Clinical Study Of Multimodal Ultrasonography In Differential Diagnosis And Guiding Biopsy Of Superficial Lymphadenopathy

Part I Value of high frequency ultrasonography in diagnosis of superficial lymph nodesObjective:To investigate the value of high frequency ultrasonography in superficial lymphadenopathy.Methods:Three hundred and five cases of superficial lymph nodes were scanned by high frequency ultrasonography.The aspect ratio,echogenicity,absence/eccentricity of the echogenic hilus,boundary,blood supply distribution and hemodynamics were observed.The lymph nodes were divided into different groups according to pathologic reports.All cases were proved to be benign or malignant by pathology.According to pathologic results,Lymph nodes were divide into two groups:benign?reactive nodes group;tuberculous lymphadenitis?,malignant?metastatic lymphadenectasis;lymphomas?.The statistical analysis was performed.Results:One hundred and thirteen cases were benign including 60 cases of reactive nodes,53cases of tuberculous lymphadenitis.A total of 192 cases were malignant including 138cases of metastatic lymphadenectasis and 54 cases of lymphomas.The sensitivity,specificity,accuracy,positive predictive value and negative predictive value of conventional ultrasound were 71.4%?57.5%?66.2%?74%?54.2%respectively.L/S,echogenicity,vascular pattern and RI between benign and malignant group showed statistical significant differences,while no statistical difference in boundary and the absence/eccentricity of the echogenic hilus between the two groups was found.Tuberculous lymphadenitis was similar to metastatic lymphadenectasis in L/S,the absence/eccentricity of the echogenic hilus and peripheral vessels,but there were statistically differences between the two groups in RI.Most reactive lymph nodes showed hilar vessels.Lymphomas were mainly performed mixed vessels and hilar vessels.There were statistically differences between the reactive nodes and lymphomas in RI.Conclusion:Although there was overlap of sonographic features between different pathological lesions,superficial high ultrasonography plays an certain role in qualitative diagnosis of lymph nodes.It can be used as the first choice for differential diagnosis.Part II The research of ultrasonic elastography in the diagnosis of superficial lymph nodesObjective:To evaluate the clinical value of elastosonography applied in differentiating benign from malignant superficial lymph nodes.Methods:One hundred and twenty-five cases were scanned by ultrasonic elastography.The elastogram were classified according to the four-score.The hardness of lesion tissue and surrounding tissue was compared and strain ratio were calculated by the measure software.The cut off point of strain ratio was determined with receiver operating curve?ROC?.All of cases proved by the pathology.The characteristics of elastosonography ultrasound in different groups were compared.Results:Fifty-seven cases were benign and all of them were reactive nodes,Sixty-eight cases were malignant including 33 cases of lymphomas and 35 cases of metastatic lymphadenectasis.The sensitivity,specificity,accuracy,positive predictive value and negative predictive value of elastography scores were 60.3%?82.5%?70.4%?80.4%?63.5%respectively.The SR of benign and malignant lymph nodes to the surrounding tissues were1.28±0.31 and 2.43±1.29,the difference was statistically significant.With pathologic diagnosis as the golden standard,the cutoff point of stain ratio in superficial lymph nodes was 1.61.The sensitivity,specificity,accuracy,positive predictive value and negative predictive value of SR were 73.5%?84.2%?78.4%?84.7%?72.7%.Combined the elastography scores and stain ratio,The sensitivity,specificity,accuracy,positive predictive value and negative predictive value were 82.4%?80.7%?81.6%?83.6%?79.3%.The sensitivity,specificity,accuracy,positive predictive value and negative predictive value were 86.8%?86%?86.4%?88.1%?84.5%when conventional ultrasound combined with elastography.Conclusion:Ultrasonic elastography is expected to be an important criterion which could be helpful to provide more information in the diagnosis of superficial lymphadenopathy.Part III The application of contrast-enhanced ultrasound in differential diagnosis of superficial lymphadenopathyObjective:To evaluate perfusion characteristics of contrast-enhanced ultrasound?CEUS?and parameters of time intensity curve?TIC?in different pathological lessions.Methods:One hundred and seventy-seven cases of superficial lymph nodes were studied by contrast-enhanced ultrasound.Perfusion characteristics of CEUS were observed and recorded.The results were registered with analysis software to draw TIC,recorded TTP,MAX%,AUC,K_UP,K_DOWN,RT,mTT.All cases were proved to be benign or malignant by pathology.According to pathologic results,Lymph nodes were divide into two groups:benign?reactive nodes group;tuberculous lymphadenitis?,malignant?metastatic lymphadenectasis;lymphomas?.The statistical analysis was performed.The characteristics of contrast-enhanced ultrasound in different groups were compared.Results:Sixty-seven cases were benign including 38 cases of reactive nodes,29 cases of tuberculous lymphadenitis.A total of 110 cases were malignant including 77 cases of metastatic lymphadenectasis and 33 cases of lymphomas.The sensitivity,specificity,accuracy,positive predictive value and negative predictive value were 92.7%?86.6%?90.4%?91.9%?87.9%when conventional ultrasound combined with contrast-enhanced ultrasound.The enhancement pattern of centrifugal and mixed between benign and malignant group showed statistical significant differences,while no statistical difference in centripetal enhancement and distribution equilibrium of contrast agent between the two groups.Reactive nodes were mainly manifested by centrifugal type and homogeneous enhancement.Tuberculous lymphadenitis were mostly centripetal type and heterogeneous enhancement.Metastatic lymphadenectasis were mainly performed centripetal and mixed type,and lymphomas were mixed type and homogeneous enhancement.TIC showed that compared with reactive lymph nodes and metastasis lymphadenectasis,lymphomas had longer TTP,higher IMAX%and larger area under the curve.The different of K_UP,K_DOWN between metastatic and reactive lymph node were statistically significant.There was no statistical difference in RT,MTT among the three groups.Conclusion:Different lymph node diseases performed different perfusion characteristics,contrast-enhanced ultrasonography has a higher practical value in qualitative diagnosis of superficial lymphadenopathy.It provides a valuable basis for differential diagnosis.Part IV Comparative analysis of ultrasonic elastography and contrast-enhanced ultrasound on superficial lymph node biopsyObjective:To investigate the clinical value of needle biopsy in superficial lymphadenitis guided by elastosonography and contrast-enhanced ultrasonography.Methods:One hundred and fifty-nine patients with superficial lymph node were randomly divided into two groups.The lymph nodes of group A were used as ultrasound elastography-guided biopsy;the lymph nodes of group B were contrast-enhanced ultrasound firstly to determine the target lymph node and the puncture point,then were detected with needle biopsy.Results:There were 82 and 77 superficial lymphadenopathy cases in each group.The extraction effect of Group A were significantly higher than that of Group B?Mean Rank72.86 vs.86.66,P<0.05?.And the biopsypositive rate of Group A was higher compared to Group B?98.7%vs 95.1%?.Conclusion:The extraction effect and accuracy of puncturing superficial lymph node under contrast-enhanced ultrasound were higher,compared with under ultrasound elastography.It has high clinical value and worth to be extended in clinical application.