Resident and Fellow Education Feature: US Evaluation of Axillary Lymph Nodes

Net, Jose; Mirpuri, Tarun Mohan; Plaza, Michael J.; Escobar, Cristina A.; Whittington, Elizabeth; Collado-Mesa, Fernando; Yepes, Monica M.

doi:10.1148/rg.347140081

Cited by 36 publications

(22 citation statements)

References 3 publications

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“…Differential diagnoses for small nodules located in the perithyroidal region include an enlarged parathyroid gland, lymph node, accessory thyroid nodule or ectopic thyroid tissue, carotid body paraganglioma, nerve sheath tumor, venous vascular malformation, and lipoma. Enlarged parathyroid glands due to adenoma, hyperplasia, or cysts are hypoechoic lesions 4 23 , as are lymph nodes 24 25 26 . The presence of an echogenic hilus and hilar vascularity on Doppler imaging assists in the identification of lymph nodes 26 .…”

Section: Discussionmentioning

confidence: 99%

Phantom Nodules Detected by Ultrasound Examination of the Neck: The Possibility of Ectopic Cervical Thymic Tissue in Adults

Ota

Hirokawa

Suzuki

et al. 2018

Ultrasound Int Open

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PurposeThe aim of this study was to investigate the ultrasound characteristics and clinical significance of slightly hyperechoic lesions, referred to as phantom nodules, in the perithyroidal area in patients.Materials and MethodsA total of 128 patients who underwent thyroidectomy with central neck lymph node dissection at Kuma Hospital in Hyogo, Japan were included in the study. We detected 16 phantom nodules during preoperative ultrasound examinations, defined as slightly hyperechoic masses located in the perithyroidal areas, in 13 of these 128 patients (10.2%; mean age: 55.6 years, range: 36–75 years).ResultsAll phantom nodules were located in the caudal region of the thyroid gland, and the mean maximum dimension was 7.2 mm. 12 of the 16 nodules were round or oval, while the remaining 4 were fusiform and molded by the surrounding tissue. All nodules were well-defined, solid, homogeneous, hyperechoic masses. No speckled echo pattern, internal linear echo, or vascular flow signal was observed. All 4 nodules subjected to histological examination were composed of ectopic thymic tissue. In 2 of these 4, the parenchyma was severely involuted and almost entirely replaced by adipose tissue.ConclusionTo the best of our knowledge, this is the first report wherein some of the detected hyperechoic perithyroidal masses were composed of ectopic thymic tissue, and some were primarily composed of adipose tissue that completely replaced involuted ectopic thymic tissue. The results of the study suggest that these so-called phantom nodules are clinically insignificant and do not require fine needle aspiration cytology or further investigation.

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Section: Discussionmentioning

confidence: 99%

Phantom Nodules Detected by Ultrasound Examination of the Neck: The Possibility of Ectopic Cervical Thymic Tissue in Adults

Ota

Hirokawa

Suzuki

et al. 2018

Ultrasound Int Open

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“…The parameters of suspicious ALNs indicated on US were as follows: cortical thickening ≥3 mm was taken as the main criterion, and asymmetric cortex, LSR <2, disappearance of hilum or abundant blood flow was taken as the second criterion. 7,8 ALNs on US that met any of these criteria were characterized as suspicious for metastases.…”

Section: Us Evaluationmentioning

confidence: 99%

<p>Establishment of Simple Nomograms for Predicting Axillary Lymph Node Involvement in Early Breast Cancer</p>

Zong¹,

Deng²,

Ge³

et al. 2020

CMAR

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These authors contributed equally to this workPurpose: Axillary lymph node (ALN) involvement is an important prognostic factor of early invasive breast cancer. The objective of this study was to establish simple nomograms for predicting ALN involvement based on ultrasound (US) characteristics and evaluate the predictive value of US in the detection of ALN involvement. Patients and Methods: A total of 1328 patients with cT1-2N0 breast cancer by physical exam were retrospectively analyzed. Univariate analysis was used for the comparison of variables, and multivariate analysis was performed by binary logistic regression analysis. The R software was used to establish simple nomograms based on the US characteristics alone. The receiver operating characteristic (ROC) curves of the prediction model and the verification group were drawn, and the area under the curve (AUC) was calculated to evaluate the discrimination of the prediction model. A calibration curve was plotted to assess the nomogram predictions vs the actual observations of the ALN metastasis rate and axillary tumor burden rate. Results: The ALN metastasis rates of the training group and the validation group were 35.1% and 34.1%, respectively. Multivariate analysis showed that molecular subtype, lymphovascular invasion, mass descriptors (size, margin, microcalcification and blood flow signal) and LN descriptors (shape, cortical thickness and long-to-short ratio) were independent impact factors in early breast cancer. The AUC of ALN metastasis rate of prediction model based on US features was 0.802, the AUC of high tumor burden rate was 0.873, and the AUC of external validation group was 0.731 and 0.802, respectively. The calibration curve of the nomogram showed that the nomogram predictions are consistent with the actual metastasis rate and the high tumor burden rate. The results showed that preoperative US had a sensitivity of 59.4% and a specificity of 88.9% for predicting the ALN metastasis rate. Conclusion: The successfully established nomograms based on US characteristics to predict ALN metastasis rate and high axillary tumor burden rate in early breast cancer can achieve individual prediction. Compared with other nomogram predictions, it is more intuitive, and can help clinical decision-making; thus, it should be promoted. However, at this time US features alone are insufficient to replace sentinel lymph node biopsy.

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“…Cortical thickness (>3 mm), loss of fatty hilum and a round shape are considered to indicate an abnormal LN on US. 8 The physicians decided whether to perform FNAC after the US scan. In the case of suspicious LNs, the most suspicious LN was selected, and FNAC was performed by physicians.…”

Section: Evaluation Of Nodal Statusmentioning

confidence: 99%

False‐negative ultrasound‐guided fine‐needle aspiration of axillary lymph nodes in breast cancer patients

et al. 2020

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Introduction The purpose of this study was to clarify the clinicopathological features of patients with false‐negative fine needle aspiration cytology (FNAC) and to determine the factors associated with negative FNAC. Methods Patients with negative FNAC from January 2010 to December 2019 were included. The patients with positive sentinel nodes (SN) were divided into two groups: micrometastasis (≤2 mm) group and macrometastasis (>2 mm) group. The clinicopathological characteristics were compared between the two groups using the χ2 test. Results A total of 165 patients with negative FNAC were included; 52 (31.5%) had positive SNs. Of the 52 patients, 13 (25%) had micrometastasis and the remaining 39 (75%) had macrometastasis. Of the 113 patients with negative SNs, none had metastases found in non‐SNs. No significant differences were observed in age, cT stage or subtype, and preoperative ultrasound findings between the two groups. Conclusions The false‐negative rate of FNAC was high (31.5%). Micrometastatic disease was seen in patients with negative FNAC, and this might be the cause of false‐negative FNAC results.

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Resident and Fellow Education Feature: US Evaluation of Axillary Lymph Nodes

Cited by 36 publications

References 3 publications

Phantom Nodules Detected by Ultrasound Examination of the Neck: The Possibility of Ectopic Cervical Thymic Tissue in Adults

Phantom Nodules Detected by Ultrasound Examination of the Neck: The Possibility of Ectopic Cervical Thymic Tissue in Adults

<p>Establishment of Simple Nomograms for Predicting Axillary Lymph Node Involvement in Early Breast Cancer</p>

False‐negative ultrasound‐guided fine‐needle aspiration of axillary lymph nodes in breast cancer patients

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