Lerchbaumer Markus H, Wakonig Katharina Margherita, Arens Philipp, Dommerich Steffen, Fischer Thomas
Department of Radiology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Charitéplatz 1, 10117 Berlin, Germany.
Department of Otorhinolaryngology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Campus Virchow Klinikum and Campus Charité Mitte, Charitéplatz 1, 10117 Berlin, Germany.
Cancers (Basel). 2022 Mar 22;14(7):1597. doi: 10.3390/cancers14071597.
Background: Enlarged cervical lymph nodes (CLN) are preferably examined by ultrasound (US) by using criteria such as size and echogenicity to assess benign and suspicious CLN, which should be histologically evaluated. This study aims to assess the differentiation of malign and benign CLN by using multiparametric US applications (mpUS). Methods: 101 patients received a standardized US protocol prior to surgical intervention using B-mode−US, shear-wave elastography (SWE) and contrast-enhanced ultrasound (CEUS). SWE was assessed by 2D real-time SWE conducting a minimum of five measurements, CEUS parameters were assessed with post-processing perfusion software. Histopathological confirmation served as the gold standard. Results: B-mode−US and SWE analysis of 104 CLN (36 benign, 68 malignant) showed a significant difference between benign and malignant lesions, presenting a larger long axis and higher tissue stiffness (both p < 0.001). Moreover, tissue stiffness assessed by SWE was significantly higher in CLN with regular B-mode−US criteria (Solbiati Index > 2 and short-axis < 1 cm, p < 0.001). No perfusion parameter on CEUS showed a significant differentiation between benign and malignant CLN. Discussion: As the only multiparametric parameter, SWE showed higher tissue stiffness in malignant CLN, also in subgroups with regular B-mode criteria. This fast and easy application may be a promising noninvasive tool to US examination to ameliorate the sonographic differentiation of inconclusive CLN.
对于肿大的颈部淋巴结（CLN），最好通过超声（US）检查，利用大小和回声性等标准来评估良性和可疑的CLN，这些CLN应进行组织学评估。本研究旨在通过使用多参数超声应用（mpUS）来评估恶性和良性CLN的差异。方法：101例患者在手术干预前接受了标准化的超声检查方案，包括B型超声、剪切波弹性成像（SWE）和超声造影（CEUS）。通过二维实时SWE进行至少五次测量来评估SWE，使用后处理灌注软件评估CEUS参数。组织病理学确认作为金标准。结果：对104个CLN（36个良性，68个恶性）进行B型超声和SWE分析显示，良性和恶性病变之间存在显著差异，恶性病变的长轴更大且组织硬度更高（均p<0.001）。此外，在符合常规B型超声标准（索尔比亚蒂指数>2且短轴<1 cm）的CLN中，通过SWE评估的组织硬度显著更高（p<0.001）。CEUS上的任何灌注参数在良性和恶性CLN之间均未显示出显著差异。讨论：作为唯一的多参数指标，SWE显示恶性CLN的组织硬度更高，在符合常规B型超声标准的亚组中也是如此。这种快速且易于应用的方法可能是一种有前景的超声检查无创工具，可改善不确定CLN的超声鉴别诊断。
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