Republic of China.
- Shanghai Institute of Medical Imaging, Shanghai, 200032, People's Republic of China.
| | - Ramasamy Paulmurugan
- Department of Radiology, Molecular Imaging Program at Stanford (MIPS), Stanford University School of Medicine, 3155 Porter Drive, Palo Alto, CA, 94305, USA.
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19
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Using Point-of-Care Ultrasound to Characterize Acute Inguinal Swelling of Young Children in the Pediatric Emergency Department. Pediatr Emerg Care 2020; 36:304-307. [PMID: 32011551 DOI: 10.1097/pec.0000000000002014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Acute inguinal swelling in young children is frequently assumed to be an inguinal hernia, often prompting a bedside reduction attempt. We report 3 cases of inguinal swelling where the use of point-of-care ultrasound changed the patients' management by identifying an alternate diagnosis, thus avoiding unnecessary and painful procedures as well as their associated sedation risks.
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20
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Nie J, Ling W, Yang Q, Jin H, Ou X, Ma X. The Value of CEUS in Distinguishing Cancerous Lymph Nodes From the Primary Lymphoma of the Head and Neck. Front Oncol 2020; 10:473. [PMID: 32373513 PMCID: PMC7186353 DOI: 10.3389/fonc.2020.00473] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Accepted: 03/16/2020] [Indexed: 02/05/2023] Open
Abstract
Aim: The purpose of this study was to assess the ability of contrast-enhanced ultrasonography (CEUS) in the differential diagnosis of cancerous lymph nodes. Methods: Contrast-enhanced ultrasonography was performed in the cervical nodules of included patients, and the diagnoses were confirmed by pathological examination. Contrast-enhanced ultrasonography images and parameters of head and neck lymphomas were compared with those of cancerous lymph nodes. Besides, receiver operating characteristic curve was operated to access the diagnostic value of CEUS. Results: Finally, a total of 63 head and neck lymphomas and 80 cervical cancerous lymph nodes were enrolled in this study. Results showed that the CEUS images of lymphoma were mainly characterized by homogeneous enhancement (71.43%), and approximately half of them were centripetal perfusion (58.73%), whereas most CEUS images of cancerous lymph nodes were inhomogeneous enhancement (82.50%) and centripetal perfusion (92.50%). Quantitative analysis of CEUS parameters indicated that PI (derived peak intensity) and AUC (area under the curve) of lymphomas were both lower than those of cancerous lymph nodes (PI: 8.78 vs. 10.51, AUC: 652.62 vs. 784.09, respectively) (P < 0.05). Receiver operating characteristic analysis showed that the sensitivity of CEUS parameters in the differential diagnosis was significant (80.00%), although the specificity was not high (47.62%). When parameters were combined with the image features, the accuracy of diagnosis was greatly improved (from 0.655 to 0.899). Conclusion: Contrast-enhanced ultrasonography could be a promising tool for the differential diagnosis of head and neck lymphomas and cancerous lymph nodes.
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Affiliation(s)
- Ji Nie
- Department of Biotherapy, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University and Collaborative Innovation Center of Biotherapy, Chengdu, China.,West China School of Medicine, Sichuan University, Chengdu, China
| | - Wenwu Ling
- Department of Ultrasound, West China Hospital, Sichuan University, Chengdu, China
| | - Qianru Yang
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Hongyu Jin
- West China School of Medicine, Sichuan University, Chengdu, China.,Department of Liver Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Xuejin Ou
- Department of Oncology, West China Hospital, Sichuan University, Chengdu, China
| | - Xuelei Ma
- Department of Biotherapy, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University and Collaborative Innovation Center of Biotherapy, Chengdu, China
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21
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Comparison of Diagnostic Performance of B-Mode Ultrasonography and Shear Wave Elastography in Cervical Lymph Nodes. Ultrasound Q 2019; 35:290-296. [PMID: 31283566 DOI: 10.1097/ruq.0000000000000464] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The purpose of this study was to compare the diagnostic performance of B-mode ultrasonography (US) and shear wave elastography (SWE) for differentiating benign from malignant cervical lymph nodes (LNs). This study evaluated 130 cervical LNs in 127 patients. On conventional B-mode US, short-axis and long-axis diameters, long-to-short-axis ratio, cortical morphology, border, and presence of necrosis or calcification were evaluated. Maximum elasticity value (Emax) was collected for SWE. The area under the receiver operator characteristic curve (AUC), sensitivity, and specificity of B-mode US features and SWE were compared. Final histopathologic results showed 89 benign and 41 metastatic LNs. Among the B-mode US features, cortical morphology had the highest AUC (0.884). When 54 kPa of Emax was applied as a cutoff value, the SWE showed significantly lower AUC than cortical morphology (0.734, P = 0.02). Both sensitivity and specificity for cortical morphology on B-mode US were higher than for Emax (80.5% vs 65.9%, P = 0.212 and 89.9% vs 76.4%, P = 0.026, respectively). Conventional B-mode US resulted in higher diagnostic yield than SWE in evaluating cervical LNs in our study. However, further studies on potential factors that may affect the SWE velocity are needed to validate the diagnostic value of SWE.
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22
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Tarrazo Suárez JA, Morales Cano JM, Pujol Salud J, Sánchez Barrancos IM, Diaz Sánchez S, Conangla Ferrín L. [Usefulness and reliability of point of care ultrasound in Family Medicine: Focused ultrasound in neck and emergency]. Aten Primaria 2019; 51:367-379. [PMID: 31101376 PMCID: PMC6836943 DOI: 10.1016/j.aprim.2019.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Accepted: 03/13/2019] [Indexed: 11/17/2022] Open
Abstract
La ecografía clínica es una herramienta que complementa a la anamnesis y a la exploración física, lo que facilita y agiliza la toma de decisiones en cualquier entorno de atención médica El médico de familia es el especialista que más se puede beneficiar del empleo de la ecografía porque debe ser competente en todos los terrenos de la enfermedad El estudio mediante ecografía, por su fiabilidad, seguridad, reproducibilidad y bajo coste debe estar accesible para su empleo en atención primaria, tanto en el ámbito de la atención normal como la urgente Esta técnica, aplicada en escenarios concretos y con una sistemática de estudio definida, confirma o descarta enfermedades, lo que orienta el diagnóstico con elevada fiabilidad, así como sustenta de modo eficaz la conducta del profesional Este artículo revisa la fiabilidad y la utilidad de la ecografía clínica en escenarios como la enfermedad cervical, y en diferentes situaciones de urgencia, como sospecha de trombosis venosa profunda en la extremidad inferior, traumatismo toracoabdominal, inestabilidad hemodinámica o parada cardiaca
La ecografía es una herramienta de gran valor para el diagnóstico y el manejo de una gran variedad de situaciones clínicas cotidianas. El médico de familia como especialista generalista debe ser competente para el abordaje de prácticamente cualquier problema de salud que afecte a su población, por lo que, en sus manos, esta herramienta puede proporcionar un elevado impacto sobre la calidad y la eficacia del proceso asistencial. Este es el último artículo de una serie dedicada a mostrar la aplicabilidad de la ecografía clínica en nuestras manos, en la que hemos revisado la mayoría de sus aplicaciones, como la ecografía clínica abdominal, la nefrourológica, la musculoesquelética, la cardiaca o la pulmonar. Queremos terminar con escenarios como la afección del cuello o su uso en situaciones de urgencia, en las que proporciona datos definitivos para la orientación diagnóstica, el manejo clínico e incluso la supervivencia del paciente, tales como el paciente con sospecha de trombosis venosa profunda en miembros inferiores, traumatismo toracoabdominal, compromiso hemodinámico o parada cardiaca.
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Affiliation(s)
- José Antonio Tarrazo Suárez
- Medicina Familiar y Comunitaria; Grupo de Trabajo de Ecografía, Sociedad Española de Medicina Familiar y Comunitaria; Centro de Salud Siero-Sariego, Servicio Asturiano de Salud, Pola de Siero, Asturias, España
| | - José Manuel Morales Cano
- Medicina Familiar y Comunitaria; Grupo de Trabajo de Ecografía, Sociedad Española de Medicina Familiar y Comunitaria; Centro de Salud Ciudad Real 2, Servicio de Salud de Castilla-La Mancha, Ciudad Real, España
| | - Jesús Pujol Salud
- Medicina Familiar y Comunitaria; Grupo de Trabajo de Ecografía, Sociedad Española de Medicina Familiar y Comunitaria; Centro de Atención Primaria Balaguer, Instituto Catalán de Salud, Balaguer, Lleida, España
| | - Ignacio Manuel Sánchez Barrancos
- Medicina Familiar y Comunitaria; Grupo de Trabajo de Ecografía, Sociedad Española de Medicina Familiar y Comunitaria; Consultorio de Membrilla, Centro de Salud Manzanares 2, Servicio de Salud de Castilla-La Mancha, Membrilla, Ciudad Real, España.
| | - Santiago Diaz Sánchez
- Medicina Familiar y Comunitaria; Grupo de Trabajo de Ecografía, Sociedad Española de Medicina Familiar y Comunitaria; Centro de Salud Pintores de Parla, Servicio Madrileño de Salud, Parla, Madrid. España
| | - Laura Conangla Ferrín
- Medicina Familiar y Comunitaria; Grupo de Trabajo de Ecografía, Sociedad Española de Medicina Familiar y Comunitaria; Centro de Atención Primaria Badalona-2, Centre Dalt la Vila, Instituto Catalán de Salud, Badalona, Barcelona, España
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Belotta AF, Gomes MC, Rocha NS, Melchert A, Giuffrida R, Silva JP, Mamprim MJ. Sonography and sonoelastography in the detection of malignancy in superficial lymph nodes of dogs. J Vet Intern Med 2019; 33:1403-1413. [PMID: 30883935 PMCID: PMC6524127 DOI: 10.1111/jvim.15469] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Accepted: 02/14/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The clinical applicability of sonography and sonoelastography (SOE) in the detection of lymph node malignancy in dogs has not been established. OBJECTIVES To compare sonographic and sonoelastographic findings between malignant and benign superficial lymph nodes and to evaluate the diagnostic performance of those methods. ANIMALS One-hundred sixteen lymph nodes of 54 dogs. METHODS A prospective observational study was used to investigate sonographic features and elasticity scores of malignant and benign superficial lymph nodes. Lymph nodes were categorized as malignant or benign according to cytology or histopathology. Quantitative variables were compared using Student's unpaired t test. Prevalence of categorical variables was compared using nonparametric Mann-Whitney U test. Diagnostic performance was calculated by receiver-operating characteristic analysis. RESULTS Forty-nine malignant and 67 benign lymph nodes were included. Malignant nodes had larger long axis (LA; P = .0002), short axis (SA; P < .0001) and short-to-long axis ratio (P < .0001) in comparison with benign nodes. Malignant nodes had a higher prevalence of mixed vascular distribution on Doppler color flow mapping (P < .005) and on power Doppler (P < .0001) and higher resistivity index (RI; P < .0001), pulsatility index (P < .0001), and elasticity score (P < .0001) in comparison with benign nodes. Short axis, elasticity score, and RI offered the best accuracies, 80.2%, 78.1%, and 77.7% (P < .05), respectively, for malignancy detection. CONCLUSIONS AND CLINICAL IMPORTANCE Results support the use of Doppler sonography and SOE as auxiliary methods to brightness mode sonography to detect nodal malignancy.
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Affiliation(s)
- Alexandra F Belotta
- Department of Animal Reproduction and Veterinary Radiology, School of Veterinary Medicine and Animal Science, Sao Paulo State University, Botucatu, Brazil
| | - Marcela C Gomes
- Department of Veterinary Clinics, School of Veterinary Medicine and Animal Science, Sao Paulo State University, Botucatu, Brazil
| | - Noeme S Rocha
- Department of Veterinary Clinics, School of Veterinary Medicine and Animal Science, Sao Paulo State University, Botucatu, Brazil
| | - Alessandra Melchert
- Department of Veterinary Clinics, School of Veterinary Medicine and Animal Science, Sao Paulo State University, Botucatu, Brazil
| | - Rogério Giuffrida
- Department of Preventive Veterinary Medicine, School of Veterinary Medicine, Oeste Paulista University, Presidente Prudente, Brazil
| | - Jeana P Silva
- Department of Animal Reproduction and Veterinary Radiology, School of Veterinary Medicine and Animal Science, Sao Paulo State University, Botucatu, Brazil
| | - Maria J Mamprim
- Department of Animal Reproduction and Veterinary Radiology, School of Veterinary Medicine and Animal Science, Sao Paulo State University, Botucatu, Brazil
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Chang W, Tang L, Lu C, Wu M, Chen M. Shear wave elastography in the evaluation of level VI lymph nodes in papillary thyroid carcinoma: combined with gray-scale ultrasound ex vivo. BMC Cancer 2018; 18:1001. [PMID: 30342491 PMCID: PMC6195959 DOI: 10.1186/s12885-018-4897-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 10/03/2018] [Indexed: 02/18/2023] Open
Abstract
Background The evaluation of cervical lymph nodes is very important for patients with papillary thyroid carcinoma (PTC). Conventional ultrasound is recommended to assess the status of cervical lymph nodes but the diagnostic performance is not satisfying especially in level VI lymph nodes. Recently, shear wave elastography has shown great potential in diagnosis. Therefore, this study aimed at exploring the value of shear wave elastography in ultrasound evaluation for level VI lymph nodes in papillary thyroid carcinoma. Because Hashimoto’s thyroiditis may influence the diagnostic performance, a subgroup was also analysed that included only lymph nodes from PTC without Hashimoto’s thyroiditis. Methods Eighty-Seven level VI lymph nodes from 22 consecutive patients with papillary thyroid carcinoma were evaluated by gray-scale ultrasound and SWE in condition of ex vivo before rapid frozen section. Gray-scale ultrasound and shear wave elastography indexes of metastatic and non-metastatic lymph nodes were evaluated by statistical analysis separately in all patients and in patients without Hashimoto’s thyroiditis. Indexes included long diameter, short diameter, short-to-long diameter ratio (S/L ratio), Emean, Emin, Emax and ESD. The rapid frozen section result of each lymph node was used as gold standard to evaluate the diagnostic performance of gray-scale ultrasound and combination method which combined gray-scale ultrasound and SWE. Results In all patients, significant indexes included short diameter (p = 0.009), S/L ratio (p = 0.003), Emax (p = 0.016) and ESD (p = 0.006). In patients without Hashimoto’s thyroiditis, significant indexes included short diameter (p = 0.002), S/L ratio (p = 0.003), Emean (p = 0.030), Emax (p < 0.001) and ESD (p = 0.001). Combining gray-scale ultrasound with SWE, combination method had higher AUC than gray-scale ultrasound both in all patients (0.887 vs 0.841) and patients without Hashimoto’s thyroiditis (0.925 vs 0.866). Gray-scale ultrasound had higher AUC in patients without Hashimoto’s thyroiditis than in all patients (0.866 vs 0.841), which was the same with combination method (0.925 vs 0.887). Conclusion Shear wave elastography can provide additional information for ultrasound evaluation of level VI lymph nodes in papillary thyroid carcinoma, especially in papillary thyroid carcinoma without Hashimoto’s thyroiditis.
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Affiliation(s)
- Wanying Chang
- Department of Diagnostic Ultrasound, Tong Ren Hospital, Shanghai Jiao Tong University School of Medicine, No. 1111 Xian Xia Road, Shanghai, 200336, China
| | - Lei Tang
- Department of Diagnostic Ultrasound, Tong Ren Hospital, Shanghai Jiao Tong University School of Medicine, No. 1111 Xian Xia Road, Shanghai, 200336, China
| | - Caiwei Lu
- Department of Pathology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197 Rui Jin 2nd Road, Shanghai, 200025, China
| | - Min Wu
- Department of Pathology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197 Rui Jin 2nd Road, Shanghai, 200025, China
| | - Man Chen
- Department of Diagnostic Ultrasound, Tong Ren Hospital, Shanghai Jiao Tong University School of Medicine, No. 1111 Xian Xia Road, Shanghai, 200336, China.
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Differentiation of benign and metastatic axillary lymph nodes in breast cancer: additive value of shear wave elastography to B-mode ultrasound. Clin Imaging 2018; 50:258-263. [DOI: 10.1016/j.clinimag.2018.04.013] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Revised: 04/05/2018] [Accepted: 04/12/2018] [Indexed: 12/18/2022]
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26
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Dawoud MM, Nagy HA, Allam AA. Role of strain elastosonography, B mode and color duplex ultrasonography in differentiation between benign and malignant axillary lymph nodes. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2018. [DOI: 10.1016/j.ejrnm.2018.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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The role of CEUS in characterization of superficial lymph nodes: a single center prospective study. Oncotarget 2018; 7:52416-52422. [PMID: 27191746 PMCID: PMC5239562 DOI: 10.18632/oncotarget.9385] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Accepted: 05/05/2016] [Indexed: 12/02/2022] Open
Abstract
Accurate lymph node characterization is important in a large number of clinical settings. We evaluated the usefulness of Contrast Enhanced Ultrasound (CEUS) in distinguishing between benign and malignant lymph nodes compared with conventional ultrasonography in the differential diagnosis of superficial lymphadenopathy. We present our experience for 111 patients enrolled in a single center. 111 superficial lymph nodes were selected and only 1 lymph node per patient underwent CEUS. A definitive diagnosis for all lymph nodes was obtained by ultrasonographically guided biopsy and/or excision biopsy. The size of the lymph nodes, the site (neck, axilla, inguinal region) being easily accessible for biopsy, and the US and color Doppler US characteristics guided us in selecting the nodes to be evaluated by CEUS. In our study we identified different enhancement patterns in benign and malignant lymph nodes, with a high degree of diagnostic accuracy for superficial lymphadenopathy in comparison with conventional US.
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Jiang W, Xue H, Wang Q, Zhang X, Wang Z, Zhao C. Value of contrast-enhanced ultrasound and PET/CT in assessment of extramedullary lymphoma. Eur J Radiol 2017; 99:88-93. [PMID: 29362156 DOI: 10.1016/j.ejrad.2017.12.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 11/07/2017] [Accepted: 12/05/2017] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The aim of the study was to evaluate clinical value of contrast-enhanced ultrasonography (CEUS) and PET/CT for assessment of extramedullary lymphoma, using histopathology as reference standard. METHOD A total of 63 patients with histopathologically-confirmed extramedullary lymphoma who had underwent CEUS and PET/CT examinations of suspicious lymph nodes included in the study. CEUS patterns and parameters (arrival time, peak time and intensity, base intensity, area under the time-intensity curve, ascending and descending slopes) and PET/CT parameters including maximum standardized uptake value, mean standardized uptake value, and metabolic tumor volume (MTV) were evaluated. Patients were classified into Hodgkin lymphomas (HL), non-Hodgkin lymphomas (NHL), early (stage I and II) and advanced (stage III and IV) lymphoma, B cells and T cells lymphoma, and aggressive and indolent lymphoma. The differences between the two independent samples were compared using non-parametric rank and inspection, P < 0.05 was considered statistically significant. The optimal cut-off value for parameters was used to predict the staging and pathology using Receiver Operating Characteristic (ROC) curve analysis. RESULT In the early and advanced group, the differences between △T and ascending slope (AS) were statistically significant (p = 0.010, 0.024 < 0.05). Hodgkin lymphomas (HL) or non-Hodgkin lymphomas (NHL) results were determined by optimal cut-off value of AT and TP (p = 0.001, 0.001 < 0.05). Aggressive or indolent lymphoma were determined by optimal cut-off values of Color Doppler flow resistance index (P = 0.001 < 0.05) and SUVmax (p = 0.001 < 0.05). There was no statistically significant difference between B and T cell lymphoma. And there was no statistically significant difference among the qualitative indexes. The optimal cutoff value for statistically significant indicators was calculated by ROC. CONCLUSION The quantitative parameters of CEUS and SUVmax of PET/CT are proven useful in assessment of different clinical and pathologic patterns of extramedullary lymphoma.
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Affiliation(s)
- Wenbin Jiang
- Department of Ultrasound, The Affiliated Hospital of Qingdao University, China.
| | - Hongwei Xue
- Department of Lymphoma, The Affiliated Hospital of Qingdao University, China.
| | - Qinqin Wang
- Department of Ultrasound, The Affiliated Hospital of Qingdao University, China.
| | - Xiaojuan Zhang
- Department of Ultrasound, The Affiliated Hospital of Qingdao University, China.
| | - Zhenguang Wang
- Department of Nuclear Medicine, The Affiliated Hospital of Qingdao University, China.
| | - Cheng Zhao
- Department of Ultrasound, The Affiliated Hospital of Qingdao University, China.
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Öztoprak S, Gärtner H, Schick B, Bozzato A. [Influence of external and endogenous factors on cervical lymph nodes : Sonographic study of size and morphology]. HNO 2017; 66:383-389. [PMID: 29264634 DOI: 10.1007/s00106-017-0455-4] [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: 10/18/2022]
Abstract
BACKGROUND Sonographic evaluation of the dignity of cervical lymph nodes is essential for further diagnostics and treatment concepts in various diseases. The aim of this prospective monocenter study was to determine the sonomorphology and size of benign changes of lymph nodes in healthy subjects and patients who had undergone surgery, in order to examine the influence of various factors. MATERIALS AND METHODS Data from 205 healthy subjects and 15 patients before and after surgery were analyzed. Sonographically representative lymph nodes were measured in diameter and volumes were calculated; margins, the recognizability of a hilus, and vascularization were documented. A detailed medical history was taken using a standardized questionnaire. RESULTS In 20-39-year-olds, lymph node diameters were larger than in 40-59- and over 60-year-olds, and in 40-59-year-olds, the lymph nodes were larger than over 60-year-old subjects. Individuals with consumption of less than 10 and 10-20 cigarettes per day showed larger cervical lymph nodes compared to subjects with a consumption of more than 20 cigarettes per day. Smokers who additionally exercised routinely showed larger lymph nodes than those who never smoked or exercised. In addition, we observed that both the size and the number of cervical lymph nodes increased postoperatively compared to preoperative. CONCLUSION The recorded lymph nodes corresponded to the established sonographic criteria of benign lymph nodes. Our results show that age, smoking intensity, combination of smoking with sporting activity, and surgery influence the size of sonographically measured cervical lymph nodes.
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Affiliation(s)
- S Öztoprak
- Klinik für Hals‑, Nasen- und Ohrenheilkunde, Universitätsklinikums des Saarlandes, Homburg/Saar, Deutschland. .,Klinikum Mutterhaus der Borromäerinnen gGmbH, Feldstraße 16, 54290, Trier, Deutschland.
| | - H Gärtner
- Klinik für Hals‑, Nasen- und Ohrenheilkunde, Universitätsklinikums des Saarlandes, Homburg/Saar, Deutschland
| | - B Schick
- Klinik für Hals‑, Nasen- und Ohrenheilkunde, Universitätsklinikums des Saarlandes, Homburg/Saar, Deutschland
| | - A Bozzato
- Klinik für Hals‑, Nasen- und Ohrenheilkunde, Universitätsklinikums des Saarlandes, Homburg/Saar, Deutschland
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Geh I, Gollins S, Renehan A, Scholefield J, Goh V, Prezzi D, Moran B, Bower M, Alfa-Wali M, Adams R. Association of Coloproctology of Great Britain & Ireland (ACPGBI): Guidelines for the Management of Cancer of the Colon, Rectum and Anus (2017) - Anal Cancer. Colorectal Dis 2017; 19 Suppl 1:82-97. [PMID: 28632308 DOI: 10.1111/codi.13709] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Ian Geh
- Queen Elizabeth Hospital, Birmingham, UK
| | | | - Andrew Renehan
- University of Manchester and Christie Hospital, Manchester, UK
| | - John Scholefield
- University of Nottingham and Queens Medical Centre, Nottingham, UK
| | - Vicky Goh
- King's College and Guy's & St Thomas' Hospital, London, UK
| | | | - Brendan Moran
- Basingstoke & North Hampshire Hospital, Basingstoke, UK
| | - Mark Bower
- Imperial College and Chelsea & Westminster Hospital, London, UK
| | | | - Richard Adams
- Cardiff University and Velindre Cancer Centre, Cardiff, UK
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Tan S, Miao LY, Cui LG, Sun PF, Qian LX. Value of Shear Wave Elastography Versus Contrast-Enhanced Sonography for Differentiating Benign and Malignant Superficial Lymphadenopathy Unexplained by Conventional Sonography. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2017; 36:189-199. [PMID: 27925679 DOI: 10.7863/ultra.16.01014] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Accepted: 03/30/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVES This study aimed to compare the efficacy of shear wave elastography (SWE) and contrast-enhanced sonography in the differential diagnosis of superficial lymphadenopathy with abnormal imaging findings, which could not be otherwise confirmed by conventional sonography. METHODS Forty-two enlarged superficial lymph nodes in 42 patients who met the screening criteria for this study were evaluated by both contrast-enhanced sonography and SWE. All lymph nodes underwent both methods using biopsy pathologic findings as a reference standard. RESULTS The maximum elastic modulus, mean elastic modulus, and standard deviation of the elastic modulus were the main distinguishing features on SWE; they were significantly higher in malignant lesions than benign ones. The threshold value for the maximum elastic modulus was set at 37.9 kPa, and the sensitivity, specificity, and accuracy of differential diagnosis of superficial lymph nodes were 81.8%, 80.0%, and 81.0%, respectively. The diagnosis of benignity and malignancy by this index was statistically significant (P < .001). The lymph nodes were divided into benign and malignant groups according to different types based on the degree and range of intensity on contrast-enhanced sonography: intense or moderate homogeneous enhancement (n = 26) and heterogeneous, low homogeneous, or absent enhancement (n = 16). The sensitivity, specificity, and accuracy of contrast-enhanced sonography were 27.3%, 50.0%, and 38.1%. There was no statistically significant difference in the values between the benign and malignant groups (χ2 = 2.295; P = .130). CONCLUSIONS Compared with contrast-enhanced sonography, SWE has better diagnostic value and efficiency in differentiation of superficial lymph nodes unexplained by conventional sonography. When conventional sonography cannot differentiate malignant superficial lymph nodes from benign ones, SWE is a useful adjunctive tool for assessment of lymph nodes.
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Affiliation(s)
- Shi Tan
- Department of Ultrasound, Beijing Friendship Hospital, Capital Medical University, Beijing, China
- Department of Ultrasound, Peking University Third Hospital, Beijing, China
| | - Li-Ying Miao
- Department of Ultrasound, Peking University Third Hospital, Beijing, China
| | - Li-Gang Cui
- Department of Ultrasound, Peking University Third Hospital, Beijing, China
| | - Peng-Fei Sun
- Department of Ultrasound, Peking University Third Hospital, Beijing, China
| | - Lin-Xue Qian
- Department of Ultrasound, Beijing Friendship Hospital, Capital Medical University, Beijing, China
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Chammas MC, Macedo TAA, Lo VW, Gomes AC, Juliano A, Cerri GG. Predicting malignant neck lymphadenopathy using color duplex sonography based on multivariate analysis. JOURNAL OF CLINICAL ULTRASOUND : JCU 2016; 44:587-594. [PMID: 27492569 DOI: 10.1002/jcu.22380] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Revised: 05/31/2016] [Accepted: 06/14/2016] [Indexed: 06/06/2023]
Abstract
PURPOSE To select the best predictors of cervical lymph node malignancy based on gray-scale and power Doppler sonography using multivariate analysis. METHODS We evaluated sonographically a total of 97 lymph nodes in the neck that were subjected to fine-needle aspiration biopsy. The gray-scale and power Doppler sonography parameters that we analyzed using multivariate logistic regression included size, shape, echogenicity, echotexture, margins, hilum, presence of microcalcifications or necrosis, vascularization, and resistance index (RI). RESULTS The three variables with a diagnostic accuracy exceeding 80% were an altered vascularization, heterogeneous echotexture, and abnormal hilum. Malignant nodes exhibited higher RI and larger sizes than benign nodes, and the best cutoff values to distinguish malignant from benign lymph nodes were an RI of 0.77 and a short axis ≥ 0.9 cm. Altered vascularization, a short axis ≥ 0.9 cm, and abnormal hilum were the best predictors of malignancy. CONCLUSIONS The best sonographic predictors of lymph node malignancy are, in descending order, an altered vascularization, a short axis ≥ 0.9 cm, an abnormal hilum, and a heterogeneous echotexture. © 2016 Wiley Periodicals, Inc. J Clin Ultrasound 44:587-594, 2016.
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Affiliation(s)
- Maria C Chammas
- Department of Radiology of the Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Enéas de Carvalho Aguiar, 255 3o. andar, Cerqueira Cesar, São Paulo, SP CEP: 05403-001, Brazil
| | - Túlio A A Macedo
- Setor de Radiologia do Hospital de Clínicas da Universidade Federal de Uberlândia, Av. Pará 1720, Jd. Umuarama, Uberlândia, MG CEP: 38405-320, Brazil.
| | - Victor W Lo
- Department of Radiology of the Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Enéas de Carvalho Aguiar, 255 3o. andar, Cerqueira Cesar, São Paulo, SP CEP: 05403-001, Brazil
| | - Andrea C Gomes
- Department of Radiology of the Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Enéas de Carvalho Aguiar, 255 3o. andar, Cerqueira Cesar, São Paulo, SP CEP: 05403-001, Brazil
| | - Adriana Juliano
- Department of Radiology of the Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Enéas de Carvalho Aguiar, 255 3o. andar, Cerqueira Cesar, São Paulo, SP CEP: 05403-001, Brazil
| | - Giovanni G Cerri
- Department of Radiology of the Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Enéas de Carvalho Aguiar, 255 3o. andar, Cerqueira Cesar, São Paulo, SP CEP: 05403-001, Brazil
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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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Revzin MV, Ersahin D, Israel GM, Kirsch JD, Mathur M, Bokhari J, Scoutt LM. US of the Inguinal Canal: Comprehensive Review of Pathologic Processes with CT and MR Imaging Correlation. Radiographics 2016; 36:2028-2048. [PMID: 27715712 DOI: 10.1148/rg.2016150181] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Ultrasonography (US) has a fundamental role in the initial examination of patients who present with symptoms indicating abnormalities of the inguinal canal (IC), an area known for its complex anatomy. A thorough understanding of the embryologic and imaging characteristics of the contents of the IC is essential for any general radiologist. Moreover, an awareness of the various pathologic conditions that can affect IC structures is crucial to preventing misdiagnoses and ensuring optimal patient care. Early detection of IC abnormalities can reduce the risk of morbidity and mortality and facilitate proper treatment. Abnormalities may be related to increased intra-abdominal pressure, which can result in development of direct inguinal hernias and varicoceles, or to congenital anomalies of the processus vaginalis, which can result in development of indirect hernias and hydroceles. US is also helpful in assessing postoperative complications of hernia repair, such as hematoma, seroma, abscess, and hernia recurrence. In addition, it is often the modality initially used to detect neoplasms arising from or invading the IC. US is an important tool in the examination of patients suspected of having undescended testes or posttraumatic testicular retraction and is essential for the examination of patients suspected of having torsion or infectious inflammatory conditions of the spermatic cord. Online supplemental material is available for this article. ©RSNA, 2016.
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Affiliation(s)
- Margarita V Revzin
- From the Department of Diagnostic Radiology, Yale University School of Medicine, 333 Cedar St, PO Box 208042, Room TE-2, New Haven, CT 06520
| | - Devrim Ersahin
- From the Department of Diagnostic Radiology, Yale University School of Medicine, 333 Cedar St, PO Box 208042, Room TE-2, New Haven, CT 06520
| | - Gary M Israel
- From the Department of Diagnostic Radiology, Yale University School of Medicine, 333 Cedar St, PO Box 208042, Room TE-2, New Haven, CT 06520
| | - Jonathan D Kirsch
- From the Department of Diagnostic Radiology, Yale University School of Medicine, 333 Cedar St, PO Box 208042, Room TE-2, New Haven, CT 06520
| | - Mahan Mathur
- From the Department of Diagnostic Radiology, Yale University School of Medicine, 333 Cedar St, PO Box 208042, Room TE-2, New Haven, CT 06520
| | - Jamal Bokhari
- From the Department of Diagnostic Radiology, Yale University School of Medicine, 333 Cedar St, PO Box 208042, Room TE-2, New Haven, CT 06520
| | - Leslie M Scoutt
- From the Department of Diagnostic Radiology, Yale University School of Medicine, 333 Cedar St, PO Box 208042, Room TE-2, New Haven, CT 06520
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Jin Y, He YS, Zhang MM, Parajuly SS, Chen S, Zhao HN, Peng YL. Value of contrast-enhanced ultrasonography in the differential diagnosis of enlarged lymph nodes: a meta-analysis of diagnostic accuracy studies. Asian Pac J Cancer Prev 2016; 16:2361-8. [PMID: 25824765 DOI: 10.7314/apjcp.2015.16.6.2361] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE To evaluate the diagnostic accuracy of contrast-enhanced ultrasonography (CEUS) in differentiating between benign and malignant enlarged lymph nodes using meta-analysis. MATERIALS AND METHODS Pubmed, Embase, SCI and Cochrane databases were searched for studies (up to September 1, 2014) reporting the diagnostic performance of CEUS in discriminating between benign and malignant lymph nodes. Inclusion criteria were: prospective study; histopathology as the reference standard; and sufficient data to construct 2?2 contingency tables. Methodological quality was assessed using Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2). Patient clinical characteristics, sensitivity and specificity were extracted. The summary receiver operating characteristic curve was used to examine the accuracy of CEUS. A meta-analysis was performed to evaluate the clinical utility in identification of benign and malignant lymph nodes. Sensitivity analysis was performed after omitting outliers identified in a bivariate boxplot and publication bias was assessed with Egger testing. RESULTS The pooled sensitivity, specificity and AUROC were 0.92 (95%CI, 0.85-0.96), 0.91 (95%CI, 0.82-0.95) and 0.97 (95%CI, 0.95-0.98), respectively. After omitting 3 outlier studies, heterogeneity decreased. Sensitivity analysis demonstrated no disproportionate influences of individual studies. Publication bias was not significant. CONCLUSIONS CEUS is a promising diagnostic modality in differentiating between benign and malignant lymph nodes and can potentially reduce unnecessary fine-needle aspiration biopsies of benign nodes.
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Affiliation(s)
- Ya Jin
- Department of Ultrasound in West China Hospital, University of Sichuan, Chengdu, China E-mail :
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Kim SJ, Park YM. Clinical Importance and Sonographic Features of Nonpalpable Axillary Lymphadenopathy Identified on Breast Sonography in Patients Without Malignancy. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2015; 34:2193-2202. [PMID: 26507694 DOI: 10.7863/ultra.15.01056] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Accepted: 03/12/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVES The purpose of this study was to evaluate the clinical importance and sonographic features of nonpalpable axillary lymphadenopathy identified on breast sonography in patients without malignancy. METHODS Our study included 71 women and 2 men (mean age, 47.5 years; range, 16-69 years) with axillary lymphadenopathy identified on breast sonography. None of the 73 patients had known malignancy or presented with palpable lymph nodes or symptoms of mastitis. The lesions were pathologically diagnosed in 53 patients by surgical biopsy (n = 8), ultrasound-guided core needle biopsy (n = 17), or ultrasound -guided fine needle aspiration (n = 28). Twenty patients underwent follow-up imaging for 6 to 60 months (mean, 17 months). The sonographic features of the axillary lymph nodes were analyzed for all patients. RESULTS The final diagnoses included benign reactive hyperplasia (n = 45), Kikuchi disease (n = 4), tuberculosis (n = 3), and sarcoidosis (n = 1). None of the 20 patients who underwent follow-up imaging developed malignancy. Suspicious sonographic features were frequently observed (loss of the fatty hilum, round shape, abnormal cortical thickening, and marked hypoechogenicity: 79.5%, 75.3%, 82.1%, and 9.6%, respectively) and were mostly complex, with the most common combination being a round shape and loss of the fatty hilum in 61.6% patients. CONCLUSIONS No malignancy was detected in all 73 patients, despite frequent manifestations of complex and extremely suspicious sonographic features. Short-term follow-up imaging rather than immediate biopsy can be recommended for nonpalpable lymphadenopathy in patients without known malignancy.
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Affiliation(s)
- Suk Jung Kim
- Department of Radiology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea (S.J.K.); and Department of Radiology, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea (Y.M.P.)
| | - Young Mi Park
- Department of Radiology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea (S.J.K.); and Department of Radiology, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea (Y.M.P.).
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Eberhardt F, Köhler C, Winter K, Alef M, Kiefer I. [Sonographically detectable changes in abdominal lymph nodes in dogs with malignant lymphoma. Evaluation with special consideration of the Solbiati-Index]. TIERAERZTLICHE PRAXIS AUSGABE KLEINTIERE HEIMTIERE 2015; 43:309-16. [PMID: 26076988 DOI: 10.15654/tpk-150078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Accepted: 05/22/2015] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Characterization of the disorders of abdominal lymph nodes in dogs with malignant lymphoma and evaluation of the Solbiati-Index (SI) and the relationship between the short axis and the length of the lymph node (S : L ratio) as malignancy criteria. MATERIAL AND METHODS Retrospective analysis of data from dogs with malignant lymphoma. Inclusion criteria were cytological or histological diagnosis of the malignant lymphoma and an ultrasound examination of the abdomen prior to initiation of therapy. Criterion for exclusion was the application of a cytostatic agent prior to diagnosis. Furthermore, abdominal lymph nodes with non-neoplastic disorders were examined, when sonography as well as cytological/histological examinations were available. RESULTS A total of 261 lymph nodes (127 dogs) with malignant lymphoma and 17 lymph nodes (nine dogs) with benign disorders were evaluated. Sonography revealed massively rounded, clearly enlarged lymph nodes in 115/127 dogs (91%) with malignant lymphoma, while the lymph nodes of the other 12 dogs (9%) displayed an enlargement in the long axis. All 17 lymph nodes with benign disorders were enlarged in the long axis. The nodal parenchyma of 91% of the 127 dogs (malignant lymphoma) presented as hypoechoic to anechoic, and the cortex and medulla could not be differentiated. In the remaining 9% of dogs, a physiological isoechoic nodal parenchyma was observed. The parenchyma of lymph nodes with benign disorders was sonographically inconspicuous. In 71% of the 127 dogs with malignant lymphoma, the SI was < 2 and the S : L ratio > 0.5 (indicative for malignancy). Of the nine dogs with benign lymph node disorders, 71% had an SI of > 2 and 76% of them had an S : L ratio < 0.5 (indicative of a benign process). CONCLUSION AND CLINICAL RELEVANCE The significant increase in the size, rounding and hypoechoic changes in the lymph nodes in dogs with malignant lymphoma are indicative parameters of malignancy. In addition, the SI and the S:L ratio serve as a differentiation between benign and malign processes. Because of blurred boundaries between the malignant and benign changes, the various parameters should always be considered in conjunction.
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Affiliation(s)
- F Eberhardt
- Franziska Eberhardt, Klinik für Kleintiere, der Universität Leipzig, An den Tierkliniken 23, 04104 Leipzig, E-Mail:
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Abstract
The cervical lymph nodes can be affected by a variety of infectious, inflammatory, benign, and malignant pathologic conditions. Clinical history and physical examination with the complementary use of imaging is essential to accurately make a diagnosis or appropriate differential. Knowledge of cervical lymph node anatomy, drainage pathways, morphologic variations, and common nodal pathology is key to correct interpretation of cervical lymph nodes on imaging. Computed tomography (CT), MR, ultrasound, and PET/CT are complementary imaging modalities that can be used in the evaluation of cervical lymph node pathology.
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Affiliation(s)
- Laura B Eisenmenger
- Department of Radiology, University of Utah, 30 North 1900 East #1A071, Salt Lake City, UT 84132-2140, USA; Department of Biomedical Informatics, University of Utah, 30 North 1900 East #1A071, Salt Lake City, UT 84132-2140, USA
| | - Richard H Wiggins
- Department of Radiology, University of Utah, 30 North 1900 East #1A071, Salt Lake City, UT 84132-2140, USA; Department of Biomedical Informatics, University of Utah, 30 North 1900 East #1A071, Salt Lake City, UT 84132-2140, USA; Division of Otolaryngology-Head and Neck Surgery, University of Utah, 30 North 1900 East #1A071, Salt Lake City, UT 84132-2140, USA.
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Nagaraju S, Vaishnav S, Burke LH, Norman EM. Histiocytic necrotising lymphadenitis (Kikuchi-Fujimoto disease) of axillary lymph nodes. BMJ Case Rep 2015; 2015:bcr2014203776. [PMID: 25564582 PMCID: PMC4289788 DOI: 10.1136/bcr-2014-203776] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/18/2014] [Indexed: 01/14/2023] Open
Abstract
Kikuchi-Fujimoto disease (KFD) or histiocytic necrotising lymphadenitis is a rare entity, occurring most commonly in young Asian adults. KFD is characterised by fever with tender lymph node enlargement. The cervical group of lymph nodes is most commonly involved, and the diagnosis is conclusively made by lymph node biopsy and histopathology. KFD is a self-limiting condition, which usually resolves over 1-4 months. Symptomatic treatment with antipyretics and/or non-steroidal anti-inflammatory drugs is recommended. Here we describe an uncommon presentation of KFD in a young woman in which only the axillary lymph nodes were enlarged.
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Affiliation(s)
- Santosh Nagaraju
- Thomas E. Starzl Transplantation Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Sakshi Vaishnav
- Western Michigan University School of Medicine, Kalamazoo, Michigan, USA
| | - Leandra H Burke
- Western Michigan University School of Medicine, Kalamazoo, Michigan, USA
| | - Earl M Norman
- Western Michigan University School of Medicine, Kalamazoo, Michigan, USA
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ElSaid NAE, Nada OMM, Habib YS, Semeisem AR, Khalifa NM. Diagnostic accuracy of diffusion weighted MRI in cervical lymphadenopathy cases correlated with pathology results. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2014. [DOI: 10.1016/j.ejrnm.2014.06.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Lang S, Kansy B. Cervical lymph node diseases in children. GMS CURRENT TOPICS IN OTORHINOLARYNGOLOGY, HEAD AND NECK SURGERY 2014; 13:Doc08. [PMID: 25587368 PMCID: PMC4273169 DOI: 10.3205/cto000111] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The lymph nodes are an essential part of the body’s immune system and as such are affected in many infectious, autoimmune, metabolic and malignant diseases. The cervical lymph nodes are particularly important because they are the first drainage stations for key points of contact with the outside world (mouth/throat/nose/eyes/ears/respiratory system) – a critical aspect especially among children – and can represent an early clinical sign in their exposed position on a child’s slim neck. Involvement of the lymph nodes in multiple conditions is accompanied by a correspondingly large number of available diagnostic procedures. In the interests of time, patient wellbeing and cost, a careful choice of these must be made to permit appropriate treatment. The basis of diagnostic decisions is a detailed anamnesis and clinical examination. Sonography also plays an important role in differential diagnosis of lymph node swelling in children and is useful in answering one of the critical diagnostic questions: is there a suspicion of malignancy? If so, full dissection of the most conspicuous lymph node may be necessary to obtain histological confirmation. Diagnosis and treatment of childhood cervical lymph node disorders present the attending pediatric and ENT physicians with some particular challenges. The spectrum of differential diagnoses and the varying degrees of clinical relevance – from banal infections to malignant diseases – demand a clear and considered approach to the child’s individual clinical presentation. Such an approach is described in the following paper.
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Affiliation(s)
- Stephan Lang
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Benjamin Kansy
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Essen, University Duisburg-Essen, Essen, Germany
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Strain elastography of abnormal axillary nodes in breast cancer patients does not improve diagnostic accuracy compared with conventional ultrasound alone. AJR Am J Roentgenol 2014; 203:1371-8. [PMID: 25415717 DOI: 10.2214/ajr.13.12349] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The purpose of this study was to determine the diagnostic value of strain elastography (SE) alone and in combination with gray-scale ultrasound in the diagnosis of benign versus metastatic disease for abnormal axillary lymph nodes in breast cancer patients. SUBJECTS AND METHODS Patients with breast cancer and axillary lymph nodes suspicious for metastatic disease on conventional ultrasound who underwent SE of the suspicious node before ultrasound-guided fine-needle aspiration biopsy (FNAB) were included in this study. On conventional ultrasound, the long- and short-axis diameters, long-axis-to-short-axis ratio, cortical echogenicity, thickness, and evenness were documented. The nodal vascularity was assessed on power Doppler imaging. Elastograms were evaluated for the percentage of black (hard) areas in the lymph node, and the SE-ultrasound size ratio was calculated. Two readers assessed the images independently and then in consensus in cases of disagreement. ROC AUCs were calculated for conventional ultrasound, SE, and both methods combined. Interreader reliability was assessed using kappa statistics. RESULTS A total of 101 patients with 104 nodes were examined; 35 nodes were benign, and 69 had metastases. SE alone showed a significantly lower AUC (62%) than did conventional ultrasound (92%) (p<0.001). There was no difference between the AUC of conventional ultrasound and the AUC of the combination of conventional ultrasound and SE (93%) (p=0.16). Interreader reliability was moderate for all variables (κ≥0.60) except the SE-ultrasound size ratio (κ=0.35). CONCLUSION Added SE does not improve the diagnostic ability of conventional ultrasound when evaluating abnormal axillary lymph nodes.
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Arienti V, Di Giulio R, Cogliati C, Accogli E, Aluigi L, Corazza GR. Bedside ultrasonography (US), Echoscopy and US point of care as a new kind of stethoscope for Internal Medicine Departments: the training program of the Italian Internal Medicine Society (SIMI). Intern Emerg Med 2014; 9:805-14. [PMID: 25145290 DOI: 10.1007/s11739-014-1113-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Accepted: 07/30/2014] [Indexed: 02/06/2023]
Abstract
In recent years, thanks to the development of miniaturized ultrasound devices, comparable to personal computers, tablets and even to smart phones, we have seen an increasing use of bedside ultrasound in internal medicine departments as a novel kind of ultrasound stethoscope. The clinical ultrasound-assisted approach has proved to be particularly useful in assessing patients with nodules of the neck, dyspnoea, abdominal pain, and with limb edema. In several cases, it has allowed a simple, rapid and precise diagnosis. Since 2005, the Italian Society of Internal Medicine and its Ultrasound Study Group has been holding a Summer School and training courses in ultrasound for residents in internal medicine. A national network of schools in bedside ultrasound was then organized for internal medicine specialists who want to learn this technique. Because bedside ultrasound is a user-dependent diagnostic method, it is important to define the limits and advantages of different new ultrasound devices, to classify them (i.e. Echoscopy and Point of Care Ultrasound), to establish appropriate different levels of competence and to ensure their specific training. In this review, we describe the point of view of the Italian Internal Medicine Society on these topics.
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Affiliation(s)
- Vincenzo Arienti
- Department of Internal Medicine, Internal Medicine A, Maggiore Hospital, Bologna, Italy,
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Raja Lakshmi C, Sudhakara Rao M, Ravikiran A, Sathish S, Bhavana SM. Evaluation of reliability of ultrasonographic parameters in differentiating benign and metastatic cervical group of lymph nodes. ISRN OTOLARYNGOLOGY 2014; 2014:238740. [PMID: 24944833 PMCID: PMC4040195 DOI: 10.1155/2014/238740] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/22/2014] [Accepted: 03/31/2014] [Indexed: 12/26/2022]
Abstract
The aim of the current study is to determine the efficacy of ultrasound in differentiating between benign and metastatic group of cervical lymph nodes. The study included forty-five subjects who were divided into three groups with 15 in each, by stratified random sampling method. Group 1 comprised fifteen patients without signs and symptoms of any infection and neoplasms in head and neck region (control group). Group 2 included fifteen patients with signs and symptoms of malignancy in head and neck region. Group 3 consisted of fifteen patients with signs and symptoms of odontogenic infections. "MY LAB-40" ultrasound machine with linear array transducer of 7.5 MHZ frequency was used for detecting cervical lymph nodes following Hajek's classification. The patients further underwent ultrasound guided FNAC under standard aseptic protocol and samples were subjected to cytopathological evaluation. Chi square analysis and one way ANOVA test were applied to obtain the results. We concluded that ultrasound and USG FNAC can be used accurately to assess the status of lymph nodes. The ultrasonographic features of lymph nodes with round shape, absence of hilar echo, sharp nodal borders, hyperechoic internal echogenicity, and presence of intranodal necrosis were highly suggestive of metastatic cervical lymph nodes.
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Affiliation(s)
- Chintamaneni Raja Lakshmi
- Department of Oral Medicine and Radiology, Drs. Sudha and Nageswara Rao Siddhartha Institute of Dental Sciences, Gannavaram Mandal, Krishna District, Andhra Pradesh 521286, India
| | - M. Sudhakara Rao
- Department of Otorhinolaryngology, Dr. Pinnamaneni Siddhartha Institute of Medical Sciences and Research Foundation, Gannavaram Mandal, Andhra Pradesh 521286, India
| | - A. Ravikiran
- Department of Oral Medicine and Radiology, Sibar Institute of Dental Sciences, Takkellapadu, Guntur, Andhra Pradesh 522509, India
| | - Sivan Sathish
- Department of Oral Medicine and Radiology, Chettinad Dental College & Research Institute, Rajiv Gandhi Salai, Kelambakkam, Kanchipuram District 603103, India
| | - Sujana Mulk Bhavana
- Department of Oral Medicine and Radiology, Drs. Sudha and Nageswara Rao Siddhartha Institute of Dental Sciences, Gannavaram Mandal, Krishna District, Andhra Pradesh 521286, India
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Dudau C, Hameed S, Gibson D, Muthu S, Sandison A, Eckersley RJ, Clarke P, Cosgrove DO, Lim AK. Can contrast-enhanced ultrasound distinguish malignant from reactive lymph nodes in patients with head and neck cancers? ULTRASOUND IN MEDICINE & BIOLOGY 2014; 40:747-754. [PMID: 24462154 DOI: 10.1016/j.ultrasmedbio.2013.10.015] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Revised: 10/01/2013] [Accepted: 10/16/2013] [Indexed: 06/03/2023]
Abstract
The purpose of this study was to investigate the utility of contrast-enhanced ultrasound in differentiating benign from malignant cervical lymph nodes in patients with squamous cell carcinoma of the head and neck. A consecutive series of 17 patients with known head and neck malignancy scheduled for neck surgery and lymph node clearance were recruited for contrast-enhanced ultrasound evaluation. Sonographic signal intensity as a function of time, comparing features of time to peak, time to arrival and time to wash-out, was quantified. The selected node was removed surgically and submitted for histology. Contrast-enhanced ultrasound examination had 100% sensitivity and 85.7% specificity for lymph node involvement. Functional analysis revealed contrast peaks significantly earlier in the malignant nodes (mean ± standard deviation) of 24.14 ± 2.7 s compared with 29.33 ± 3.4 s (p = 0.0128). Contrast-enhanced ultrasound holds promise in the detection and characterization of metastatic nodes that would not be diagnosed as abnormal on the basis of conventional ultrasound criteria.
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Affiliation(s)
- Cristina Dudau
- National Hospital for Neurology & Neurosurgery, Queen Square, London, United Kingdom.
| | - Shema Hameed
- National Hospital for Neurology & Neurosurgery, Queen Square, London, United Kingdom
| | - Daren Gibson
- National Hospital for Neurology & Neurosurgery, Queen Square, London, United Kingdom
| | - Senthil Muthu
- National Hospital for Neurology & Neurosurgery, Queen Square, London, United Kingdom
| | - Ann Sandison
- National Hospital for Neurology & Neurosurgery, Queen Square, London, United Kingdom
| | - Rob J Eckersley
- National Hospital for Neurology & Neurosurgery, Queen Square, London, United Kingdom
| | - Peter Clarke
- National Hospital for Neurology & Neurosurgery, Queen Square, London, United Kingdom
| | - David O Cosgrove
- National Hospital for Neurology & Neurosurgery, Queen Square, London, United Kingdom
| | - Adrian K Lim
- National Hospital for Neurology & Neurosurgery, Queen Square, London, United Kingdom
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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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Bontumasi N, Jacobson JA, Caoili E, Brandon C, Kim SM, Jamadar D. Inguinal lymph nodes: size, number, and other characteristics in asymptomatic patients by CT. Surg Radiol Anat 2014; 36:1051-5. [DOI: 10.1007/s00276-014-1255-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2013] [Accepted: 01/06/2014] [Indexed: 10/25/2022]
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Seo MJ, Lee JJ, Kim HO, Chae SY, Park SH, Ryu JS, Ahn SH, Lee JW, Son BH, Gong GY, Moon DH. Detection of internal mammary lymph node metastasis with (18)F-fluorodeoxyglucose positron emission tomography/computed tomography in patients with stage III breast cancer. Eur J Nucl Med Mol Imaging 2013; 41:438-45. [PMID: 24196918 DOI: 10.1007/s00259-013-2600-y] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Accepted: 10/01/2013] [Indexed: 12/01/2022]
Abstract
PURPOSE The present study assessed the positive predictive value (PPV) of (18)F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) for the detection of internal mammary node (IMN) metastasis in patients with clinical stage III breast cancer. METHODS Patients who were diagnosed with clinical stage III breast cancer and underwent pretreatment (18)F-FDG PET/CT were retrospectively analyzed. The (18)F-FDG PET/CT scans were prospectively reviewed by two board-certified nuclear medicine physicians in a blinded manner. The intensities of IMNs were graded into four categories (no activity and lower, similar, and higher activities than that of the mediastinal blood pool). IMNs were measured from the combined CT (largest diameter of the short axis). Histologic data of the IMNs were obtained by ultrasonography-guided fine-needle aspiration biopsy or surgical excision. The PPV was calculated for pathologically confirmed IMNs. Visual grade, maximum standardized uptake values (SUVmax), and sizes were analyzed according to the pathology results. RESULTS There were 249 clinical stage III breast cancer patients (age 48.0 ± 10.1 years, range 26-79 years) who had undergone initial (18)F-FDG PET/CT prior to treatment. Excluding 33 cases of stage IV breast cancer, 62 of 216 patients had visible IMNs on (18)F-FDG PET/CT, and histologic confirmation was obtained in 31 patients. There were 27 metastatic and four nonmetastatic nodes (PPV 87.1%). Metastatic nodes mostly presented with visual grade 3 (83.9%), and SUVmax and size were 3.5 ± 4.3 and 5.6 ± 2.0 mm, respectively. CONCLUSION (18)F-FDG PET/CT has a high PPV for IMN metastasis in clinical stage III breast cancer, indicating the possibility of metastasis in IMNs with FDG uptake similar to/lower than that of the blood pool or small-sized nodes.
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Affiliation(s)
- Min Jung Seo
- Department of Nuclear Medicine, University of Ulsan College of Medicine, Asan Medical Center, 86 Asanbyeongwon-gil, Songpa-gu, Seoul, 138-736, Korea
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The Outline of Prognosis and New Advances in Diagnosis of Oral Squamous Cell Carcinoma (OSCC): Review of the Literature. ACTA ACUST UNITED AC 2013. [DOI: 10.1155/2013/519312] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Objective. Oral squamous cell carcinoma (OSCC) has a remarkable incidence over the world and a fairly strenuous prognosis, encouraging further research on the prognostic factors and new techniques for diagnosis that might modify disease outcome. Data Sources. A web-based search for all types of articles published was initiated using Medline/Pub Med, with the key words such as oral cancer, prognostic factors of oral cancer, diagnostic method of oral cancer, and imaging techniques for diagnosis of oral cancer. The search was restricted to articles published in English, with no publication date restriction (last update April, 2013). Review Methods. In this paper, I approach the factors of prognosis of OSCC and the new advances in diagnostic technologies as well. I also reviewed available studies of the tissue fluorescence spectroscopy and other noninvasive diagnostic aids for OSCC. Results. The outcome is greatly influenced by the stage of the disease (especially TNM). Prognosis also depends or varies with tumour primary site, nodal involvement, tumour thickness, and the status of the surgical margins. Conclusion. Tumour diameter is not the most accurate when compared to tumour thickness or depth of invasion, which can be related directly to prognosis. There is a wide agreement on using ultrasound guided fine needle aspiration biopsies in the evaluation of lymph node metastasis.
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