Department of Radiology, Boston Medical Center, Boston University School of Medicine, One Boston Medical Center Place, Boston, MA, 02118, United States.
Department of Radiology, Boston Medical Center, Boston University School of Medicine, One Boston Medical Center Place, Boston, MA, 02118, United States; Research Center for Cooperative Projects, Hokkaido University Graduate School of Medicine, Kita 15, Nishi 7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan.
Eur J Radiol. 2020 Nov;132:109310. doi: 10.1016/j.ejrad.2020.109310. Epub 2020 Oct 1.
Cervical lymph nodes with cystic changes are an important finding seen with several pathologies including papillary thyroid carcinoma (PTC), tuberculosis (TB) and HPV-positive oropharyngeal squamous cell carcinoma (HPV + OPSCC). In the absence of known primary tumor or conclusive medical history, differentiating among these nodes is difficult. We compared the pathologic nodes of PTC, TB and HPV + OPSCC to identify imaging features useful for their differentiation.
Fifty-five PTC, 58 TB and 51 HPV + OPSCC nodes were selected based on surgical pathology records and suspicious morphological features. These nodes were compared for morphological features: long axis length, nodal shape, nodal location, presence of cystic change, area of cystic change:area of entire node ratio, Hounsfield unit of the cystic component, degree of enhancement, enhancement pattern, presence of calcification, presence of perinodal infiltration, and presence of surrounding inflammatory changes.
PTC nodes formed calcifications more frequently and demonstrated greater enhancement (P < 0.01). TB nodes were characterized by their irregular shape (P < 0.05), irregular enhancement surrounding the cystic change (P < 0.01), greater frequencies of perinodal infiltration (P < 0.01) and surrounding inflammatory changes (P < 0.01). While no unique features were seen with HPV+OPSCC, they were characterized by the absence of those features that distinguished the other groups: these nodes tended to have smooth, circumscribed margins with no hyperenhancement, calcifications or inflammatory changes. PTC and TB nodes were more frequently identified in the lower neck, while HPV+OPSCC nodes were localized to the upper neck (P < 0.01).
PTC, TB and HPV + OPSCC lymph nodes can be differentiated based on their morphologies and locations.
具有囊性改变的颈部淋巴结是多种病理学表现的重要发现，包括甲状腺乳头状癌（PTC）、结核（TB）和 HPV 阳性口咽鳞状细胞癌（HPV+OPSCC）。在没有已知原发性肿瘤或明确病史的情况下，区分这些淋巴结是很困难的。我们比较了 PTC、TB 和 HPV+OPSCC 的病理性淋巴结，以确定有助于区分它们的影像学特征。
根据手术病理记录和可疑的形态学特征，选择了 55 个 PTC、58 个 TB 和 51 个 HPV+OPSCC 淋巴结。对这些淋巴结进行了形态特征比较：长轴长度、淋巴结形状、淋巴结位置、囊性改变的存在、囊性改变面积：整个淋巴结面积比、囊性成分的亨斯菲尔德单位、增强程度、增强模式、钙化的存在、周围神经浸润的存在以及周围炎症改变的存在。
PTC 淋巴结形成钙化的频率更高，增强程度更大（P<0.01）。TB 淋巴结的特征是形状不规则（P<0.05），囊性改变周围的增强不规则（P<0.01），周围神经浸润（P<0.01）和周围炎症改变（P<0.01）的频率更高。HPV+OPSCC 没有独特的特征，但它们的特征是缺乏其他组的特征：这些淋巴结往往具有光滑、界限分明的边缘，没有高增强、钙化或炎症改变。PTC 和 TB 淋巴结更常出现在颈部下部，而 HPV+OPSCC 淋巴结位于颈部上部（P<0.01）。
根据形态和位置可以区分 PTC、TB 和 HPV+OPSCC 淋巴结。
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