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1
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Mori N, Li L, Matsuda M, Mori Y, Mugikura S. Prospects of perfusion contrast-enhanced ultrasound (CE-US) in diagnosing axillary lymph node metastases in breast cancer: a comparison with lymphatic CE-US. J Med Ultrason (2001) 2024; 51:587-597. [PMID: 38642268 PMCID: PMC11499517 DOI: 10.1007/s10396-024-01444-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 02/18/2024] [Indexed: 04/22/2024]
Abstract
Accurate diagnosis of lymph node (LN) metastasis is vital for prognosis and treatment in patients with breast cancer. Imaging 1modalities such as ultrasound (US), MRI, CT, and 18F-FDG PET/CT are used for preoperative assessment. While conventional US is commonly recommended due to its resolution and sensitivity, it has limitations such as operator subjectivity and difficulty detecting small metastases. This review shows the microanatomy of axillary LNs to enhance accurate diagnosis and the characteristics of contrast-enhanced US (CE-US), which utilizes intravascular microbubble contrast agents, making it ideal for vascular imaging. A significant focus of this review is on distinguishing between two types of CE-US techniques for axillary LN evaluation: perfusion CE-US and lymphatic CE-US. Perfusion CE-US is used to assess LN metastasis via transvenous contrast agent administration, while lymphatic CE-US is used to identify sentinel LNs and diagnose LN metastasis through percutaneous contrast agent administration. This review also highlights the need for future research to clarify the distinction between studies involving "apparently enlarged LNs" and "clinical node-negative" cases in perfusion CE-US research. Such research standardization is essential to ensure accurate diagnostic performance in various clinical studies. Future studies should aim to standardize CE-US methods for improved LN metastasis diagnosis, not only in breast cancer but also across various malignancies.
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Affiliation(s)
- Naoko Mori
- Department of Radiology, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, Akita, 010-8543, Japan.
| | - Li Li
- Department of Diagnostic Radiology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-Machi, Aoba-Ku, Sendai, 980-8574, Japan
| | - Masazumi Matsuda
- Department of Radiology, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, Akita, 010-8543, Japan
| | - Yu Mori
- Department of Orthopaedic Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-Machi, Aoba-Ku, Sendai, 980-8575, Japan
| | - Shunji Mugikura
- Department of Diagnostic Radiology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-Machi, Aoba-Ku, Sendai, 980-8574, Japan
- Division of Image Statistics, Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
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2
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Ishi Y, Omotehara T, Wu X, Kuramasu M, Kawata S, Itoh M. Distribution of Contractile Structures in a Mouse and Human Lymph Node Associated with Lymph Flow. Acta Histochem Cytochem 2023; 56:137-144. [PMID: 38318104 PMCID: PMC10838635 DOI: 10.1267/ahc.23-00054] [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: 08/17/2023] [Accepted: 11/28/2023] [Indexed: 02/07/2024] Open
Abstract
Lymph nodes have contractile structures, but their distribution in a lymph node has been less considered in terms of facilitation of lymph flow. Axillary, inguinal, and mesenteric lymph nodes were collected from mice and human cadavers, and their sections were immunostained for alpha-smooth muscle actin (αSMA) and high molecular weight caldesmon (H-caldesmon). The αSMA-positive cells were localized in the capsule beneath the ceiling epithelium on the afferent side in both mice and humans. We found an additional layer of the αSMA-positive cells in the human lymph node, surrounding the inner layer perpendicularly. H-caldesmon was expressed only in these cells of the outer layer. In some human lymph nodes highly containing fat tissue in the medulla, the capsule disappeared on the efferent side, resulting in a disrupted sinusoidal lymph pathway. These findings suggest that human lymph nodes have additional smooth muscles in the outer region of the capsule to facilitate lymph flow. The αSMA-positive cells in the outer and inner layers of human lymph nodes probably have different functions in contraction. The presence of lipomatosis in a human lymph node will reduce its contribution to the lymph flow.
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Affiliation(s)
- Yasuhisa Ishi
- Department of Anatomy, Tokyo Medical University, Tokyo, Japan
| | - Takuya Omotehara
- Department of Anatomy, Tokyo Medical University, Tokyo, Japan
- Department of Anatomy and Life Structure, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Xi Wu
- Department of Anatomy, Tokyo Medical University, Tokyo, Japan
| | - Miyuki Kuramasu
- Department of Anatomy, Tokyo Medical University, Tokyo, Japan
| | - Shinichi Kawata
- Department of Anatomy, Tokyo Medical University, Tokyo, Japan
| | - Masahiro Itoh
- Department of Anatomy, Tokyo Medical University, Tokyo, Japan
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3
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Chantarojanasiri T, Ratanachu-Ek T, Ohno E, Hirooka Y. Contrast-enhanced endoscopic ultrasound for swollen lymph nodes. J Med Ultrason (2001) 2023:10.1007/s10396-023-01347-2. [PMID: 37542669 DOI: 10.1007/s10396-023-01347-2] [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: 04/03/2023] [Accepted: 06/30/2023] [Indexed: 08/07/2023]
Abstract
Endoscopic ultrasound (EUS) is an important tool for the evaluation of lymphadenopathy, especially in intra-thoracic or intra-abdominal regions. EUS also provides tissue diagnosis via EUS fine-needle aspiration or biopsy. To select the target for biopsy or aspiration, conventional B-mode images are used for the evaluation, but this approach still lacks diagnostic accuracy. Contrast-enhanced EUS has been used to evaluate the vascularity of lesions. Most malignant lymphadenopathy shows heterogenous enhancement or defect of enhancement, while quantitative studies using time-intensity curves in contrast-enhanced harmonic EUS show a rapid decline in enhancement pattern. These findings are useful as an auxiliary method for tissue diagnosis or in cases in which tissue diagnosis is contraindicated.
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Affiliation(s)
- Tanyaporn Chantarojanasiri
- Division of Gastroenterology, Department of Internal Medicine, Rajavithi Hospital, Rangsit University, Bangkok, Thailand.
| | | | - Eizaburo Ohno
- Department of Gastroenterology and Hepatology, Fujita Health University Hospital Cancer Center, Fujita Health University, Aichi, Japan
| | - Yoshiki Hirooka
- Department of Gastroenterology and Hepatology, Fujita Health University Hospital Cancer Center, Fujita Health University, Aichi, Japan
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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: 0.5] [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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Chawla S, Loevner L, Mohan S, Lin A, Sehgal CM, Poptani H. Dynamic contrast-enhanced MRI and Doppler sonography in patients with squamous cell carcinoma of head and neck treated with induction chemotherapy. JOURNAL OF CLINICAL ULTRASOUND : JCU 2022; 50:1353-1359. [PMID: 36205388 DOI: 10.1002/jcu.23361] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 09/05/2022] [Accepted: 09/15/2022] [Indexed: 06/16/2023]
Abstract
In view of the inherent limitations associated with performing dynamic contrast enhanced-magnetic resonance imaging (DCE-MRI) in clinical settings, current study was designed to provide a proof of principle that Doppler sonography and DCE-MRI derived perfusion parameters yield similar hemodynamic information from metastatic lymph nodes in squamous cell carcinomas of head and neck (HNSCCs). Strong positive correlations between volume fraction of plasma space in tissues (Vp ) and blood volume (r = 0.72, p = 0.02) and between Vp and %area perfused (r = 0.65, p = 0.04) were observed. Additionally, a moderate positive correlation trending towards significance was obtained between volume transfer constant (Ktrans ) and %area perfused (r = 0.49, p = 0.09).
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Affiliation(s)
- Sanjeev Chawla
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Laurie Loevner
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Suyash Mohan
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Alexander Lin
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Chandra M Sehgal
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Harish Poptani
- Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, UK
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Lorenzon M, Spina E, Tulipano Di Franco F, Giovannini I, De Vita S, Zabotti A. Salivary Gland Ultrasound in Primary Sjögren’s Syndrome: Current and Future Perspectives. Open Access Rheumatol 2022; 14:147-160. [PMID: 36072437 PMCID: PMC9444027 DOI: 10.2147/oarrr.s284763] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 08/24/2022] [Indexed: 12/12/2022] Open
Affiliation(s)
- Michele Lorenzon
- Institute of Radiology, Department of Medicine, University of Udine, Udine, Italy
- Correspondence: Michele Lorenzon, Institute of Radiology, Department of Medicine, University of Udine, Udine, Italy, Tel +39 0432 559232, Email
| | - Erica Spina
- Institute of Radiology, Department of Medicine, University of Udine, Udine, Italy
| | | | - Ivan Giovannini
- Rheumatology Clinic, Department of Medical and Biological Sciences, Azienda Sanitaria Universitaria Friuli Centrale c/o University of Udine, Udine, Italy
| | - Salvatore De Vita
- Rheumatology Clinic, Department of Medical and Biological Sciences, Azienda Sanitaria Universitaria Friuli Centrale c/o University of Udine, Udine, Italy
| | - Alen Zabotti
- Rheumatology Clinic, Department of Medical and Biological Sciences, Azienda Sanitaria Universitaria Friuli Centrale c/o University of Udine, Udine, Italy
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7
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Künzel J, Brandenstein M, Zeman F, Symeou L, Platz Batista da Silva N, Jung EM. Multiparametric Ultrasound of Cervical Lymph Node Metastases in Head and Neck Cancer for Planning Non-Surgical Therapy. Diagnostics (Basel) 2022; 12:diagnostics12081842. [PMID: 36010193 PMCID: PMC9406677 DOI: 10.3390/diagnostics12081842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 07/27/2022] [Accepted: 07/28/2022] [Indexed: 11/16/2022] Open
Abstract
Background: We aimed to evaluate multiparametric ultrasound, to achieve a better understanding of the baseline characteristics of suspected cervical lymph node metastases in head and neck cancer before induction chemotherapy or chemoradiation. Methods: From February 2020 to April 2021, our complete ultrasound examination protocol was carried out on clinically evident malignant lymph nodes of histologically proven HNSCC in the pre-therapeutic setting. Results: A total of 13 patients were eligible for analysis. Using elastography, irregular clear hardening in areas in the center of the lymph node could be detected in all cases. Elastographic Q-analysis showed a significantly softer cortex compared to the center and surrounding tissue. The time–intensity curve analysis showed high values for the area under the curve and a short time-to-peak (fast wash-in) in all cases compared to the surrounding tissue. A parametric evaluation of contrast enhanced the ultrasound in the early arterial phase and showed an irregular enhancement from the margin in almost all investigated lymph nodes. These results show that the implementation of comprehensive, multiparametric ultrasound is suitable for classifying suspected lymph node metastasis more precisely than conventional ultrasound alone in the pre-therapeutic setting of HNSCC. Thus, these parameters may be used for improvements in the re-staging after chemoradiation or neoadjuvant therapy monitoring, respectively.
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Affiliation(s)
- Julian Künzel
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital of Regensburg, 93053 Regensburg, Germany;
- Correspondence:
| | - Moritz Brandenstein
- Department of Radiology, University Hospital of Regensburg, 93053 Regensburg, Germany; (M.B.); (N.P.B.d.S.); (E.M.J.)
| | - Florian Zeman
- Center of Clinical Studies, University Hospital of Regensburg, 93053 Regensburg, Germany;
| | - Luisa Symeou
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital of Regensburg, 93053 Regensburg, Germany;
| | | | - Ernst Michael Jung
- Department of Radiology, University Hospital of Regensburg, 93053 Regensburg, Germany; (M.B.); (N.P.B.d.S.); (E.M.J.)
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8
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Weimer JM, Rink M, Müller L, Arens C, Bozzato A, Künzel J. Sonografische Diagnostik im Kopf-Hals-Bereich – Teil 2: Transzervikale Sonografie. Laryngorhinootologie 2022; 101:156-175. [DOI: 10.1055/a-1667-8675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
| | | | | | | | | | - Julian Künzel
- Klinik und Poliklinik für Hals-Nasen-Ohren-Heilkunde, Universitätsklinikum Regensburg, Regensburg
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9
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Tamanini G, Cominardi A, Brighi N, Fusaroli P, Lisotti A. Endoscopic ultrasound assessment and tissue acquisition of mediastinal and abdominal lymph nodes. World J Gastrointest Oncol 2021; 13:1475-1491. [PMID: 34721779 PMCID: PMC8529915 DOI: 10.4251/wjgo.v13.i10.1475] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 04/16/2021] [Accepted: 07/21/2021] [Indexed: 02/06/2023] Open
Abstract
The differential diagnosis between benign and malignant lymph nodes (LNs) has a fundamental role in the characterization and staging of malignant conditions, as well as in subsequent patients’ management. All imaging modalities (i.e. computed tomography and magnetic resonance imaging) rely mainly on size; endoscopic ultrasound (EUS) criteria based on B-mode evaluation and Doppler features fail to adequately characterize with high specificity LNs nature. The introduction of EUS-elastography and contrast-enhanced harmonic EUS are useful techniques to increase the diagnostic yield in identifying metastatic LNs, to identify which suspicious LN should require pathological characterization and, finally, to target tissue acquisition. EUS-guided tissue acquisition (EUS-TA) is increasingly being used for diagnosing lymphadenopathy whenever the characterization modifies patients’ subsequent management and when no superficial LN is accessible. Since target therapy are currently available (i.e. lung cancer, breast cancer), EUS-TA of malignant LNs could be required to identify tumor biology. In this field, both fine needle aspiration and biopsy needles are able to guarantee accurate results with almost perfect specificity and sub-optimal sensitivity. We finally propose a diagnostic algorithm based on most recent, high-level evidence for the diagnostic approach to suspected LNs assessment.
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Affiliation(s)
- Giacomo Tamanini
- Department of Gastroenterology Unit, Hospital of Imola, University of Bologna, Imola 40026, BO, Italy
| | - Anna Cominardi
- Department of Gastroenterology Unit, Hospital of Imola, University of Bologna, Imola 40026, BO, Italy
| | - Nicole Brighi
- Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola 47014, FC, Italy
| | - Pietro Fusaroli
- Department of Gastroenterology Unit, Hospital of Imola, University of Bologna, Imola 40026, BO, Italy
| | - Andrea Lisotti
- Department of Gastroenterology Unit, Hospital of Imola, University of Bologna, Imola 40026, BO, Italy
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10
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Application of multimodal ultrasonography for differentiating benign and malignant cervical lymphadenopathy. Jpn J Radiol 2021; 39:938-945. [PMID: 33970452 DOI: 10.1007/s11604-021-01131-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 05/01/2021] [Indexed: 12/16/2022]
Abstract
OBJECTIVES The purpose of this study was to evaluate the diagnostic value of multimodal ultrasonography, including SWE and CEUS, for the differentiation of benign and malignant cervical lymphadenopathy. METHODS A total of 103 patients with 109 enlarged neck lymph nodes underwent SWE and CEUS. There were 25 hyperplastic lymph nodes, 66 metastatic lymph nodes, and 18 cases of lymphoma. RESULTS Using 31.6 kPa as the Emax cutoff, the sensitivity, specificity and accuracy of measurements on both benign and malignant cervical lymph nodes were 55.95%, 96%, and 65.2%, respectively. CEUS showed that lymph nodes with reactive hyperplasia mainly exhibited uniform perfusion via the lymphatic hilum (18/25; 72%; P < 0.01). The main manifestation of lymphoma was uniform perfusion through the lymphatic hila (10/18; 55.6%; P < 0.01). Metastatic lymph nodes mainly exhibited uneven perfusion (57/66; 86.4%; P < 0.01). The sensitivity, specificity, and accuracy of multimodal ultrasonography for the diagnosis of benign and malignant cervical lymphadenopathies were 90.5%, 72%, and 86.2%, respectively. CONCLUSIONS Our findings suggest that multimodal ultrasonography can detect the stiffness (elasticity), perfusion pattern, and characteristics of lymph nodes and is a valuable tool for differentiating between benign and malignant lymphadenopathies.
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11
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Piskunowicz M, Back SJ, Darge K, Humphries PD, Jüngert J, Ključevšek D, Lorenz N, Mentzel HJ, Squires JH, Huang DY. Contrast-enhanced ultrasound of the small organs in children. Pediatr Radiol 2021; 51:2324-2339. [PMID: 33830288 PMCID: PMC8566395 DOI: 10.1007/s00247-021-05006-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 11/17/2020] [Accepted: 02/08/2021] [Indexed: 11/28/2022]
Abstract
In pediatric and adult populations, intravenous contrast-enhanced ultrasound (CEUS) remains off-label for imaging of organs other than the liver and heart. This limited scope inhibits potential benefits of the new modality from a more widespread utilization. Yet, CEUS is potentially useful for imaging small organs such as the thyroid gland, lymph nodes, testes, ovaries and uterus, with all having locations and vasculature favorable for this type of examination. In the adult population, the utility of CEUS has been demonstrated in a growing number of studies for the evaluation of these small organs. The aim of this article is to present a review of pediatric CEUS of the thyroid gland, lymph nodes, testes, ovaries and uterus as well as to draw from the adult literature indications for possible applications in children.
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Affiliation(s)
- Maciej Piskunowicz
- Department of Radiology, Medical University of Gdansk, M. Sklodowskiej-Curie 3a Street, 80-210, Gdansk, Poland.
| | - Susan J. Back
- grid.25879.310000 0004 1936 8972Department of Radiology, Children’s Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA USA
| | - Kassa Darge
- grid.25879.310000 0004 1936 8972Department of Radiology, Children’s Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA USA
| | - Paul D. Humphries
- grid.424537.30000 0004 5902 9895Department of Radiology, Great Ormond Street Hospital for Children NHS Trust, London, UK
| | - Jörg Jüngert
- grid.5330.50000 0001 2107 3311Department of Pediatrics, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - Damjana Ključevšek
- grid.29524.380000 0004 0571 7705Department of Radiology, University Children’s Hospital Ljubljana, Ljubljana, Slovenia
| | - Norbert Lorenz
- grid.4488.00000 0001 2111 7257Children’s Hospital, Dresden Municipal Hospital, Teaching-Hospital of Technical University Dresden, Dresden, Germany
| | - Hans-Joachim Mentzel
- grid.275559.90000 0000 8517 6224Section of Pediatric Radiology, Institute of Diagnostic and Interventional Radiology, University Hospital, Jena, Germany
| | - Judy H. Squires
- grid.239553.b0000 0000 9753 0008Department of Radiology, University of Pittsburgh Medical Center, Children’s Hospital of Pittsburgh, Pittsburgh, PA USA
| | - Dean Y. Huang
- grid.46699.340000 0004 0391 9020Department of Radiology, King’s College Hospital, Denmark Hill, London, UK
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12
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Rohan K, Ramesh A, Sureshkumar S, Vijayakumar C, Abdulbasith KM, Krishnaraj B. Evaluation of B-Mode and Color Doppler Ultrasound in the Diagnosis of Malignant Cervical Lymphadenopathy. Cureus 2020; 12:e9819. [PMID: 32953329 PMCID: PMC7495950 DOI: 10.7759/cureus.9819] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background B-mode ultrasound (BMUS) and color doppler ultrasound (CDUS) could be valuable in evaluating cervical lymphadenopathy compared to palpation. This study aimed at evaluating the efficacy of BMUS and CDUS in differentiating cervical lymph nodes into benign and malignant nature. Methodology In this cross-sectional analytical study, a total of 166 patients, who were referred for US-guided fine-needle aspiration cytology (FNAC) of cervical nodes, were included. Patients with cystic/ necrotic cervical nodes or without FNAC/biopsy report were excluded. All study patients underwent BMUS and CDUS, followed by the reference investigation of FNAC/biopsy for analysis. In BMUS, short-axis diameter (SAD), short-axis/long-axis diameter ratio (S/L), presence or absence of echogenic hilum and well defined or ill-defined borders were analyzed. In CDUS, the vascular pattern of a cervical node was categorized as hilar, peripheral or mixed. In cases with multiple cervical lymph nodes, the node having the most suspicious features on the greyscale US was chosen. The results were compared with the final FNAC/biopsy reports. Results A total of 166 patients were analyzed in this study. The cut-off point of SAD and S/L ratio for the cervical lymph nodes was 1.28cm and 0.595. The S/L ratio was the best BMUS parameter with a sensitivity of 75%, the specificity of 81%, and an accuracy of 79%. Loss of echogenic hilum was the most sensitive parameter in this study with a sensitivity of 95.4% and an accuracy of 79.5%. The presence of ill-defined margins was significantly higher in the malignant nodes than the benign nodes with a p-value <0.001. The presence of peripheral/mixed vascularity was higher in the malignant nodes than the benign nodes with a p-value <0.001. Conclusions Malignant nodes had significantly higher SAD, higher S/L ratio, loss of echogenic hilum, presence of ill-defined margins and peripheral/mixed vascularity compared to benign nodes. The loss of echogenic hilum was the most accurate and sensitive parameter, while the S/L ratio was found to be the most specific BMUS parameter in the detection of malignant nodes. BMUS and CDUS identify malignant nodes and also helps in guiding FNAC/biopsy.
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Affiliation(s)
- Kamat Rohan
- Radiodiagnosis, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
| | - Ananthakrishnan Ramesh
- Radiodiagnosis, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
| | - Sathasivam Sureshkumar
- Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
| | - Chellappa Vijayakumar
- Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
| | - K M Abdulbasith
- Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
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13
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Aplicaciones clínicas de la ecografía pulmonar. Med Clin (Barc) 2020; 154:260-268. [DOI: 10.1016/j.medcli.2019.11.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 11/06/2019] [Accepted: 11/09/2019] [Indexed: 12/28/2022]
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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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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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Künzel J, Bozzato A, Strieth S. Sonographie in der Nachsorge bei Kopf- und Halskarzinomen. HNO 2017; 65:939-952. [DOI: 10.1007/s00106-017-0411-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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A Risk Model based on Ultrasound, Ultrasound Elastography, and Histologic Parameters for Predicting Axillary Lymph Node Metastasis in Breast Invasive Ductal Carcinoma. Sci Rep 2017; 7:3029. [PMID: 28596561 PMCID: PMC5465090 DOI: 10.1038/s41598-017-03582-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 05/02/2017] [Indexed: 01/07/2023] Open
Abstract
To develop a risk model for predicting axillary lymph node metastasis (LNM) in patients with breast invasive ductal carcinoma (IDCs) using ultrasound (US), US elastography of virtual touch tissue imaging (VTI) and virtual touch tissue imaging & quantification (VTIQ), and histologic parameters. This study included 162 breast IDCs in 162 patients. Univariate and multivariate analyses were used to identify the risk factors and a risk model was created. The results found that 64 (39.5%) of 162 patients had axillary LNMs. The risk score (RS) for axillary LNM was defined as following: RS = 1.3 × (if lesion size ≥20 mm) + 2.6 × (if taller than wide shape) + 2.2 × (if VTI score ≥5) + 3.9 × (if histological grade III) + 1.9 × (if positive C-erbB-2). The rating system was divided into 6 stages (i.e. Stage I, Stage II, Stage III, Stage IV, Stage V, and Stage VI) and the associated risk rates in terms of axillary LNM were 0% (0/19), 6.1% (2/33), 7.7% (3/39), 65.5% (19/29), 92.3% (24/26), and 100% (16/16), respectively. The risk model for axillary LNM established in the study may facilitate subsequent treatment planning and management in patients with breast IDCs.
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Bekhouche A, Tardivon A. Statut ganglionnaire axillaire chez les patientes prises en charge pour un cancer du sein : évaluation préopératoire et évolution de la prise en charge. IMAGERIE DE LA FEMME 2017. [DOI: 10.1016/j.femme.2017.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Tan S, Miao LY, Cui LG, Sun PF, Qian LX. Value of Shear Wave Elastography Versus Contrast-Enhanced Sonography for Differentiating Benign and Malignant Superficial Lymphadenopathy Unexplained by Conventional Sonography. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2017; 36:189-199. [PMID: 27925679 DOI: 10.7863/ultra.16.01014] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Accepted: 03/30/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVES This study aimed to compare the efficacy of shear wave elastography (SWE) and contrast-enhanced sonography in the differential diagnosis of superficial lymphadenopathy with abnormal imaging findings, which could not be otherwise confirmed by conventional sonography. METHODS Forty-two enlarged superficial lymph nodes in 42 patients who met the screening criteria for this study were evaluated by both contrast-enhanced sonography and SWE. All lymph nodes underwent both methods using biopsy pathologic findings as a reference standard. RESULTS The maximum elastic modulus, mean elastic modulus, and standard deviation of the elastic modulus were the main distinguishing features on SWE; they were significantly higher in malignant lesions than benign ones. The threshold value for the maximum elastic modulus was set at 37.9 kPa, and the sensitivity, specificity, and accuracy of differential diagnosis of superficial lymph nodes were 81.8%, 80.0%, and 81.0%, respectively. The diagnosis of benignity and malignancy by this index was statistically significant (P < .001). The lymph nodes were divided into benign and malignant groups according to different types based on the degree and range of intensity on contrast-enhanced sonography: intense or moderate homogeneous enhancement (n = 26) and heterogeneous, low homogeneous, or absent enhancement (n = 16). The sensitivity, specificity, and accuracy of contrast-enhanced sonography were 27.3%, 50.0%, and 38.1%. There was no statistically significant difference in the values between the benign and malignant groups (χ2 = 2.295; P = .130). CONCLUSIONS Compared with contrast-enhanced sonography, SWE has better diagnostic value and efficiency in differentiation of superficial lymph nodes unexplained by conventional sonography. When conventional sonography cannot differentiate malignant superficial lymph nodes from benign ones, SWE is a useful adjunctive tool for assessment of lymph nodes.
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Affiliation(s)
- Shi Tan
- Department of Ultrasound, Beijing Friendship Hospital, Capital Medical University, Beijing, China
- Department of Ultrasound, Peking University Third Hospital, Beijing, China
| | - Li-Ying Miao
- Department of Ultrasound, Peking University Third Hospital, Beijing, China
| | - Li-Gang Cui
- Department of Ultrasound, Peking University Third Hospital, Beijing, China
| | - Peng-Fei Sun
- Department of Ultrasound, Peking University Third Hospital, Beijing, China
| | - Lin-Xue Qian
- Department of Ultrasound, Beijing Friendship Hospital, Capital Medical University, Beijing, China
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Altinbas NK, Oz I, Ustuner E, Gulpinar B, Peker E, Akkaya Z, Peker A, Ceyhan K, Yagci C. Intranodal Palisaded Myofibroblastoma: Radiological and Cytological Overview. Pol J Radiol 2016; 81:342-6. [PMID: 27504146 PMCID: PMC4959455 DOI: 10.12659/pjr.895743] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2015] [Accepted: 12/29/2015] [Indexed: 11/18/2022] Open
Abstract
Background Intranodal palisaded myofibroblastoma is a benign and very rare mesenchymal neoplasm of the lymph nodes originating from differentiated smooth muscle cells and myofibroblasts. Case Report We report a case of intranodal palisaded myofibroblastoma in an 84-year-old woman with Parkinson’s disease that presented as a left inguinal mass. The diagnosis was made using ultrasound-guided fine needle aspiration biopsy and consequent cytopathological examination that included immunohistochemical analysis. Herein, we discuss the presentation of a rare intranodal palisaded myofibroblastoma with emphasis on its ultrasonographic and cytopathologic features. Conclusions Intranodal palisaded myofibroblastoma should be considered in the differential diagnosis of inguinal lymphadenopathy and the diagnosis is possible with cytopathologic exam and immunohistochemical analysis using ultrasound-guided FNA biopsy, guiding the clinician to nodal excision rather than aggressive measures.
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Affiliation(s)
| | - Ilker Oz
- Department of Radiology, Bulent Ecevit University, Faculty of Medicine, Zonguldak, Turkey
| | - Evren Ustuner
- Department of Radiology, Ankara University, Faculty of Medicine, Ankara, Turkey
| | - Basak Gulpinar
- Department of Radiology, Ankara University, Faculty of Medicine, Ankara, Turkey
| | - Elif Peker
- Department of Radiology, Ankara University, Faculty of Medicine, Ankara, Turkey
| | - Zehra Akkaya
- Department of Radiology, Ankara University, Faculty of Medicine, Ankara, Turkey
| | - Ahmet Peker
- Department of Radiology, Ankara University, Faculty of Medicine, Ankara, Turkey
| | - Koray Ceyhan
- Department of Pathology, Ankara University, Faculty of Medicine, Ankara, Turkey
| | - Cemil Yagci
- Department of Radiology, Ankara University, Faculty of Medicine, Ankara, Turkey
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Shen CT, Wei WJ, Qiu ZL, Song HJ, Luo QY. Value of post-therapeutic ¹³¹I scintigraphy in stimulated serum thyroglobulin-negative patients with metastatic differentiated thyroid carcinoma. Endocrine 2016; 51:283-90. [PMID: 26093847 DOI: 10.1007/s12020-015-0660-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Accepted: 06/09/2015] [Indexed: 11/30/2022]
Abstract
Metastatic differentiated thyroid carcinoma (DTC) with positive (131)I scintigraphy, but negative stimulated Tg (sTg) is relatively rare in clinical practice. The clinical characteristics of these patients were analyzed in the current study. A total of 3367 consecutive histologically proven DTC patients were analyzed retrospectively from January 2007 to June 2013. Tg negativity was defined as a sTg level of <2 ng/mL without positive anti-Tg antibody (TgAb level of <100 IU/mL) under thyroid-stimulating hormone stimulation (TSH level of ≥30 mIU/L). Analyses were performed using the Statistical Package for the Social Sciences, version 20.0 (SPSS, Chicago, IL, USA). Seventy-one patients (median age 45 years, range 17-68 years) were post-therapeutic (131)I-SPECT/CT positive and sTg negative (PTP-TN) constituting 2.1 % of all patients. Of these 71 patients, 2 (2.8 %) had bone metastasis, 11 (15.5 %) had lung metastasis, and 59 (83.1 %) had lymph node metastasis. Fifty-six patients had cervical lymph node metastasis (cLNM), and US was positive in 15 patients (26.8 %), while negative in 41 patients (73.2 %). When compared to patients with concordant positive results for sTg and (131)I scintigraphy, US showed a relatively lower positive rate in the detection of cLNM in PTP-TN patients (28.8 vs. 53.8 %; χ (2) = 6.70; P = 0.01). In conclusion, even with sTg <2 ng/mL, there is a low risk of metastatic DTC. US had limitations in PTP-TN patients, while post-therapy (131)I-SPECT/CT demonstrated an advantage in the detection of functioning metastasis despite low sTg levels in patients with metastatic DTC.
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Affiliation(s)
- Chen-Tian Shen
- Department of Nuclear Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, People's Republic of China
| | - Wei-Jun Wei
- Department of Nuclear Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, People's Republic of China
| | - Zhong-Ling Qiu
- Department of Nuclear Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, People's Republic of China
| | - Hong-Jun Song
- Department of Nuclear Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, People's Republic of China
| | - Quan-Yong Luo
- Department of Nuclear Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, People's Republic of China.
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Hammon M, Dankerl P, Janka R, Wachter DL, Hartmann A, Schulz-Wendtland R, Uder M, Wenkel E. Fine needle aspiration cytology of lymph nodes in breast cancer follow-up is a feasible alternative to watchful waiting and to histology. BMC WOMENS HEALTH 2015; 15:114. [PMID: 26631071 PMCID: PMC4668692 DOI: 10.1186/s12905-015-0269-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Accepted: 11/20/2015] [Indexed: 02/05/2023]
Abstract
Background Early detection of loco-regional breast cancer recurrence improves patients’ overall survival, as treatment can be initiated or active treatment can be changed. If a suspicious lymph node is diagnosed during a follow-up exam, surgical excision is often performed. The aim of this study was to evaluate the diagnostic performance of the minor invasive ultrasound-guided fine-needle aspiration cytology (FNAC) in sonomorphologically suspicious lymph nodes in breast cancer follow-up. Methods Between April 2010 and November 2012, we performed ultrasound-guided FNAC in 38 sonographically suspicious lymph nodes of 37 breast cancer follow-up patients. Cytological specimens were evaluated if the sample material was sufficient for diagnosis and if they contained cancer cells. Patients with negative cytology were followed up clinically and sonographically. To evaluate the diagnostic performance we calculated sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for physical examination, the different sonomorphological malignancy criteria and FNAC. Results In 36/38 (94.7 %) lymph nodes, the pathologist had enough material to establish a final diagnosis; in 2/38 (5.3 %) lymph nodes, the probe material was non-evaluable during cytology, these 2 were excluded from further statistical evaluation. Cytology revealed malignancy in 21 lymph nodes and showed no evidence for malignancy in 15 lymph nodes. There was no evidence for malignant disease in follow-up exams in the 15 cytologically benign lymph nodes with an average follow-up time of 3 years. The diagnostic performances of physical examination and FNAC were: Sensitivity 52/100 %, specificity 88/100 %, PPV 85/100 %, NPV 60/100 %, respectively. Conclusions Our preliminary results show that FNAC is a safe and fast diagnostic approach for the evaluation of suspicious lymph nodes in the follow-up of patients with breast cancer and, thus, together with follow-up represents a feasible alternative to surgery.
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Affiliation(s)
- Matthias Hammon
- Department of Radiology, University Hospital Erlangen, Maximiliansplatz 1, 91054, Erlangen, Germany.
| | - Peter Dankerl
- Department of Radiology, University Hospital Erlangen, Maximiliansplatz 1, 91054, Erlangen, Germany.
| | - Rolf Janka
- Department of Radiology, University Hospital Erlangen, Maximiliansplatz 1, 91054, Erlangen, Germany.
| | - David L Wachter
- Department of Pathology, University Hospital Erlangen, Erlangen, Germany.
| | - Arndt Hartmann
- Department of Pathology, University Hospital Erlangen, Erlangen, Germany.
| | - Rüdiger Schulz-Wendtland
- Department of Radiology, University Hospital Erlangen, Maximiliansplatz 1, 91054, Erlangen, Germany.
| | - Michael Uder
- Department of Radiology, University Hospital Erlangen, Maximiliansplatz 1, 91054, Erlangen, Germany.
| | - Evelyn Wenkel
- Department of Radiology, University Hospital Erlangen, Maximiliansplatz 1, 91054, Erlangen, Germany.
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Al-Hilli Z, Hieken TJ, Boughey JC. Axillary Ultrasound in the Management of the Newly Diagnosed Breast Cancer Patient. Breast J 2015; 21:634-41. [DOI: 10.1111/tbj.12497] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Zahraa Al-Hilli
- Division of Subspecialty General Surgery; Department of Surgery; Mayo Clinic College of Medicine; Mayo Clinic Cancer Center; Rochester Minnesota
| | - Tina J. Hieken
- Division of Subspecialty General Surgery; Department of Surgery; Mayo Clinic College of Medicine; Mayo Clinic Cancer Center; Rochester Minnesota
| | - Judy C. Boughey
- Division of Subspecialty General Surgery; Department of Surgery; Mayo Clinic College of Medicine; Mayo Clinic Cancer Center; Rochester Minnesota
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Abstract
Medical imaging is an important tool in the evaluation and classification of pediatric head and neck masses. Such lesions may include congenital, inflammatory, infectious, vascular, or neoplastic processes. Ultrasound is often the first line modality in the workup of a neck mass in a child, followed by MRI or CT depending on the scenario. This information must be interpreted in the context of the patient's clinical history, physical examination, and demographics. The medical imaging workup of a neck mass in a child must be focused to yield the maximum information possible while minimizing the risks of radiation and sedation.
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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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Guimarães AC, de Carvalho GM, Bento LR, Correa C, Gusmão RJ. Clinical manifestations in children with tonsillar lymphoma: A systematic review. Crit Rev Oncol Hematol 2014; 90:146-51. [DOI: 10.1016/j.critrevonc.2013.12.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Revised: 11/24/2013] [Accepted: 12/04/2013] [Indexed: 12/17/2022] Open
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Stramare R, Beltrame V, Del Villano R, Motta R, Frigo AC, Rubaltelli L. Analysis by high resolution ultrasound of superficial lymph nodes: anatomical, morphological and structural variations. Clin Imaging 2014; 38:96-9. [DOI: 10.1016/j.clinimag.2013.11.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2013] [Revised: 08/20/2013] [Accepted: 11/21/2013] [Indexed: 10/26/2022]
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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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Ecanow JS, Abe H, Newstead GM, Ecanow DB, Jeske JM. Axillary Staging of Breast Cancer: What the Radiologist Should Know. Radiographics 2013; 33:1589-612. [DOI: 10.1148/rg.336125060] [Citation(s) in RCA: 124] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Heusch P, Sproll C, Buchbender C, Rieser E, Terjung J, Antke C, Boeck I, Macht S, Scherer A, Antoch G, Heusner TA, Handschel J. Diagnostic accuracy of ultrasound, ¹⁸F-FDG-PET/CT, and fused ¹⁸F-FDG-PET-MR images with DWI for the detection of cervical lymph node metastases of HNSCC. Clin Oral Investig 2013; 18:969-78. [PMID: 23892450 DOI: 10.1007/s00784-013-1050-z] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Accepted: 07/05/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE This study aimed to compare (18)F-fluorodesoxyglucose positron emission tomography/MRI ((18)F-FDG-PET-MRI) fusion images, including diffusion-weighted imaging (DWI), (18)F-FDG-PET/CT, and ultrasound (US) regarding their performance in nodal staging of patients with head and neck squamous cell carcinoma (HNSCC). MATERIALS AND METHODS Eighteen patients prospectively underwent ultrasound examination, (18)F-FDG- PET/CT, and MRI before oral tumor resection and bilateral neck dissection. PET data sets were fused with contrast-enhanced T1-weighted MR images. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy for nodal detection were calculated for all the imaging modalities. Furthermore, the accuracy of the correct N-staging was calculated for all methods. Detailed histopathology served as the standard of reference. RESULTS The sensitivity, specificity, PPV, NPV, and accuracy for detection of lymph node metastases were 63, 99, 86, 96, and 95 % for ultrasound; 30, 97, 56, 92, and 90 % for (18)F-FDG-PET/CT; 52, 96, 59, 94, and 91 % for (18)F-FDG-PET-MRI; and 53, 97, 67, 95, and 92 % for (18)F-FDG-PET-MRI plus DWI, respectively. There was no significant difference in the diagnostic accuracy for lymph node metastasis detection between (18)F-FDG-PET-MRI and (18)F-FDG-PET/CT (p = 0.839) and between (18)F-FDG-PET-MRI plus DWI and (18)F-FDG-PET/CT (p = 0.286), respectively. US was significantly more accurate than (18)F-FDG-PET/CT (p = 0.009), whereas no significant difference was seen between (18)F-FDG-PET-MRI and US (p = 0.223) or (18)F-FDG-PET-MRI plus DWI and US (p = 0.115). The nodal stage was correctly rated by (18)F-FDG-PET-MRI in eight patients, (18)F-FDG-PET-MRI plus DWI in nine patients, US in 12 patients, and (18)F-FDG-PET/CT in five out of 18 patients. CONCLUSION Software-based fusion of (18)F-FDG-PET-MRI and (18)F-FDG-PET-MRI plus DWI may not increase nodal detection and N-staging performance in patients with oral malignancies compared to US and (18)F-FDG-PET/CT. CLINICAL RELEVANCE Surgical staging of cervical lymph nodes will not be replaced even by advanced imaging modalities in the near future.
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Affiliation(s)
- Philipp Heusch
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University of Dusseldorf, 40225, Dusseldorf, Germany
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Slaisova R, Benda K, Jarkovsky J, Petrasova H, Szturz P, Valek V. Contrast-enhanced ultrasonography compared to gray-scale and power doppler in the diagnosis of peripheral lymphadenopathy. Eur J Radiol 2013; 82:693-8. [DOI: 10.1016/j.ejrad.2012.12.008] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2012] [Revised: 12/09/2012] [Accepted: 12/10/2012] [Indexed: 10/27/2022]
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Napolitano G, Romeo A, Bianco A, Gasperi M, Zeppa P, Brunese L. B-flow twinkling sign in preoperative evaluation of cervical lymph nodes in patients with papillary thyroid carcinoma. Int J Endocrinol 2013; 2013:203610. [PMID: 23878537 PMCID: PMC3710605 DOI: 10.1155/2013/203610] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Accepted: 04/26/2013] [Indexed: 12/13/2022] Open
Abstract
Papillary thyroid cancer (PTC) is the most common histologic type of differentiated thyroid cancer. The first site of metastasis is the cervical lymph nodes (LNs). The ultrasonography (US) is the best diagnostic method for the detection of cervical metastatic LNs. We use a new technique, B-flow imaging (BFI), recently used for evaluation of thyroid nodules, to estimate the presence of BFI twinkling signs (BFI-TS), within metastatic LNs in patients with PTC. Two hundred and fifty-two patients with known PTC were examined for preoperative evaluation with conventional US and BFI. Only 83 with at least one metastatic LN were included. All patients included underwent surgery; the final diagnosis was based on the results of histology. The following LN characteristics were evaluated: shape, abnormal echogenicity, absent hilum, calcifications, cystic appearance, peripheral vascularization, and BFI-TS. A total of 604 LNs were analyzed. Of these, 298 were metastatic, according to histopathology. The BFI-TS showed high values of specificity (99.7%) and sensitivity (80.9%). The combination of each conventional US sign with the BF-TS increases the specificity. Our findings suggest that BFI can be helpful in the selection of suspicious neck LNs that should be examined at cytologic examination for accurate preoperative staging and individual therapy selection.
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Affiliation(s)
- Giuseppina Napolitano
- Department of Health Science, Chair of Radiology, University of Molise, Contrada Tappino, 86100 Campobasso, Italy
| | - Antonio Romeo
- Department of Health Science, Chair of Radiology, University of Molise, Contrada Tappino, 86100 Campobasso, Italy
| | - Andrea Bianco
- Department of Health Science, Chair of Radiology, University of Molise, Contrada Tappino, 86100 Campobasso, Italy
| | - Maurizio Gasperi
- Department of Health Science, Chair of Radiology, University of Molise, Contrada Tappino, 86100 Campobasso, Italy
| | - Pio Zeppa
- Department of Medicine and Surgery, the University of Salerno (IT), Italy
| | - Luca Brunese
- Department of Health Science, Chair of Radiology, University of Molise, Contrada Tappino, 86100 Campobasso, Italy
- *Luca Brunese:
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Kagawa T, Yuasa K, Fukunari F, Shiraishi T, Miwa K. Quantitative evaluation of vascularity within cervical lymph nodes using Doppler ultrasound in patients with oral cancer: relation to lymph node size. Dentomaxillofac Radiol 2011; 40:415-21. [PMID: 21960398 DOI: 10.1259/dmfr/18694011] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES The aim of this study was to quantitatively evaluate the relationship between vascularity within lymph nodes and lymph node size on Doppler ultrasound images of patients with oral cancer. METHODS A total of 310 lymph nodes (86 metastatic, 224 benign) from 63 patients with oral cancer were classified into 4 groups according to their short axis diameters: Group 1, short axis diameters of 4-5 mm; Group 2, 6-7 mm; Group 3, 8-9 mm; and Group 4, ≥ 10 mm. Vascular and scattering indices of lymph nodes on Doppler ultrasound images were analysed quantitatively. The vascular index was defined as the ratio of blood flow area to the whole lymph node area and the scattering index was defined as the number of isolated blood flow signal units. RESULTS For metastatic lymph nodes, the vascular index was highest in Group 1 and decreased as lymph node size increased. The vascular index of benign lymph nodes did not differ significantly among the four groups. The vascular index of metastatic lymph nodes was significantly higher than that of benign lymph nodes in Group 1. For metastatic lymph nodes, the scattering index increased as lymph node size increased and was significantly higher than that of benign lymph nodes in Groups 2-4. CONCLUSIONS An increase in vascularity is a characteristic of Doppler ultrasound findings in small metastatic lymph nodes. As the metastatic lymph node size increases, blood flow signals become scattered, and the scattering index increases.
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Affiliation(s)
- T Kagawa
- Department of Diagnostics & General Care, Fukuoka Dental College, Sawara-ku, Fukuoka, Japan.
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Ashraf M, Biswas J, Jha J, Nayak S, Singh V, Majumdar S, Bhowmick A, Dam A. Clinical utility and prospective comparison of ultrasonography and computed tomography imaging in staging of neck metastases in head and neck squamous cell cancer in an Indian setup. Int J Clin Oncol 2011; 16:686-93. [PMID: 21674359 DOI: 10.1007/s10147-011-0250-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2011] [Accepted: 04/21/2011] [Indexed: 11/27/2022]
Abstract
BACKGROUND Preoperative lymph node screening of all neck compartments is favored by clinicians for the management of the neck. The presence of a metastatic node on one side of the neck reduces the 5-year survival rate to 50%, and the presence of a metastatic node on both sides of the neck reduces the 5-year survival rate to 25%. MATERIALS AND METHODS This study compared the evaluation of lymph node metastases by ultrasonography (USG) and computed tomography (CT) in patients with squamous cell cancer of the head and neck region. RESULTS Five hundred and eighty-four patients with squamous cell cancer of the head and neck were prospectively evaluated for the presence of cervical lymph node metastases. All patients underwent clinical examination (palpation), USG and CT imaging. Neck dissection was performed in all the patients, and the results of the preoperative evaluation were correlated with the surgical and histopathological findings. Metastases in neck nodes were identified in 148 patients by histopathological examination. Doppler USG correctly identified 136 node-positive patients (n = 148; sensitivity 91.8%, specificity 97%). CT imaging correctly identified 122 patients with metastatic lymph nodes (n = 148; sensitivity 83%, specificity 93%). Positive predictive values of USG and CT imaging were 95.6% and 91.3%, respectively, whereas the negative predictive values of these two imaging studies were 95.4% and 89.6%, respectively. CONCLUSIONS The accuracy and sensitivity of USG in detection of cervical lymph node metastases make it a potentially promising and cheap preoperative tool for staging neck node metastases and optimizing the treatment plan for surgeons, especially in countries such as India.
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Affiliation(s)
- Mohammad Ashraf
- Department of Surgical Oncolgy, Chittaranjan National Cancer Institute, 37 S P Mukherjee Road, Kolkata 26, India.
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Contrast-enhanced ultrasound for characterizing lymph nodes with focal cortical thickening in patients with cutaneous melanoma. AJR Am J Roentgenol 2011; 196:W8-12. [PMID: 21178038 DOI: 10.2214/ajr.10.4711] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVE The aim of this study was to ascertain the utility of contrast-enhanced ultrasound in assessing the significance of focal cortical thickening in the lymph nodes of patients followed up after surgery for cutaneous melanoma. MATERIALS AND METHODS Ultrasound was used to examine 460 consecutive patients to identify nodes with focal hypoechoic cortical thickening. Patients whose nodes revealed these features underwent contrast-enhanced ultrasound and ultrasound-guided fine-needle aspiration cytology (FNAC) focusing on the area of cortical thickening. Enhancement in the arterial and parenchymal phases was evaluated: A generalized homogeneous or intense enhancement was considered benign and the presence of a perfusion defect was considered metastatic. RESULTS After exclusion of 24 patients with frank signs of malignancy at gray-scale ultrasound, the study included 436 patients. Focal hypoechoic cortical thickening was seen in 44 of 436 nodes in as many patients. In 29 nodes, the area of focal thickening showed contrast enhancement similar to that of the remaining cortex on contrast-enhanced ultrasound. In 15 nodes, the area of cortical thickening was less well vascularized than the adjacent parenchyma in the arterial phase and there were areas with perfusion defects that were more evident in the parenchymal phase. FNAC focusing on the areas of focal cortical thickening identified 13 metastatic nodes and 31 nodes with benign features. Contrast-enhanced ultrasound compared with FNAC correctly classified 42 of 44 nodes, showing a sensitivity of 100% and a specificity of 99.5%. CONCLUSION Although our findings need to be confirmed in larger series, they indicate that contrast-enhanced ultrasound can be useful in clinical practice for characterizing focal cortical thickening in lymph nodes. The exclusion or identification of regional lymph node metastases is of fundamental importance in oncologic staging because this issue directly influences both the prognosis and the choice of therapeutic strategy.
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Liao LJ, Wang CT, Young YH, Cheng PW. Real-time and computerized sonographic scoring system for predicting malignant cervical lymphadenopathy. Head Neck 2010; 32:594-8. [PMID: 19693943 DOI: 10.1002/hed.21225] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND To identify malignant cervical lymphadenopathy, we established a real-time, computerized scoring system based on sonographic findings and demographic data. METHODS One hundred eight patients with neck lymphadenopathy, receiving ultrasonography and ultrasound-guided fine-needle aspiration (US-FNA), were used to construct a predictive model. This model was validated by another independent patient cohort. RESULTS A predictive scoring scale was proposed by multivariate logistic regression analysis: 0.06 x (age) + 4.76 x (S/L ratio) + 2.15 x (internal echo) + 1.80 x (vascular pattern). Cervical lymphadenopathy was regarded as malignant with a score >or=7. The formula was programmed into a synchronized, computerized sonographic reporting system. Prospective validation of this predictive tool showed excellent sensitivity (100%), specificity (88.0%), and overall accuracy (90.1%). CONCLUSION A real-time and practical sonographic scoring system was built and validated to provide the physician prompt and reliable probability guidance for performing US-FNA cytology in managing cervical lymphadenopathy.
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Affiliation(s)
- Li-Jen Liao
- Department of Otolaryngology, Far Eastern Memorial Hospital, Taipei, Taiwan
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Characterization of Mediastinal Lymph Node Physiology In Vivo by Optical Spectroscopy during Endoscopic Ultrasound-Guided Fine Needle Aspiration. J Thorac Oncol 2010; 5:981-7. [DOI: 10.1097/jto.0b013e3181ddbc0e] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Stramare R, Scagliori E, Mannucci M, Beltrame V, Rubaltelli L. The role of contrast-enhanced gray-scale ultrasonography in the differential diagnosis of superficial lymph nodes. Ultrasound Q 2010; 26:45-51. [PMID: 20216194 DOI: 10.1097/ruq.0b013e3181cf4469] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Lymph node micrometastases are common, but too often in clinical practice lack the tools for their accurate prebiopsy detection. The gray-scale contrast-enhanced ultrasonography technique permits high-resolution imaging of both the arterial and parenchymal phase and allows visualization of diffuse and partial alterations of nodal perfusion even in lymph nodes with a maximum diameter smaller than 1 cm. The gray-scale contrast-enhanced ultrasonography can supply further useful information in case where doubt has arisen with conventional techniques. The results obtained show that it affords highly accurate differentiation between benign and metastatic lymph nodes.
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Affiliation(s)
- Roberto Stramare
- Department of Medical Diagnostic Sciences and Special Therapies, University of Padova, Via Giustiniani 2, Padua, Italy.
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Abstract
Head and neck malignancy is rare in children. However, distinguishing malignant tumours from the more common and numerous benign causes of neck masses in childhood is crucial as many malignant conditions have an excellent prognosis with appropriate oncological management. Ultrasound, computed tomography and magnetic resonance imaging all have crucial roles in the diagnosis of head and neck malignancy in children and there is an emerging role for positron emission tomography, particularly in the management and follow-up of lymphoma. We describe the imaging appearances of the common malignant tumours arising in the extracranial head and neck in children, focusing on lymphoma, rhabdomyosarcoma and nasopharyngeal carcinoma. The clinical presentation and radiological appearances of benign tumours in the head and neck in children may overlap with those seen in malignant disease. We describe the imaging appearances of juvenile angiofibroma, vascular abnormalities involving the extracranial head and neck and cervical teratomas. Advances in both imaging techniques and cancer staging systems, many of the latter aimed at avoiding over-treatment and treatment-related complications, will lead to an increasingly central role for imaging in childhood head and neck cancer.
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Affiliation(s)
- Claire Lloyd
- Department of Radiology, Imperial College Healthcare NHS Trust, Charing Cross Hospital Campus, Fulham Palace Road, London, SW6 8RF, UK.
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Hamamoto J, Notsute D, Tokunaga K, Sasaki J, Kojima K, Saeki S, Tanaka R, Tanaka H, Kohrogi H. Diagnostic usefulness of endobronchial ultrasound-guided transbronchial needle aspiration in a case with malignant pleural mesothelioma. Intern Med 2010; 49:423-6. [PMID: 20190476 DOI: 10.2169/internalmedicine.49.2825] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 74-year old man was admitted to our hospital with right diffuse pleural thickening and effusion and with subcarinal lymph node swelling. The effusion obtained by thoracentesis showed no malignant cells, although positron emission tomography showed abnormal uptake in the right pleural thickening and subcarinal lymph node. Histopathological examination of the lymph node specimens obtained by endobronchial ultrasound-guided transbronchial needle aspiration showed a sheet of epithelioid-like large atypical cells. The tumor cells were immunohistochemically positive for calretinin and cytokeratin 5/6, and negative for CEA and TTF-1. Therefore, malignant pleural mesothelioma of epithelioid type was diagnosed.
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Affiliation(s)
- Junji Hamamoto
- Department of Respiratory Medicine, Kumamoto University Hospital, Faculty of Medical and Pharmaceutical Sciences, Kumamoto University.
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Abstract
BACKGROUND Ultrasonography (US) is increasingly being employed by endocrinologists and surgeons in the diagnosis and management of patients with thyroid nodules and thyroid cancer. Recent consensus guidelines from the American Thyroid Association highlight the importance of this modality by recommending that patients with thyroid nodules should undergo further evaluation with cervical US to stratify the risk of malignancy. Likewise, ultrasound is advocated for the preoperative and postoperative diagnosis of cervical lymph node metastases. SUMMARY This article will summarize the US characteristics that impart a suspicious appearance on thyroid nodules and cervical lymph nodes as well as those findings that are reassuring. Likewise, the indications for thyroid nodule and lymph node fine-needle aspiration will be reviewed. Finally, this article will briefly discuss adjunctive tools in US such as elastography, percutaneous ethanol ablation, and radiofrequency ablation. CONCLUSIONS US may be used to help stratify the risk of malignancy in thyroid nodules and cervical lymph nodes. This tool further aids in the diagnosis of malignancy when used in conjunction with fine-needle aspiration. US plays an important role as both a diagnostic and therapeutic tool in the evaluation of patients with neck masses.
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Affiliation(s)
- Jennifer A Sipos
- Division of Endocrinology and Metabolism, The Ohio State University , Columbus, Ohio, USA.
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Zhou J, Zhu SY, Liu RC, Luo F, Shu DX. Vascularity index of laryngeal cancer derived from 3-D ultrasound: a predicting factor for the in vivo assessment of cervical lymph node status. ULTRASOUND IN MEDICINE & BIOLOGY 2009; 35:1596-1600. [PMID: 19632759 DOI: 10.1016/j.ultrasmedbio.2009.04.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2008] [Revised: 04/20/2009] [Accepted: 04/22/2009] [Indexed: 05/28/2023]
Abstract
To demonstrate whether a calculated vascularity index (VI) can predict metastases of cervical lymph nodes, the VI values of the primary tumors were obtained by using 3-D sonography in 87 subjects with laryngeal cancer confirmed by laryngoscope and biopsy. N-staging of the subjects was determined by pathological nodal harvesting. The relationship between the VI and pathological N-staging was evaluated by correlation coefficient. To test the accuracy of the VI for predicting cervical lymph node involvement, a receiver operating characteristic (ROC) curve was constructed, and the best operating point was determined by Youden's index. For comparison, 2-D sonography was applied to detect metastatic cervical lymph nodes. The accuracy, sensitivity and specificity of the VI, 2-D sonography and a combination of the two methods for diagnosis of metastatic cervical lymph nodes were compared. There was a positive linear correlation between the VI and pN-staging (r=0.740, p<0.001). The area under the ROC curve for the VI was 0.919. The best operating point of the VI was 4.4565, which derived higher sensitivity than that of 2-D sonography (95% vs. 81%, p=0.031), but lower specificity (75% vs. 95%, p=0.012). The combination of the two methods yielded a higher accuracy (97% vs. 85% and 89%, p=0.002 and 0.016), a higher sensitivity to 2-D sonography (95% vs. 81%, p=0.031) and a higher specificity to VI (98% vs. 75%, p=0.002). The VI of laryngeal cancer can be a useful factor for predicting metastases of cervical lymph nodes.
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Affiliation(s)
- Jun Zhou
- First College of Clinical Medical Science, China Three Gorges University, Nanning, Guangxi, China.
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High-resolution ultrasonographic features of axillary lymph node metastasis in patients with breast cancer. Breast 2009; 18:119-22. [DOI: 10.1016/j.breast.2009.02.004] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2008] [Revised: 02/12/2009] [Accepted: 02/12/2009] [Indexed: 02/05/2023] Open
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Dangore-Khasbage S, Degwekar SS, Bhowate RR, Banode PJ, Bhake A, Choudhary MS, Lohe VK. Utility of color Doppler ultrasound in evaluating the status of cervical lymph nodes in oral cancer. ACTA ACUST UNITED AC 2009; 108:255-63. [PMID: 19272807 DOI: 10.1016/j.tripleo.2009.01.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2008] [Revised: 12/17/2008] [Accepted: 01/05/2009] [Indexed: 10/21/2022]
Abstract
OBJECTIVE The aim was to study the utility of color Doppler ultrasound (CDUS) in diagnosis of cervical lymphadenopathy in oral cancer patients. STUDY DESIGN In a prospective study, 70 cervical lymph nodes in 30 known primary oral cancer patients were evaluated with CDUS during a period of 8 months. The intranodal perfusion sites and vascular resistance were the key CDUS features used to differentiate between reactive and metastatic cervical lymph nodes. Histopathologic confirmations were obtained by excisional biopsy of the lymph nodes. The results of preoperative clinical palpation of cervical lymph nodes and CDUS evaluation were compared with histopathologic outcome. RESULTS Clinical evaluation suspected 61 cervical lymph nodes to be malignant. According to the CDUS, out of 70 nodes, 49 lymph nodes showed features of benign lymphadenopathy and 21 lymph nodes showed features of malignant lymphadenopathy, whereas histopathologic evaluations were in favor of reactive for 57 (81.42%) and for malignant lymphadenopathy in 13 (18.57%). CONCLUSION The CDUS evaluation was found to be highly significant with a sensitivity of 92.90% and a specificity of 84.21%, after comparing the CDUS findings with histopathologic findings.
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Hall JD, Kahaleh M, White GE, Talreja J, Northup PG, Shami VM. Presence of lymph node vasculature: a new EUS criterion for benign nodes? Dig Dis Sci 2009; 54:118-21. [PMID: 18473175 DOI: 10.1007/s10620-008-0314-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2007] [Accepted: 04/24/2008] [Indexed: 01/30/2023]
Abstract
OBJECTIVES Lymph nodes normally have prominent centrally located blood vessels, which may become obliterated with tumor infiltration. The presence of intranodal vasculature has been noted to coincide with benign cytology. We sought to determine the test characteristics of the presence of intranodal mediastinal vasculature during endoscopic ultrasound (EUS). METHODS 67 mediastinal lymph nodes evaluated by EUS in 66 patients over a 1-year period were evaluated for the presence of intranodal vasculature, which was considered benign when it traversed through the node without disruption. RESULTS Of the 67 lymph nodes evaluated, 29 (43%) were found to be malignant on cytopathologic review. Benign vascular markings were present in 15/67 (22.4%) lymph nodes evaluated. All 15 (100%) of these nodes were found to have benign fine-needle aspiration (FNA) results. The presence of benign vasculature had a negative predictive value of 100%. CONCLUSIONS The presence of intranodal vasculature was universally associated with a benign diagnosis. The addition of this EUS finding improves the ability to characterize lymph nodes and predict the likelihood of malignant involvement.
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Affiliation(s)
- Joshua D Hall
- Digestive Health Center of Excellence, University of Virginia Health System, Box 800708, Charlottesville, VA 22908-0708, USA
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Abe H, Schmidt RA, Kulkarni K, Sennett CA, Mueller JS, Newstead GM. Axillary Lymph Nodes Suspicious for Breast Cancer Metastasis: Sampling with US-guided 14-Gauge Core-Needle Biopsy—Clinical Experience in 100 Patients. Radiology 2009; 250:41-9. [DOI: 10.1148/radiol.2493071483] [Citation(s) in RCA: 144] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Aspecto ecográfico y en power doppler de las metástasis macroscópicas locorregionales del melanoma cutáneo. RADIOLOGIA 2008; 50:483-8. [DOI: 10.1016/s0033-8338(08)76335-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Abstract
Hodgkin lymphoma (HL) and non-Hodgkin lymphoma (NHL) represent 10% to 15% of all malignancies occurring in children younger than 20 years of age. Advances in cross-sectional imaging and the availability of positron emission tomography (PET) and PET-CT have had a major impact on imaging and management of pediatric patients. This article reviews the clinical features of lymphoma, focusing on the spectrum of imaging findings seen in diagnosis, staging, and follow-up of HL and NHL. Pediatric NHL has four major histologic subtypes: Burkitt lymphoma, diffuse large B-cell lymphoma, anaplastic large cell lymphoma, and lymphoblastic lymphoma. The most important subtype of HL is nodular sclerosis.
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