| Objective: The goal of this study is to evaluate the value of twodimensional,color Doppler and contrast-enhanced ultrasound imaging and tofind a more reliable method in differential diagnosis of superficial lymphnodes.Methods: The study included60patients with various cancer(9casesnasopharyngeal carcinoma,2cases malignant melanoma,15cases thyroidcarcinoma,1case tongue cancer,18cases breast carcinoma,10cases small cellcarcinoma of lung,1case penis cancer and4cases ovarian cancer) in thefourth Hospital of Hebei Medical University between Mar.2010and Aug.2011were examined ultrasound.male:36cases,female:24cases, with a mean age of47.8±5.6years, Totally260superficial lymph nodes were tested by colorDoppler ultrasound diagnostic apparatus. Be allergic to contrast media,seriousheart disease, hypertension, mental disease, pregnant women were evacuated,36patients were enrolled and43lymph nodes were selected to performcontrast-enhanced ultrasound examination.In the two dimensional ultrasound examination, the short to long axisratio (S/L),hilum exit or not, a sharp margin between cortex and medulla exitor not, were observed and analyzed. In the color-Doppler ultrasoundimaging,the vascular pattern were observed and the resistance index(RI) weremeasured. In the contrast-enhanced ultrasound examination, perfusion patternswere analyzed, arrival time(AT),time to peak(TP),peak intensity(PI),the areasunder cure(AUC) and the difference between the SImax-SImin of each nodeswere measured.The260superficial lymph nodes were divided into benign and malignantgroups based on histopathologic diagnosis．All the dates were analysed. Measurement dates: S/L,RI,AT,TTP,PI and SImax-SImin were performedt-test, statistical significance when P<0.05;Enumeration dates:hilum exit ornot,sharp margin between cortex and medulla exit or not,the vascular patternsand perfusion patterns were performed Chi-square test, statistical significancewhen P<0.05. The cut off was calculated as standardized value to make thesum of sensitivity and specificity biggest. Sensitivity, specificity, positivepredict value, negative predict value, and accuracy were calculated when therewere statistical significances in these parameters. Evaluate the coincidenceusing Receiver Operator Cure(ROC), accuracy is low when the area under thecure(AUC) was smaller than0.7,accuracy is midding when AUC was biggerthan0.7and smaller than0.9, accuracy is high when AUC was bigger than0.9.Results:1Histopathologic diagnosis, There were167malignant lymph nodes and93benign lymph nodes, classified as malignant group and benign grouprespectively.2The S,S/L in malignant group were significantly higher than those inbenign group (P<0.01).3There were statistical significance in hilum between the two groups(P<0.05).4There were statistical significance in margin of cortex and medullabetween the two groups (P<0.05).5There were statistical significance in vascular patterns between the twogroups (P<0.05).6The RI in malignant group were significantly higher than in benigngroup (P<0.05).7There were statistical significance in perfusion patterns between thetwo groups (P<0.05).8The SImin in malignant group were significantly lower than in benigngroup (P<0.01),and the SImax-SImin in malignant group were significantlyhigher than in benign group(P<0.01).9There were no statistical significances in arrival time, time to peak,peak intensity between the two groups (P>0.05),but there were statisticalsignificance in AUC(P<0.01).10The sum of sensitivity and specificity was the highest usingstandardized values of S/L=0.5,RI=0.6,SImax-SImin=28%.11Compared with histopathologic diagnosis, S/L<0.5were classifiedas benign, S/L>0.5were classified as malignant, sensitivity was67.7%,specificity was78.4%,positive predict value was85.0%,negativepredict value was57.5%and accuracy was71.5%.12Compared with histopathologic diagnosis, hilum exited wereclassified as benign, no hilum were classified as malignant, sensitivity was71.9%,specificity was73.1%,positive predict value was82.8%,negativepredict value was59.1%and accuracy was72.3%.13Compared with histopathologic diagnosis, nodes having a sharpmargin between cortex and medulla were classified as benign, having no sharpmargin between cortex and medulla were classified as malignant, sensitivitywas70.7%,specificity was81.7%,positive predict value was87.4%,negativepredict value was60.8%and accuracy was74.6%.14Compared with histopathologic diagnosis, central vascular patternswere classified as benign, peripheral vascular patterns were classified asmalignant, Sensitivity was74.9%,specificity was71.0%,positive predict valuewas86.2%,negative predict value was57.4%and accuracy was73.5%.15Compared with histopathologic diagnosis, RI<0.6were classifiedas classified as benign, RI>0.6were classified as malignant, sensitivity was72.4%,specificity was62.3%,positive predict value was79.4%,negativepredict value was58.1%and accuracy was70.8%.16Compared with histopathologic diagnosis, adterminal perfusionpatterns were classified as benign, concentric perfusion patterns wereclassified as malignant, sensitivity was86.2%,specificity was78.6%,positivepredict value was89.3%,negative predict value was73.3%and accuracy was83.7%.17Compared with histopathologic diagnosis, SImax-SImin<28% were classified as benign, SImax-SImin>28%were classified as malignant,Sensitivity was93.1%,specificity was85.7%,positive predict value was93.1%,negative predict value was85.7%and accuracy was90.7%.18All the significant parameters were analysed by receiver operatorcure(ROC),the areas under the cure(AUC) were: AUC of S/L0.71,AUC ofhilum0.74,AUC of sharp border between cortex and medulla exit ornot0.76,ACU of vascular patterns0.75,AUC of RI0.70,diagnosis accuracy ofthese parameters was midding,ACU of perfusion patterns0.86;AUC ofSImax-SImin0.90.Conclusion: The two dimensional and color Doppler ultrasound canlocate and show the exact spot and the morphological changes and bloodsupply of lymph nodes,contrast-enhanced ultrasound could provide extent ofthe pathological changes of lesion and provide differential diagnosisevidence for those enlarged superficial lymph nodes.Compared with twodimensional and color Doppler ultrasound, contrast-enhanced ultrasound cansignificantly enhance the ability of identify malignant lymph nodes frombenign lymph nodes．... |
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