Virtual Touch Tissue Quantification Technique And Clinical Value Of Differential Diagnosis Of Benign And Malignant Cervical Lymph Node

Objective:Virtual touch tissue quantification technique（VTQ） is based on theacoustic radiation force impulse technology as the foundation to generateshear waves, and shear wave velocity to determine hardness, through thelymph node tissue hardness inferred neck malignancy. The purpose ofthis study was to compare to VTQ technology and ultrasound, ultrasoundelasticity imaging（UE）and virtual touch tissue image technology（VTI）,discusses its node value in the differential diagnosis of benign andmalignant of neck lymph.Materials and methods:On144lymph nodes in144patients by two-dimensional ultrasound,color Doppler flow imaging (CDFI), ultrasound elasticity imaging (UE),virtual touch tissue image technology（VTI）(computational area ratio)and virtual touch tissue quantification technique（VTQ）(shear wavevelocity （SWV） measurement of lymph node) examination.Two-dimensional ultrasound, observed the shape, boundary, internal echoof lymph and lymph nodes, measuring the short diameter, aspect ratio. CDFI examination, according to the Wu report will flow patterns aredivided into five types, I and V as benign determination, II, III, IV asmalignant judgement. UE examination, the use of strain ratio method（SR）to evaluate contrast value method, ROC curve, obtain the bestdiagnostic critical value. VTI technology, manual circle thetwo-dimensional lymph node size, then circle the VTI lymph node size,calculate the automatic computer two area ratio (VTI area/2D area，i.e.AR), and then draw the ROC curve, the optimal diagnostic criticalvalue. VTQ technology examination，five SWV measurements for eachlymph node, and the average value; ROC curve drawing, the sensitivityand specificity of the sum of the maximum method, choose theidentification of benign and malignant lymph critical value. Withultrasound guided needle biopsy to obtain histological pathology resultsas the final diagnosis standards respectively with two-dimensionalultrasound, CDFI, ultrasound elasticity imaging, VTI and VTQtechnology results were compared. In the results, for the twoclassification data, using the chi-square test; the diagnosis method, makeROC curve, constructed a receiver operating characteristic curve (ROCcurve), by calculating the area under the curve (area under curve, AUC),according to the Jorden index (sensitivity+specificity-l) critical pointapplication combined with the most high the actual diagnosis standard,also is the cut-off point. Data from the P <0.05that was statistically significant. This study used SPSS13.0statistical analysis.Results:144lymph node pathology results, a total of52benign, of which24tuberculosis, necrotizing lymphadenitis8,20malignant hyperplasia; atotal of96, including24metastatic adenocarcinoma, metastatic squamouscell carcinoma32,6of small cell carcinoma, lymphoma10(non-Hodgkin6, Hodgkin2a follicular lymphoma,2), metastatic papillarythyroid carcinoma6, follicular carcinoma of thyroid metastasis2,adenosquamous carcinoma metastasis2, can not distinguish the tissuesand cells of malignant lymph node10.(1) the conventional ultrasound In six two-dimensional ultrasoundevaluation index, the highest sensitivity for short diameter (91.30%), thelowest for boundary (43.48%); the highest specificity for boundary(69.23%), the lowest for lymph door (30.77%); the highest accuracy ofshort diameter (70.83%), the lowest boundary (52.78%). To sum up thesix standards from two-dimensional ultrasound sensitivity, specificity andaccuracy were53.26%,88.46%and68.75%.In52benign lymph nodes, CDFI performance for I or V lymph node38, and performance for the II, III, IV lymph node only14; in96malignant lymph nodes, CDFI performance for II, III, IV a total of62,while only30malignant lymph node showed I or V type, throughstatistical analysis of the differences were statistically significant (P <0.001). At the same time CDFI differential diagnosis of cervical lymphnode malignancy in sensitivity, specificity and accuracy were67.39%,73.08%and69.44%.(2) UE The application of elastic graph ratio method. The ratiomethod is according to the ratio of the measured, in combination with thepathological results produced ROC curve, according to the numericalsensitivity and specificity by summation of the maximum principle, thecritical value so as to obtain the ratio is2.170. The diagnostic criteria ofSR <2.170as benign lymph nodes, the diagnostic criteria of SR≥2.170as malignant lymph nodes. In52benign lymph nodes, SR <2.170lymphnodes of43, SR≥2.170lymph nodes of9; in92malignant lymph nodes,a total of20SR <2.170, a total of72SR≥2.170. Ratio method,sensitivity, specificity and accuracy were78.26%,82.69%and79.86%.The UE method has the very high value to the differential diagnosis ofbenign and malignant cervical lymph node.(3) VTI By VTI technology, the application of VTI technology oneach of the lymph nodes, manual circle the two-dimensional lymph nodesize, then circle the VTI lymph node size, calculate the automaticcomputer two area ratio(AR value), and then draw the ROC curve, theoptimal diagnostic critical value. Curve display, its initial rise part aresteep, show that the test resolution is accurate; the area under the curvewas0.822(0.741-0.902), p<0.001. The point of ROC curve drawing good as the threshold, calculation and sensitivity, specificity and sensitivity andspecificity of the corresponding. The results show, when the sensitivityand specificity of and the maximum is162.12%, the sensitivity was96.74%, specificity was65.38%. The corresponding point is the bestcritical point on ROC curve. AR≥1.070diagnostic criteria for VTIdiagnosis of the test results, the sensitivity is96.74%, specificity of65.38%, accuracy of85.42%.(4) VTQ By VTQ technology, according to the144lymph node in144patients, five SWV measurements for each node, to obtain the meanvalue; ROC curve drawing. Curve display, its initial rise part are steep,show that the test resolution is accurate; the area under the curve was0.948(0.914-0.982), p<0.001. The point of ROC curve drawing good asthe threshold, calculation and sensitivity, specificity and sensitivity andspecificity of the corresponding. The results show, when the sensitivityand specificity of and the maximum is179.51%, the sensitivity was89.13%, specificity was90.38%. The corresponding point is the bestcritical point on ROC curve. SWV≥2.507diagnostic criteria for VTQdiagnosis of the test results, the sensitivity is89.13%, specificity of90.38%, accuracy of89.58%.Conclusion:1. VTQ technology can objectively reflect the tissue hardness, inlymph nodes has better value for differential diagnosis of benign and malignant.2. By the VTQ technology has been cut-off value of2.507, canbetter differentiate benign and malignant cervical lymph nodesenlargement; it is two-dimensional ultrasound, color Doppler flowimaging and elastography and VTI technology more diagnostic value.3. VTQ technology is expected to as with conventional ultrasound,identification of cervical lymph nodes enlargement has become animportant reference standard diagnosis of benign and malignant.4. Strain ratio method with SR>2.170for diagnosis value thantwo-dimensional ultrasound.5. VTI technology with AR>1.070as diagnostic value is higher thanthe critical value of two-dimensional ultrasound and elastic ratio method.