多参数超声在定性评估不确定颈部淋巴结中的诊断性能

The Diagnostic Performance of Multiparametric Ultrasound in the Qualitative Assessment of Inconclusive Cervical Lymph Nodes.

作者信息

Wakonig Katharina Margherita, Dommerich Steffen, Fischer Thomas, Arens Philipp, Hamm Bernd, Olze Heidi, Lerchbaumer Markus Herbert

机构信息

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.

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.

出版信息

Cancers (Basel). 2023 Oct 18;15(20):5035. doi: 10.3390/cancers15205035.

DOI:10.3390/cancers15205035

PMID:37894402

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10605624/

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, χ (1) = 51.485, < 0.001) compared to B-mode US and CCDS (87% sensitivity, 44% specificity, 73% PPV, 65% NPV, 73% accuracy χ (1) = 12.415, < 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, χ (1) = 36.115, < 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, χ (1) = 13.219, < 0.001). Perfusion patterns, homogeneity, presence of necrosis, and malignancy differed significantly between malignant and benign CLNs ( < 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（CLN）肿大可由感染或恶性肿瘤引起，明确诊断需要组织学检查。超声（US）仍是检测的一线成像方式，新的超声技术可能会改善特征描述。我们研究的目的是调查多参数超声（mpUS）的定性评估是否能提高鉴别良性和恶性CLN的诊断性能。

方法

对105例患者的107个CLN进行术前mpUS检查，包括B模式超声、彩色编码双功超声（CCDS）、剪切波弹性成像（SWE）和超声造影（CEUS）。由两名经验丰富的超声操作员共同评估超声图像。组织病理学检查用作参考标准。

结果

与B模式超声和CCDS相比，SWE和CEUS联合显示出最高的总体诊断性能（敏感性91%，特异性77%，阳性预测值（PPV）87%，阴性预测值（NPV）83%，准确性90%，χ（1）=51.485，<0.001）（敏感性87%，特异性44%，PPV 73%，NPV 65%，准确性73%，χ（1）=12.415，<0.001）。就个体技术而言，SWE的特异性高于B模式超声和CCDS（敏感性71%，特异性90%，PPV 92%，NPV 64%，准确性78%，χ（1）=36.115，<0.001），而定性CEUS在所有研究的超声技术中显示出最佳的诊断性能（敏感性93%，特异性85%，PPV 91%，NPV 87%，准确性90%，χ（1）=13.219，<0.001）。恶性和良性CLN之间的灌注模式、均匀性、坏死的存在和恶性程度存在显著差异（<0.001）。