The Clinical Study Of Conventional Ultrasound And Ultrasound Elastography In Diagnosis And Prognosis Of Lymphoma

Part Ⅰ The study of conventional ultrasound in lymphoma involved superficial lymph nodes Objective: To retrospectively analyze the ultrasound features of lymphoma,benign and metastatic lymph nodes,and to explore the value of conventional ultrasound in the diagnosis of lymphoma involved superficial lymph nodes.Methods: From October 2013 to June 2016,258 patients with lymphoma confirmed by ultrasound-guided core needle biopsy,142 patients with benign lymph nodes confirmed by ultrasound-guided core needle biopsy or fine needle aspiration,143 patients with metastatic lymph nodes confirmed by ultrasound-guided core needle biopsy or fine needle aspiration or surgical pathology were included in this study.Suspicious lymph nodes with long axis > 1.0 cm or long axis > 0.5 cm and absence of hilum were selected for each patient,and the target lymph nodes were selected according to the following criteria:(1)long/short ratio < 2;(2)short axis > 0.5 cm;(3)absence of hilum;(4)marginal or mixed vascular pattern.If there are more than one lymph node,only the longest one is selected.The morphology,internal structure and vascular pattern of the three groups of lymph nodes were analyzed.Result: The results of overall comparison of lymphoma,benign lymph nodes and metastatic lymph nodes showed that there were significant differences in the long axis,short axis,long/short ratio,hilum and vascular pattern among the conventional ultrasound parameters(P<0.05).When comparing benign lymph nodes with lymphoma involved lymph nodes,there were significant differences in length,short axis,ratio of length to short axis,existence of lymphatic hilum and vascular pattern(P<0.05).When comparing lymph nodes with metastatic lymph nodes in lymphoma group,the difference was only found in length,short axis and vascular pattern(P<0.05).The accuracy and sensitivity of routine ultrasound in the diagnosis of benign lymph nodes and lymphoma involved lymph nodes were 75.3%,86.6%,and AUC was 0.844.The accuracy and sensitivity of routine ultrasound in the diagnosis of lymphoma and metastatic lymph nodes were 72.1%,84.4%,and AUC was 0.767.Conclusion: Lymphoma involved lymph nodes have conventional ultrasound features which are different from benign lymph nodes and metastatic lymph nodes.Conventional ultrasound can be used in differential diagnosis of lymphoma.Part Ⅱ The study of ultrasound elastography in lymphoma involved superficial lymph nodesObjective: To explore the value of strain elastography in the diagnosis of lymphoma superficial involved superficial lymph nodesMethods: 258 patients with lymphoma,142 patients with benign lymph node and 143 patients with metastastic lymph node were analyzed by strain elastography.In the color coding of ultrasound elastography,green represents soft tissue,red represents hard tissue,and colorless represents moderate.The most red areas in lymph nodes were selected from the dynamic ultrasound elastography for analysis.The lymph node ultrasound elastography was evaluated by four score method and the differential diagnostic efficacy of strain elastography combined with conventional ultrasound in three groups of lymph nodes was evaluated.Result: The results showed that there were significant differences between lymphoma and metastatic lymph nodes,between benign lymph nodes and lymphoma,and between benign and metastatic lymph nodes.Ultrasound elastography showed that the elastography of lymphoma involved lymph nodes was more hard than that of benign lymph nodes and more soft than that of metastatic lymph nodes.The accuracy and sensitivity of conventional ultrasound and ultrasound elastography in the diagnosis of benign lymph nodes and lymphoma involved lymph nodes were 76.0% and 82.7%.Similarly,the accuracy and sensitivity of conventional ultrasound and ultrasound elastography in the diagnosis of lymphoma and metastatic lymph nodes were 75.8% and 80.8%.The accuracy of combined diagnosis is higher than that of conventional ultrasound alone.Conclusion: The results showed that combined ultrasound elastography and conventional ultrasound could make up for the shortcomings of conventional ultrasound and provide a new examination method in the perspective of tissue hardness.The combined application of ultrasound elastography and conventional ultrasound in lymphoma superficial lymph node enlargement is important in clinical application.Part Ⅲ The study of prognostic evaluation in non-Hodgkin lymphoma by conventional ultrasound combined with ultrasound elastographyObjective: To evaluate the prognostic value of conventional ultrasound combined with ultrasound elastography in patients with non-Hodgkin lymphoma(NHL)by comparing with international prognostic index(IPI).Methods: 258 patients with pathologically proved lymphoma by ultrasound-guided core needle biopsy were enrolled.59 patients lost to follow-up after pathological diagnosis,25 patients had insufficient clinical data to evaluate IPI,and 6 patients with Hodgkin lymphoma were excluded.Finally,168 patients with non-Hodgkin lymphoma were assessed by IPI,and the images of conventional ultrasound and ultrasound elastography were retrospectively analyzed.The patients were divided into two groups by IPI score,and the differences of ultrasound indexes between the two groups were compared.According to the positive features,the prognostic index of ultrasound was established,and the relationship among clinical prognosis,ultrasound prognostic index and IPI was analyzed.Results: 86 patients with IPI score of 0,1 and 2 were divided into good prognosis group,82 patients with IPI score of 3,4 and 5 were divided into poor prognosis group.There were significant differences in the long axis(L),short axis(S),hilum,vascular pattern and ultrasound elastography between the two groups(P < 0.05).The ultrasound prognostic index criteria were: L > 31.90 mm,S > 12.35 mm,hilum absent,vascular pattern was marginal or mixed,elastography was hard.The accuracy and sensitivity of ultrasound prognostic index were 72.6% and 81.7% respectively,and the AUC value was 0.789(95% CI,0.721-0.857).The clinical prognosis,ultrasound prognostic index and IPI of 133 patients with complete response(CR)rate were analyzed.CR rate analysis showed that the prognosis of patients with low risk range evaluated by ultrasound prognostic index score was better than that of IPI score.Conclusion: Conventional ultrasound and ultrasound elastography are valuable in predicting the prognosis of non-Hodgkin lymphoma.Compared with international prognostic index,ultrasound prognostic index may have better predictive value for patients with good prognosis.