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Abstract：
BACKGROUND: Enlarged cervical lymph nodes (CLNs) can result from infection or malignancies, and a definitive diagnosis requires histological examination. Ultrasound (US) remains the first-line imaging modality for detection, and new US techniques may improve characterization. The aim of our study was to investigate whether the qualitative assessment of multiparametric US (mpUS) can improve diagnostic performance in the differentiation of benign and malignant CLNs.
METHODS: 107 CLNs in 105 patients were examined by preoperative mpUS consisting of B-mode US, color-coded duplex sonography (CCDS), shear wave elastography (SWE) and contrast-enhanced US (CEUS). US images were evaluated in consensus by two experienced US operators. Histopathological examination was used as reference standard.
RESULTS: SWE and CEUS combined showed the highest overall diagnostic performance (91% sensitivity, 77% specificity, 87% positive predictive value (PPV), 83% negative predictive value (NPV), 90% accuracy, χ2 (1) = 51.485, p < 0.001) compared to B-mode US and CCDS (87% sensitivity, 44% specificity, 73% PPV, 65% NPV, 73% accuracy χ2 (1) = 12.415, p < 0.001). In terms of individual techniques, SWE had higher specificity than B-mode and CCDS (71% sensitivity, 90% specificity, 92% PPV, 64% NPV, 78% accuracy, χ2 (1) = 36.115, p < 0.001), while qualitative CEUS showed the best diagnostic performance of all investigated US techniques (93% sensitivity, 85% specificity, 91% PPV, 87% NPV, 90% accuracy, χ2 (1) = 13.219, p < 0.001). Perfusion patterns, homogeneity, presence of necrosis, and malignancy differed significantly between malignant and benign CLNs (p < 0.001).
CONCLUSIONS: SWE and CEUS can facilitate the differentiation of inconclusive CLNs when performed to supplement B-mode US and CCDS. MpUS may thus aid the decision between surgery and a watch-and-scan strategy in enlarged CLNs.
METHODS: 107 CLNs in 105 patients were examined by preoperative mpUS consisting of B-mode US, color-coded duplex sonography (CCDS), shear wave elastography (SWE) and contrast-enhanced US (CEUS). US images were evaluated in consensus by two experienced US operators. Histopathological examination was used as reference standard.
RESULTS: SWE and CEUS combined showed the highest overall diagnostic performance (91% sensitivity, 77% specificity, 87% positive predictive value (PPV), 83% negative predictive value (NPV), 90% accuracy, χ2 (1) = 51.485, p < 0.001) compared to B-mode US and CCDS (87% sensitivity, 44% specificity, 73% PPV, 65% NPV, 73% accuracy χ2 (1) = 12.415, p < 0.001). In terms of individual techniques, SWE had higher specificity than B-mode and CCDS (71% sensitivity, 90% specificity, 92% PPV, 64% NPV, 78% accuracy, χ2 (1) = 36.115, p < 0.001), while qualitative CEUS showed the best diagnostic performance of all investigated US techniques (93% sensitivity, 85% specificity, 91% PPV, 87% NPV, 90% accuracy, χ2 (1) = 13.219, p < 0.001). Perfusion patterns, homogeneity, presence of necrosis, and malignancy differed significantly between malignant and benign CLNs (p < 0.001).
CONCLUSIONS: SWE and CEUS can facilitate the differentiation of inconclusive CLNs when performed to supplement B-mode US and CCDS. MpUS may thus aid the decision between surgery and a watch-and-scan strategy in enlarged CLNs.
摘要：
背景：颈部淋巴结肿大可由感染或恶性肿瘤引起，明确的诊断需要组织学检查.超声（US）仍然是用于检测的一线成像模式，和新的美国技术可能会改善表征。我们研究的目的是调查多参数US（mpUS）的定性评估是否可以改善良性和恶性CLN的鉴别诊断性能。
方法：105例患者的107例CLNs进行术前MPUS检查，彩色编码双工超声（CCDS），剪切波弹性成像（SWE）和对比增强US（CEUS）。美国图像由两名经验丰富的美国运营商一致评估。使用组织病理学检查作为参考标准。
结果：SWE和CEUS结合显示出最高的总体诊断性能（灵敏度为91％，77%的特异性，87%阳性预测值(PPV)，83%阴性预测值(NPV)，90%的准确度,与B型US和CCDS相比，χ2（1）=51.485，p<0.001）（灵敏度为87％，44％的特异性，73%PPV,65%净现值，73%准确率χ2(1)=12.415,p<0.001。就个人技术而言，SWE比B型和CCDS有更高的特异性(71%的灵敏度，90%特异性,92%PPV,64%的净现值，78%的准确度,χ2(1)=36.115，p<0.001)，虽然定性CEUS显示了所有研究的美国技术中最好的诊断性能(93%的灵敏度，85%特异性,91%PPV,87%的净现值，90%的准确度,χ2(1)=13.219,p<0.001)。灌注模式,同质性，坏死的存在，恶性和良性CLN之间的恶性差异显着（p<0.001）。
结论：SWE和CEUS在补充B型US和CCDS时可以促进不确定的CLN的分化。因此，MpUS可以帮助在扩大的CLN中进行手术和观察扫描策略之间的决定。
方法：105例患者的107例CLNs进行术前MPUS检查，彩色编码双工超声（CCDS），剪切波弹性成像（SWE）和对比增强US（CEUS）。美国图像由两名经验丰富的美国运营商一致评估。使用组织病理学检查作为参考标准。
结果：SWE和CEUS结合显示出最高的总体诊断性能（灵敏度为91％，77%的特异性，87%阳性预测值(PPV)，83%阴性预测值(NPV)，90%的准确度,与B型US和CCDS相比，χ2（1）=51.485，p<0.001）（灵敏度为87％，44％的特异性，73%PPV,65%净现值，73%准确率χ2(1)=12.415,p<0.001。就个人技术而言，SWE比B型和CCDS有更高的特异性(71%的灵敏度，90%特异性,92%PPV,64%的净现值，78%的准确度,χ2(1)=36.115，p<0.001)，虽然定性CEUS显示了所有研究的美国技术中最好的诊断性能(93%的灵敏度，85%特异性,91%PPV,87%的净现值，90%的准确度,χ2(1)=13.219,p<0.001)。灌注模式,同质性，坏死的存在，恶性和良性CLN之间的恶性差异显着（p<0.001）。
结论：SWE和CEUS在补充B型US和CCDS时可以促进不确定的CLN的分化。因此，MpUS可以帮助在扩大的CLN中进行手术和观察扫描策略之间的决定。
