Measurable and Unmeasurable Features of Ultrasound Lymph Node Images in Detection of Malignant Infiltration

Acta Clin Croat. 2017 Sep;56(3):415-424. doi: 10.20471/acc.2017.56.03.08.

Abstract

The aim of the study was to assess diagnostic value and utility of selected morphological features in predicting lymph node (LN) malignancy using B-mode, Doppler ultrasonography and multivariate settings in a tertiary radiological referral center. The study included 123 patients having undergone ultrasound-guided fine-needle aspiration and cytologic analysis (FNAC) of cervical, axillary and inguinal LNs. Each LN was characterized by long/L and short/T-axis, shape, margins, echogenicity, cortical thickness, vascularization, and examiner's subjective impression. Within the limitations of FNAC, altered shape and vascularization had relatively high specificity and positive predictive value (>80%), whereas subjective impression had high sensitivity and negative predictive value (100%) for malignancy. The cut-off levels for different features of LN by ROC analysis were as follows: long-axis 23 mm, short-axis 11 mm, L/T ratio 2.19, and maximal cortical thickness 5.1 mm. On multivariate analysis (adaptive regression splines, n=108), the addition of long-axis, L/T ratio, age and sex considerably improved diagnostic accuracy (88%), sensitivity (margins + vascularization) and specificity (subjective impression) of the diagnostic model. The combination of morphological and demographic features could improve diagnostic accuracy, usually with a trade-off between the sensitivity and specificity of the predictive model. The performance may depend on the level of expertise and institutional settings.

Keywords: Biopsy, fine-needle; Croatia; Cytodiagnosis; Lymph nodes – abnormalities; Predictive value of tests; Ultrasonography, doppler.

MeSH terms

  • Adult
  • Aged
  • Axilla
  • Biopsy, Fine-Needle / methods*
  • Croatia
  • Female
  • Groin
  • Humans
  • Image-Guided Biopsy / methods
  • Lymph Nodes* / diagnostic imaging
  • Lymph Nodes* / pathology
  • Lymphatic Metastasis / diagnostic imaging*
  • Lymphoma / diagnosis
  • Lymphoma / pathology
  • Male
  • Middle Aged
  • Neck
  • Predictive Value of Tests
  • Reproducibility of Results
  • Sensitivity and Specificity
  • Ultrasonography, Interventional / methods*