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.
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。