Preliminary Study Of Ultrasonographic Classification Diagnoses For Evaluating Malignant Risk Of Cervical Lymphadenopathy

Objctive: 1)The aim of this study was to build an ultrasonographic score criterion to evaluate the malignant risk of cervical lymphadenopahy.2)To establish an US classification criterion for the cervical lymphadnopathy and determine the percentage of malignant lymph nodes in each category.3)To explore the diagnostic value of contrast-enhanced ultrasound(CEUS)and CEUS parametric imaging in the uncertain cervical nodes,which were difficult to be determined by conventional US.Methods: 1)The sonographies of two hundreds and eighty eight cervical lymph nodes(LNs)from 288 patients were retrospectively studied.These nodes were subdivided into benign and malignant groups according to the pathological results.Seven sonographic features were compared and 4 valuble features were chosen to build a score criterion for evaluating the malignant risk of cervical lymphadenopathy.Then,the 288 LNs were evaluated by the US score criterion and given scores.2)Eighty hundreds and ten lymph nodes from 810 patients with cervical lymphadnopathy were prosctively collected and were given scores according to the US score criterion.Then,the US classification criterion was proposed according to the percentage of malignant LNs in each group with the same score.The medical history and clinical symptoms of each patient were also considered to adjust the US classification which didn't accod with these clinical informations.Finally,the percentages of malignant lymph nodes in each catergory were acquired.3)The CEUS was conducted in the 156 uncertain cases where the informations obtained from gray-scale and Doppler were not enough for a corret diagnosis.The features of enhancement and perfusion in CEUS and CEUS parametic imaging features were analyzed.Results: 1)Four sonographic features had statistical differencse between the benign and the malignant lymphadenpathy,which were L/S,echogenicity of hilum,intranodal echogenicity and intranodal vascular pattern.In multiple logistic regression analyses,the following 3 US features being significantly associated with malignant lymphadenpathy were vascular pattern(OR,5.387;95%CI,2.403-12.079;P<0.001),intranodal echogenicity(OR,4.565;95%CI,2.433-8.563;P<0.001),echogenicity of hilum(OR,2.309;95%CI,1.903-4.876;P=0.028).The score range of the US criterion was from 0 to 8.Liner-by-Liner chi-squre test show the percentage of malignant LN was increasing with the scores(P<0.05)and the binary logistic regression also show the OR values of malignant risk were increasing with the scores;2)The 810 lymph nodes from 810 patients with cervical lymphadenopathy were evaluated by the US score criterion combined with medical history and clinical symptoms.The final US classification diagnosis criterion for the cervical lymphadnopathy was as follows: grade1(very low malignant risk,6% malignancy),grade 2-a(low malignant risk,30% malignancy),grade 2-b(moderate or high malignant risk,65% malignancy),grade3(very high malignant risk,85% malignancy).The AUC of this classification cretirion was 0.855(95% CI,0.829-0882,P < 0.001).3)The CEUS enhancment and perfusion pattern in the cervical lymphadenopathy were subdivided into 3 types: type?-homogeneous enhancement(?a-beginning from hilus,type?b-beginning from non-hilus),type?-inhomogeneous enhancement with perfusion defects(?a-beginning from hilus,?b-beginning from non-hilus),type ?-lack of enhancement.There had statistic difference between the benign and the malignant lympadenopaty in subtypes of type?(P<0.05),but had no difference in subtypes of type?(P>0.05).While,there had difference between the benign and the malignant lympadenopaty in the perfusion phase of CEUS parametric imaging(P<0.05).Then,a criterion was set that a LN was thought to be benign for having the artery perfusion phase,or to be malignant for having the artery and parenchymal perfusion phase.The sensitivity of this criterion was 77.2%,specifity was 72.2% and the accuracy was 75.5%,Kappa=0.50.Conclusions: The US socre criterion based on the L/S,echogenicity of hilum,intranodal echogenicity and vascular pattern can be used to evaluate the malignant risk of cervical lymphadenopathy.The US classification dignoses based on the US socre criterion and cilincal informations can provide the malignant percentage of different grades.CEUS can be used in the uncertain cervical lymphadenopathy which were difficult to be determined by the conventional US.