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Grey scale sonogram showing a metastatic lymph node from papillary carcinoma of the thyroid (arrows). Note the hyperechoic component within the node which may be related to intranodal deposition of thyroglobulin (arrowheads).
Source publication
Malignant lymph nodes in the neck include metastases and lymphoma. Cervical nodal metastases are common in patients with head and neck cancers, and their assessment is important as it affects treatment planning and prognosis. Neck nodes are also a common site of lymphomatous involvement and an accurate diagnosis is essential as its treatment differ...
Context in source publication
Context 1
... lymph nodes are predominantly hypoechoic relative to the adjacent musculature [18,19,24,39] . However, metastatic nodes from papillary carcinoma of the thyroid are usually hyperechoic (Fig. 2), and this is believed to be related to the intranodal deposition of thyroglobulin originating from the primary tumour [8,26] ...
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Lymphadenopathy is the most common form of extrapulmonary tuberculosis; cervical region being the frequent affected site. Ultrasound is a useful noninvasive imaging modality in the assessment of cervical lymph nodes. The morphology of lymph nodes is evaluated by grey-scale sonography and the power Doppler sonography helps in the assessment the vasc...
The purpose of this study was to evaluate short- and long-axis diameters of enlarged cervical lymph nodes with ultrasonography and to determine whether the long-to-short axis (l/s) ratio is a valid diagnostic parameter in the differentiation between benign and malignant nodal disease. 730 enlarged cervical lymph nodes in 285 patients were examined...
Lymphadenopathy is the most common form of extrapulmonary tuberculosis; cervical region being the frequent affected site. Ultrasound is a useful noninvasive imaging modality in the assessment of cervical lymph nodes. The morphology of lymph nodes is evaluated by grey-scale sonography and the power Doppler sonography helps in the assessment the vasc...
Citations
... Malignant lymph nodes are typically enlarged with a round morphology or areas of focal cortical thickening ( Table 1). Loss of the normal fatty hilum, cortical heterogeneity, cortical calcifications or cystic change, and the presence of peripheral or disorganized vascularity are usually indicative of malignant lymph nodes [54] (Fig. 23). The presence of irregular, blurred, angular, or invasive margins are concerning for malignant lymph nodes with extra-nodal spread of tumor; however, smooth margins are not necessarily reassuring as malignant lymph nodes often exhibit smooth margins [55]. ...
Ultrasound (US) is the imaging modality of choice for evaluation of superficial palpable lesions. A large proportion of these lesions have characteristic sonographic appearance and can be confidently diagnosed with US without the need for biopsy or other intervention. The Society of Radiologists in Ultrasound (SRU) recently published a Consensus Conference Statement on superficial soft tissue masses. The goal of this manuscript is (a) to serve as a sonographic pictorial review for palpable lesions based on the SRU statement, (b) present the typical sonographic features of palpable lesions that can be confidently diagnosed with US, and (c) provide an overview of other palpable lesions with a framework to interpret the US studies and advise on appropriate further management.
... A.T. Ahuja et al. [19] offer a comprehensive review of the sonographic features for assessing metastatic and lymphomatous cervical LNs-various greyscale and Doppler sonographic features such as nodal size, shape, echogenicity, and vascularity to differentiate malignant and benign nodes. It is noted that lymphomatous nodes tend to be enlarged with a minimum transverse diameter of 10 mm or larger, but nodal size alone is not an accurate criterion for differentiating lymphomatous nodes from normal or other pathological LNs. ...
Simple Summary
A novel approach for automatic detection of neoplastic lesions in lymph nodes is presented, which incorporates machine learning methods and the new LN-RADS scale. The presented solution incorporates different network structures with diverse datasets to improve the overall effectiveness. Final findings demonstrate that incorporating the LN-RADS scale labels improved the overall diagnosis, especially when compared with current, standard practices. The presented solution is meant as an aid in the diagnosis process.
Abstract
The paper presents a novel approach for the automatic detection of neoplastic lesions in lymph nodes (LNs). It leverages the latest advances in machine learning (ML) with the LN Reporting and Data System (LN-RADS) scale. By integrating diverse datasets and network structures, the research investigates the effectiveness of ML algorithms in improving diagnostic accuracy and automation potential. Both Multinominal Logistic Regression (MLR)-integrated and fully connected neuron layers are included in the analysis. The methods were trained using three variants of combinations of histopathological data and LN-RADS scale labels to assess their utility. The findings demonstrate that the LN-RADS scale improves prediction accuracy. MLR integration is shown to achieve higher accuracy, while the fully connected neuron approach excels in AUC performance. All of the above suggests a possibility for significant improvement in the early detection and prognosis of cancer using AI techniques. The study underlines the importance of further exploration into combined datasets and network architectures, which could potentially lead to even greater improvements in the diagnostic process.
... While the US not only provides insights into the size, location, number, shape, and margins of the lymph nodes, the application of brightness modulation (B-mode) parameters and the utilization of CDI can enhance its diagnostic and predictive value [18]. ...
Background: The preoperative differentiation of benign form malignant cervical
lymphadenopathy (CLA) is crucial in determining the need for surgical intervention. This study aims to assess the diagnostic performance of ultrasonography (US), fine-needle aspiration cytology (FNAC), and their combination with the postoperative histopathological diagnoses of CLA.
Method: In a retrospective study between April 2021 and May 2023, 214 patients with CLA were assessed with preoperative US and FNAC. The morphological parameters, including tissue margins, vascularity, and fatty hilum echogenicity, were collected and analyzed retrospectively. The diagnostic efficacies of US, FNAC, and their combined use were compared to the postoperative histopathological findings.
Result: In the final histopathological examination, 185 cases (86.4%) were found to be benign, while 29 cases (13.6%) were determined to be malignant. The US features of fatty hilum, echogenicity, and vascularity pattern had the highest diagnostic accuracy in characterizing CLA patterns, with values of 88.3 %, 85.5 %, and 85.0 %, respectively. The ROC curve showed a significantly higher AUC value of 0.883 (95% CI: 0.832 to 0.923; p<0.0001) for the combined use of all US parameters with better sensitivity (93.10 %) and specificity (68.65 %) than individual parameters. The overall sensitivity, specificity, and accuracy of FNAC were 97.3 %, 82.8 %, and 95.3 %, respectively. Additionally, US parameters and FNAC together showed a significantly higher AUC value of 0.924 (95% CI:0.880 to 0.956; p < 0.0001) and achieved a sensitivity of 86.21 % and specificity of 88.65%.
Conclusions: The combined use of US and FNAC provides high sensitivity, specificity, and diagnostic accuracy in characterizing CLA patterns. In limited-resources settings, this approach is feasible, less invasive, and cost-effective thereby enabling clear management strategies and avoiding additional surgical interventions.
... It is important to note that while some US features are promising in identifying LN metastases, a single US feature cannot predict a malignant LN 1,4,5,[12][13][14][15][16][17] . ...
... We found optimal sensitivity and a negative positive value for detecting metastatic LNs in the follow-up of a cohort of thyroid cancer patients and no false negative results, making UNN-RADS an ideal diagnostic tool based on US features for predicting malignant LNs. UNN-RADS accurately defined the ultrasonographic features and reported It is a real challenge to differentiate benign and metastatic LNs on US as a chronic inflammatory or infectious process may show calcifications, cortical or peripheral vascularity, a loss of morphology, cortex hyperechogenicity, cystic changes, and, in some cases, a non-circumscribed margin due to perinodal inflammation 16 . All our cases classified as UNN-RADS categories 1 and 2 were benign LNs. ...
... Enlargement of the thyroid was identified as the anteroposterior diameter of the thyroid >2 cm. Any neck lymph node with two or more of the below features or hypoechoic and enhanced posterior echo was considered suspicious for metastasis: a globular shape or diameter of short axis >5 mm, irregular blurred contours, loss of the normal echogenic hilum, heterogeneity with anechoic/cystic components, Punctate echogenic foci (PEF) and presence of peripheral rather than hilar flow or chaotic vascularity (12)(13)(14). ...
Objectives
This study aimed to investigate the clinico-ultrasound features of primary squamous cell carcinoma of the thyroid (PSCCT) and secondary SCCT (SSCCT) and evaluate the accuracy of fine needle aspiration (FNA) recommendation for SCCT with American College of Radiology-Thyroid Imaging and Reporting Data System (ACR-TIRADS) and Chinese-TIRADS (C-TIRADS).
Materials and methods
We retrieved 26 SCCT patients (11 PSCCT, 15 SSCCT) from our hospital’s pathology database (5,718 patients with thyroid malignancy) over 23 years. Medical records and ultrasound data of the 26 patients with 27 SCCTs were analyzed retrospectively, and each SCCT focus was categorized based on the two TIRADSs.
Results
For 26 patients (21 males, 5 females) with an age range of 42-81 years, rapidly enlarging thyroid/neck nodules (18/26, 69.2%), dysphagia (7/26, 26.9%), hoarseness (6/26, 23.1%), dyspnea (5/26, 19.6%), cough (4/26, 15.4%), neck pain (2/26, 7.7%), B symptoms (2/26, 7.7%), and blood in sputum (1/26, 3.8%) were presented at diagnosis. Five asymptomatic patients (5/26, 19.2%) were detected by ultrasound. Hoarseness was more common in PSCCT (5/11, 45.5%) than in SSCCT (1/15, 6.7%) (P=0.032). For 27 SCCTs with a mean size of 3.7 ± 1.3 cm, the ultrasound features consisted of solid (25/27, 92.6%) or almost completely solid composition (2/27, 7.4%), hypoechoic (17/27, 63%) and very hypoechoic echogenicity (10/27, 37%), irregular/lobulated margin with extra-thyroidal extension (27/27, 100%), taller-than-wide shape (13/27, 48.1%), punctate echogenic foci (6/27, 22.2%), hypervascularity (23/27, 85.2%) and involved neck lymph (13/26, 50.0%). A total of 27 SCCTs were evaluated as high malignancy risk stratification (≥TR4 and 4B) by the two TIRADSs and recommended FNA in 96.3–100% (26/27, 27/27). Pathologically, more than half of PSCCTs (7/12, 58.3%) and a quarter of SSCCTs (4/15, 26.7%) were poorly differentiated, while moderately and well-differentiated grades were observed in 5 PSCCTs and 11 SSCCTs (P=0.007). Thirteen patients (50.0%) underwent surgery with radical operation in 5 cases (5/13, 38.5%).
Conclusion
SCCT is an extremely rare and aggressive malignancy with a male predominance. PSCCT and SSCCT had similar clinical and ultrasound features except for tumor differentiation and the symptom of hoarseness. SCCT showed a high malignancy risk stratification in ACR-TIRADS and C-TIRADS, with a high rate of FNA recommendation.
... However, this outcome was contrary to that of Wang et al. who found that the presentation of fusion was an independent predictive factor of malignant lymph nodes [19]. Tese outcomes must be interpreted with caution because the presence of fusion could be seen in both benign and malignant diseases [20]. at least two of the features could achieve the best performance in predicting malignancy [19]. ...
... Furthermore, patients from diverse backgrounds participated in this study. Diferent benign and malignant diseases, for example, lymphoma, and granulomatous infammation usually show diferent EBUS patterns [9,20]. As a result, their results may difer. ...
Background
Endobronchial ultrasound (EBUS) sonographic features help identify benign/malignant lymph nodes while conducting transbronchial needle aspiration (TBNA). This study aims to identify risk factors for malignancy based on EBUS sonographic features and to estimate the risk of malignancy in lymph nodes by constructing a nomogram.
Methods
1082 lymph nodes from 625 patients were randomly enrolled in training (n = 760) and validation (n = 322) sets. The subgroup of EBUS-TBNA postoperative negative lymph nodes (n = 317) was randomly enrolled in a training (n = 224) set and a validation (n = 93) set. Logistic regression analysis was used to identify the EBUS features of malignant lymph nodes. A nomogram was formulated using the EBUS features in the training set and later validated in the validation set.
Results
Multivariate analysis revealed that long-axis, short-axis, echogenicity, fusion, and central hilar structure (CHS) were the independent predictors of malignant lymph nodes. Based on these risk factors, a nomogram was constructed. Both the training and validation sets of 5 EBUS features nomogram showed good discrimination, with area under the curve values of 0.880 (sensitivity = 0.829 and specificity = 0.807) and 0.905 (sensitivity = 0.819 and specificity = 0.857). Subgroup multivariate analysis revealed that long-axis, echogenicity, and CHS were the independent predictors of malignancy outcomes of EBUS-TBNA postoperative negative lymph nodes. Based on these risk factors, a nomogram was constructed. Both the training and validation sets of 3 EBUS features nomogram showed good discrimination, with the area under the curve values of 0.890 (sensitivity = 0.882 and specificity = 0.786) and 0.834 (sensitivity = 0.930 and specificity = 0.636).
Conclusions
Our novel scoring system based on two nomograms can be utilized to predict malignant lymph nodes.
... The sample size is likely a major factor-positive lymph nodes are much less numerous. Morphology is suspected to be a factor, as "round" lymph nodes are more likely to be malignant [25]. Inter-rater agreement may be higher for round ...
Background
Lymph node status and lymph node count (LNC) are predictors of colorectal cancer outcome. Under-sampling of lymph nodes may lead to clinically relevant stage migration.
Methods
Colorectal cancer (CRC) cases with a synoptic report, accessioned 2012–2020 at a regional laboratory, were extracted and retrospectively studied. LNC, positive lymph node count (PLNC), tumour deposits present (TDpos), and ‘y’ (staging) prefix (YS) were retrieved and tabulated by pathologist using custom software. Statistical analyses were done with R.
Data and results
The cohort had 2,543 CRC resections. Seventeen pathologists interpreted >50 cases (range: 56–356) each and collectively saw 2,074. After cases with unavailable data were purged, 2,028 cases remained with 43,996 lymph nodes, of which 2,637/43,996 were positive. 368 cases had a ‘y’ prefix, and 379 had TDpos. The 17 pathologists’ median LNC/case was 19.0 (range: 14.0–24.0), and the mean PLNC per case was 1.4 (range: 1.0–2.0). Kruskal-Wallis rank sum tests showed there were differences in LNC (p<0.001) among pathologists; however, PLNC did not show this association (p = 0.2917). T-tests showed that mean LNC (p<0.001) and PLNC (p<0.035) differed between YS. 138 of 2,028 cases had less than the 12 LNC target. Logistic regression revealed a strong association between meeting the LNC target and pathologist (p<0.001) but TDpos was non-predictive (p = 0.4736).
Conclusions
Positive lymph node call rate has a good consistency in the laboratory; however, lymph node count varies significantly between pathologists. Standardized counting criteria are needed to improve uniformity and could be aided by synoptic reporting data.
... Regarding size, in addition to the prevalently used short-axis diameter, volume was reported as a useful predictor of metastasis [6]. Regarding shape, the short-axis/long-axis ratio established for superficial lymph nodes using ultrasound sonography was reported in a study of CT of lung cancer patients [7][8][9]. However, the reported short-axis/ long-axis ratio obtained on CT was analyzed using only axial sections. ...
Background
The presence of mediastinal lymph node metastasis is important because it is related to the treatment and prognosis of lung cancer. Although prevalently used, evaluation of lymph nodes is not always reliable. We introduced sphericity as a criterion for evaluating morphologic differences between metastatic and nonmetastatic nodes.
Methods
We reviewed the cases of 66 patients with N2 disease and of 68 patients with N0-1 disease who underwent lobectomy with mediastinal dissection between January 2012 and December 2021. The sphericity of the dissected station lymph nodes, which represents how close the node is to being a true sphere, was evaluated along with the diameter and volume. Each parameter was obtained and evaluated for ability to predict metastasis.
Results
Metastatic lymph nodes had a larger short-axis diameter (average: 8.2 mm vs. 5.4 mm, p < 0.001) and sphericity (average: 0.72 vs. 0.60, p < 0.001) than those of nonmetastatic lymph nodes. Short-axis diameter ≥ 6 mm and sphericity ≥ 0.60 identified metastasis with 76.2% sensitivity and 70.2% specificity (AUC = 0.78, p < 0.001) and 92.1% sensitivity and 53.9% specificity (AUC = 0.78, p < 0.001), respectively. For lymph nodes with a short-axis diameter ≥ 5 mm, sphericity ≥ 0.60 identified metastasis with 84.1% sensitivity and 89.3% specificity.
Conclusion
By using 3D-CT analysis to examine sphericity, we showed that metastatic lymph nodes became spherical. Our method for predicting lymph node metastasis based on sphericity of lymph nodes with a short-axis diameter ≥ 5 mm could do so with higher sensitivity than the conventional method, and with acceptable specificity.
... Ahuja et al на основе собственных исследований, а также на результатах других исследователей выделил наиболее значимые ультразвуковые признаки метастатического поражения шейных ЛУ, которые используются и в настоящее время большинством специалистов [21]. К наиболее часто встречаемым признакам метастических изменений в ЛУ шеи относятся: • соотношение размеров короткой и длинной осей менее 0,5 [22][23][24][25] [21]. ...
... Ahuja et al на основе собственных исследований, а также на результатах других исследователей выделил наиболее значимые ультразвуковые признаки метастатического поражения шейных ЛУ, которые используются и в настоящее время большинством специалистов [21]. К наиболее часто встречаемым признакам метастических изменений в ЛУ шеи относятся: • соотношение размеров короткой и длинной осей менее 0,5 [22][23][24][25] [21]. Для лимфом наиболее важными признаками специфического поражения ЛУ являются: псевдокистозный вид, кистозный некроз, кальцификация, смешанная васкуляризация (наличие воротного и периферического кровотока) [21]. ...
... К наиболее часто встречаемым признакам метастических изменений в ЛУ шеи относятся: • соотношение размеров короткой и длинной осей менее 0,5 [22][23][24][25] [21]. Для лимфом наиболее важными признаками специфического поражения ЛУ являются: псевдокистозный вид, кистозный некроз, кальцификация, смешанная васкуляризация (наличие воротного и периферического кровотока) [21]. Метастазы меланомы могут локализоваться в самых различных периферических областях в зависимости от локализации первичного очага. ...
The article is the consensus opinion of specialists involved in ultrasound examination, computed and magnetic resonance imaging of peripheral, abdominal and retroperitoneal lymph nodes, oncologists, authors of clinical recommendations of the Russian Society of Head and Neck Tumor Specialists based on an analysis of modern literary sources devoted to the problem of assessing the condition lymph nodes.
The purpose of the publication is to bring ultrasound terms to uniform standards when describing lymph nodes, to introduce the Node-RADS system into the practice of ultrasound examination, to improve mutual understanding between diagnosticians and clinicians in the interpretation of ultrasound results in assessing the condition of lymph nodes, optimize the work of primary care ultrasound diagnostic doctors.
... Among characteristics of CUS, L/S and blood flow type are related factors in the diagnosis of malignant lymph nodes. In recent years, a large number of studies have proved that L/S is an ultrasound index for the diagnosis of malignant lymph nodes, and the smaller the value of L/S, the lower the possibility of malignant lymph nodes (12)(13)(14)(15). In addition, mixed blood flow can also help to diagnose malignant lymph nodes (14,16). ...
... In recent years, a large number of studies have proved that L/S is an ultrasound index for the diagnosis of malignant lymph nodes, and the smaller the value of L/S, the lower the possibility of malignant lymph nodes (12)(13)(14)(15). In addition, mixed blood flow can also help to diagnose malignant lymph nodes (14,16). Tumor cells infiltrate lymph nodes and produce tumor angiogenesis factor (TAF) inside lymph nodes, causing the proliferation of peripheral blood vessels (6,(17)(18)(19). ...
Aim
To investigate the multimodal ultrasound(MMUS) features of cervical lymphadenopathy and to assess its value in the differential diagnosis of benign and malignant cervical lymph nodes.
Methods
A retrospective analysis of 169 patients with cervical lymph node enlargement who attended Hangzhou Red Cross Hospital from March 2020 to October 2022. All patients underwent conventional ultrasound (CUS), contrast-enhanced ultrasound (CEUS), and real-time elastography (RTE), and were divided into training set and validation set. Univariate analysis was applied to screen out statistically significant parameters, and CUS model and MMUS model were constructed by multifactorial logistic regression analysis. The receiver operator characteristic (ROC) curve was established, and the area under the curve (AUC) was used to compare CUS model with MMUS model to assess the value of MMUS.
Results
Of the cervical 169 lymph nodes in 169 patients included in the study. The 169 enrolled patients were divided into a training set (132 patients) and a validation set (37 patients). In the training set, univariate analysis showed statistically significant differences in long diameter/short diameter(L/S), border, margin, hilus, dermal medulla boundary, blood flow type, enhancement mode, enhancement type, and RTE score (all p< 0.05). Multifactor logistic analysis showed that L/S, blood flow type, enhancement mode and enhancement type were correlates of malignant lymph nodes (all p< 0.05). The comparison of AUC demonstrated that the discriminative ability of the MMUS model was superior to using the CUS model, both in the training set(p = 0.004) and validation set (p<0.001).
Conclusion
In this study, MMUS shows higher diagnostic efficiency than CUS. Ultrasound features such as L/S, blood flow type, mode of enhancement, type of enhancement are helpful in distinguishing benign and malignant lymphadenopathy. The addition of CEUS can greatly improve the sensitivity and specificity of ultrasonic diagnosis of malignant cervical lymph nodes. RTE score is of limited value in the diagnosis of malignant cervical lymph nodes.
