Measurable and Unmeasurable Features of Ultrasound Lymph Node Images in Detection of Malignant Infiltration

Abstract

The aim of the study was to assess diagnostic value and utility of selected morphological features in predicting lymph node (LN) malignancy using B-mode, Doppler ultrasonography and multivariate settings in a tertiary radiological referral center. The study included 123 patients having undergone ultrasound-guided fine-needle aspiration and cytologic analysis (FNAC) of cervical, axillary and inguinal LNs. Each LN was characterized by long/L and short/T-axis, shape, margins, echogenicity, cortical thickness, vascularization, and examiner's subjective impression. Within the limitations of FNAC, altered shape and vascularization had relatively high specificity and positive predictive value (>80%), whereas subjective impression had high sensitivity and negative predictive value (100%) for malignancy. The cut-off levels for different features of LN by ROC analysis were as follows: long-axis 23 mm, short-axis 11 mm, L/T ratio 2.19, and maximal cortical thickness 5.1 mm. On multivariate analysis (adaptive regression splines, n=108), the addition of long-axis, L/T ratio, age and sex considerably improved diagnostic accuracy (88%), sensitivity (margins + vascularization) and specificity (subjective impression) of the diagnostic model. The combination of morphological and demographic features could improve diagnostic accuracy, usually with a trade-off between the sensitivity and specificity of the predictive model. The performance may depend on the level of expertise and institutional settings.

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

“…21 It has been suggested that addition of age to subjective impression considerably improves diagnostic accuracy and specificity, principally through reclassification of suspicious LNs. 22 Our study found that the cutoff value of age in the differential diagnosis of benign and malignant LNs was 39 years and the combined information about age had relatively good sensitivity (87.1%) in predicting malignant LNs. In contrast to the cutoff age of our study, Rotim et al 22 set the cutoff value of age at 69 years to distinguish benign and malignant LNs with a sensitivity and specificity of 44% and 85%, respectively.…”

Diagnostic Accuracy of Axillary Ultrasonography Compared with Intra-operative Pathological Findings in Patients with Breast Cancer

“…These results are consistent with the results of Briton and colleagues, who indicated that AUS morphological characteristics, including absence of a hilum and a cortical thickness >4 mm were associated with malignancy (Britton et al, 2009). In the study by Rotim et al, (2017), malignant lymph nodes had a higher maximal cortical thickness and the sensitivity of AUS exceeded 80% at cortical thickness of 5.1 mm. In the present study, the ratio of lymph node cortex size to the whole width of the lymph node in its shortest axis had the highest predictive value (83%), sensitivity of 72%, and specificity of 85% at 0.53, though it is only seen in high stages of the disease.…”

“…These results show that AUS can be a more accurate diagnostic tool in advanced stages, but not in early stages, which are consistent with the results of the study by Dihge et al, (2016) that determined the accuracy of AUS associated with metastatic size (OR=1.11), obesity (OR=2.46), and histological grade (OR=4.43). Therefore, not only patients' characteristics such as obesity, which limits the detection of lymph node involvement due to axillary fat mass (Shah et al, 2014), disease characteristics such as tumor type and lymph node size also play a role in the variable sensitivity (Rotim et al, 2017). As to the results of the present study, lymph node size had a predictive value of 72% and was not a definite factor in the distinction between reactive and involved lymph nodes, while disease stage, indicated by the number of lymph nodes involved, was associated with AUS sensitivity.…”

The outcomes and decision-making process for neck lymph nodes with indeterminate fine-needle aspiration cytology

“…diagnosis (Table 2). Previous studies have shown that size, shape, margin, hilar echogenicity and vascular pattern are diagnostic factors for malignant neck LNs [10,14]. The sonographer performed US-FNA of the suspicious LN with one or more of the abnormal features mentioned above.…”