The value of multimodal ultrasonography in evaluating therapeutic response of cervical tuberculous lymphadenitis to anti-tuberculosis drugs

Abstract

PurposeIn order to research the value of multimodal ultrasonography in evaluating therapeutic response of cervical tuberculous lymphadenitis to anti-tuberculosis drugs.Materials and methodsSixty-one patients with cervical tuberculous lymphadenitis were enrolled in this study. Ultrasound examination was performed before systemic standard anti-tuberculosis treatment and within 1–2 months after treatment, and the patients were divided into effective group and ineffective group according to the follow-up at the sixth month. The multimodal ultrasound signs of the two groups were compared and analyzed.ResultsIn the effective group, there were significant differences in the maximum diameter of lymph nodes, the echo of the surrounding tissue and the enlargement of the contrast area before and after treatment (p < 0.05). At 1–2 months after treatment, there were significant differences in the maximum diameter, pus changes, CDFI, elasticity scores, echo of surrounding tissues, changes in enlarged and non-enhanced areas after contrast enhancement between the effective group and the ineffective group (p < 0.05).ConclusionThe multimodal ultrasound signs of the appearance of internal pus or non-enhancement area enlargement, enhanced echo of the surrounding tissue and enlargement after CEUS are related to poor prognosis, and may be used to evaluate the response of anti-tuberculosis chemotherapy when the size change of lymph node is not obvious in individual treatment.

Can Ultrasound Evaluation of Lymph Node Size and Necrosis Rate Predict Chemotherapy Response in Cervical Tuberculous Lymphadenitis?

“…Therefore, if the initial short diameter of the lymph nodes is large, the pressure in the lesions is high, indicating a high risk of treatment failure. In addition, there was no significant difference in the length of lymph nodes between the two groups in this study, which was consistent with the research of Yu 14 and Je et al 22 However, the results of multivariate analysis by Chahed et al 23 showed that the length of lymph nodes ≥3 cm was an independent risk factor for poor treatment effect, contradicting the results of this study.…”

“…In case of studies on tuberculous lymphadenitis, Lee et al 11 concluded that residual lymph nodes at the end of treatment have usually been used for assessing treatment outcomes. Yu et al 14 evaluated the value of multimodal ultrasonography in assessing therapeutic response of CTL to anti-TB drugs, the result showed no statistically significant difference in the maximum length diameter between the responder groups and non-responder groups before treatment, but did not involve the maximum initial area, short diameter and necrotic area ratio of lymph nodes.…”

“…The formation of necrosis is related to the progression of the disease, and its increase could be considered as a factor contributing to poor drug therapeutic response. 14 Joo et al 15 found that 32.7% of TCL cases requiring additional surgical treatment were associated with a high necrotic rate. In this study, 75.00% of non-responsive groups had a high necrosis rate, and there was a statistically significant difference in necrosis rates between the two groups.…”

“…Therapeutic response at the end of 6 months was defined as follows: (1) responder group-patients with no or only small residual palpable lymph nodes and no symptoms; (2) non-responder group-appearance of new symptoms, persistence of new lymph nodes, and/or insufficient changes in lymph nodes. 14 …”