Ryu Kyeong Hwa, Lee Kwang Hwi, Ryu JiHwa, Baek Hye Jin, Kim Suk Jung, Jung Hyun Kyung, Kim Sung Mok
1 Department of Radiology, Inje University College of Medicine, Haeundae Paik Hospital, Haeundae-ro 875, Haeundae-gu, Busan 612-030, Republic of Korea.
2 Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea.
AJR Am J Roentgenol. 2016 Jun;206(6):1286-91. doi: 10.2214/AJR.15.15381. Epub 2016 Apr 12.
The objective of our study was to compare ultrasound (US) and real-time elastography (RTE) features of benign and malignant cervical lymphadenopathies and propose a structured reporting system for lymph nodes.
The study population for this retrospective study consisted of 291 consecutive patients who underwent US-guided biopsies for cervical lymphadenopathy between 2013 and 2014. The following imaging features were analyzed: shape, margin, echogenicity, echogenic hilum, gross necrosis, calcification, matting, intranodal vascular pattern, elasticity scores (four categories), and strain ratio. A score was assigned for each significant factor from a logistic regression analysis and was multiplied by the beta coefficient. The fitted probability of malignancy was calculated. The risk of malignancy was determined on the basis of the number of suspicious features. Interobserver agreement of the imaging features was retrospectively analyzed using a coefficient of interrater agreement.
The imaging features that were significantly associated with malignant lymphadenopathy were round shape, noncircumscribed margin, hyperechogenicity, absence of hilum, gross necrosis, calcification, peripheral or mixed vascularity, high elasticity scores, and high level of strain ratio (p < 0.05). The fitted probability and risk of malignancy increased as the number of suspicious features increased. The risk of malignancy according to the Cervical Lymph Node Imaging Reporting and Data System categories was as follows: category 1, 3.3%; category 2, 10.9%; category 3, 26.7%; category 4, 51.8-74.4%; and category 5, 90.6-98.8%. An analysis of the overall interobserver agreement revealed that interobserver agreement was moderate to good.
We propose the Cervical Lymph Node Imaging Reporting and Data System, which uses the number of suspicious US and RTE features to assess the risk of malignancy in cervical lymph nodes.
本研究的目的是比较良性和恶性颈部淋巴结病的超声（US）和实时弹性成像（RTE）特征，并提出一种针对淋巴结的结构化报告系统。
本回顾性研究的研究对象为2013年至2014年间连续291例行超声引导下颈部淋巴结活检的患者。分析以下影像学特征：形态、边界、回声、回声性 hilum、大体坏死、钙化、粘连、淋巴结内血管模式、弹性评分（四类）和应变率。根据逻辑回归分析为每个显著因素指定一个分数，并乘以β系数。计算恶性肿瘤的拟合概率。根据可疑特征的数量确定恶性风险。使用评分者间一致性系数对影像学特征的观察者间一致性进行回顾性分析。
与恶性淋巴结病显著相关的影像学特征为圆形、边界不清、高回声、无 hilum、大体坏死、钙化、周边或混合血管、高弹性评分和高应变率水平（p<0.05）。随着可疑特征数量的增加，恶性肿瘤的拟合概率和风险增加。根据颈部淋巴结影像报告和数据系统分类的恶性风险如下：1类，3.3%；2类，10.9%；3类，26.7%；4类，51.8 - 74.4%；5类，90.6 - 98.8%。对整体观察者间一致性的分析表明，观察者间一致性为中等至良好。
我们提出了颈部淋巴结影像报告和数据系统，该系统使用可疑的超声和弹性成像特征数量来评估颈部淋巴结恶性肿瘤的风险。
