Logistic Regression Analysis of Conventional Ultrasound, and Contrast‐Enhanced Ultrasound Characteristics

Abstract

Objectives-This study aimed to screen the significant sonographic features for differentiation of benign and malignant superficial lymph nodes (LNs) by logistic regression analysis and fit a model to diagnose LNs.Methods-A total of 204 pathological LNs were analyzed retrospectively. All the LNs underwent conventional ultrasound (US) and contrast-enhanced ultrasound (CEUS) examinations. A total of 16 suspicious sonographic features were used to assess LNs. All variables that were statistically related to the diagnosis of LNs were included in the logistic regression analysis in order to ascertain the significant features of diagnosing LNs, and to establish a logistic regression analysis model.Results-The significant features in the logistic regression analysis model of diagnosing malignant LNs were absence of echogenic hilus, age, and absence of hilum after enhancement. According to the results of logistic regression analysis, the formula to predict whether LNs were malignant was established. The area under the receiver operating curve (ROC) was 0.908 and the accuracy, sensitivity, and specificity were 85.0%, 92.9%, and 85.3%, respectively. Conclusion-The logistic regression model for the significant sonographic features of conventional US and CEUS is an effective and accurate diagnostic tool for differentiating malignant and benign LNs.

Reassessing the Value of Contrast-Enhanced Ultrasonography in Differential Diagnosis of Cervical Tuberculous Lymphadenitis and Lymph Node Metastasis of Papillary Thyroid Carcinoma

“…After entering the lymph nodes, M. tuberculosis is phagocytosed by macrophages to induce cell-mediated immune response and delayed allergy, macrophage proliferation, and lesion limitation, as well as characteristic tuberculous granuloma and caseous necrosis of cells, resulting in tissue damage ( 25 , 30 ). The pathophysiology of benign lymph nodes, such as reactive lymph node hyperplasia, is very different from tuberculous lymphadenitis and their CEUS features can not be classified into one category ( 31 ).…”

Oncologic Imaging of the Lymphatic System: Current Perspective with Multi-Modality Imaging and New Horizon

“…Nuanced approach using a combination of several US grayscale and Doppler imaging features has been suggested to differentiate between benign and malignant lymph nodes. Morphologic features such as lymph node size, shape, presence of hilar fat, echogenicity, vascular pattern, and flow resistance have been helpful in characterizing lymph nodes ( Table 1 ) [ 20 , 21 ]. Ratio of short to long (S/L) lymph node axis can also be used to determine nodal benignity.…”

“…Normal lymph nodes are either avascular or have hilar blood flow ( Figure 8 ). Malignant or reactive lymph nodes vascularity is usually peripheral or mixed ( Figure 9 and Figure 10 ) [ 21 , 24 , 25 ]. Vascular resistance and resistive indices may offer clues in discerning malignant from reactive lymph nodes.…”

“…When tumor growth exceeds the vascular supply, focal or diffuse necrosis occurs. These changes manifest as mixed or peripheral (centripetal) vascularity, lack of hilar enhancement, and focal or diffuse hypoenhancement [ 21 , 26 , 27 , 28 , 29 , 30 , 31 , 32 ]. In contrast, reactive lymph nodes usually demonstrate increased hilar enhancement (centrifugal) and lack of necrosis/hypoenhancement [ 21 , 26 , 28 , 30 , 31 ].…”

“…These changes manifest as mixed or peripheral (centripetal) vascularity, lack of hilar enhancement, and focal or diffuse hypoenhancement [ 21 , 26 , 27 , 28 , 29 , 30 , 31 , 32 ]. In contrast, reactive lymph nodes usually demonstrate increased hilar enhancement (centrifugal) and lack of necrosis/hypoenhancement [ 21 , 26 , 28 , 30 , 31 ]. Despite the characteristic patterns of benign and malignant lymph nodes on CEUS, caution should be practiced when interpreting these findings.…”