Cervical necrotic lymphadenopathy: a diagnostic tree analysis model based on CT and clinical findings

You, Sung Hyun; Kim, Byung Jun; Yang, Kyung Sook; Kim, Bo Kyu

doi:10.1007/s00330-019-06155-2

Cited by 14 publications

(12 citation statements)

References 28 publications

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“…Among benign cervical lymphadenopathies, KD and CTL are the major differential diagnoses in patients with acute cervical lymphadenopathy 3 . In prior studies with CT, the presence of indistinct margins of necrotic foci were found to be an independent predictor of KD, with 80% accuracy 1 .…”

Section: Discussionmentioning

confidence: 99%

“…In benign cervical lymphadenopathy, both Kikuchi-Fujimoto disease (KD) and cervical tuberculous lymphadenitis (CTL) can show enlarged cervical lymph nodes with or without necrosis, with similar imaging features on contrast-enhanced CT (CECT) [1][2][3][4][5] . Although both are benign, there are differences in their treatment and course [6][7][8][9][10][11] .…”

Section: Introductionmentioning

confidence: 99%

“…Although both are benign, there are differences in their treatment and course [6][7][8][9][10][11] . Therefore, many studies have been performed to differentiate KD from CTL using CECT [1][2][3]12 . KD can show perinodal infiltration, indistinct margins of necrosis, stronger cortical enhancement of lymph nodes, and unilaterality 1,2,12,13 .…”

Section: Introductionmentioning

confidence: 99%

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Initial experience of a deep learning application for the differentiation of Kikuchi-Fujimoto’s disease from tuberculous lymphadenitis on neck CECT

Kim

Lee

et al. 2022

Preprint

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Neck contrast-enhanced CT (CECT) is a routine tool used to evaluate patients with cervical lymphadenopathy. This study aimed to evaluate the ability of convolutional neural networks (CNNs) to classify Kikuchi-Fujimoto’s disease (KD) and cervical tuberculous lymphadenitis (CTL) on neck CECT in patients with benign cervical lymphadenopathy. A retrospective analysis of consecutive patients with biopsy-confirmed KD and CTL in a single center, from January 2012 to June 2020 was performed. This study included 198 patients of whom 125 patients (mean age, 25.1 years ± 8.7, 31 men) had KD and 73 patients (mean age, 41.0 years ± 16.8, 34 men) had CTL. A neuroradiologist manually labelled the enlarged lymph nodes on the CECT images. Using these labels as the reference standard, a CNN was developed to classify the findings as KD or CTL. The CT images were divided into training (70%), validation (10%), and test (20%) subsets. The Cut&Remain method was applied to improve performance. For the test set, the best area under the receiver operating characteristic curve for classifying KD from CTL was 0.91. Our findings show that the differentiation of KD from CTL on neck CECT using a CNN is feasible with high diagnostic performance.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Initial experience of a deep learning application for the differentiation of Kikuchi-Fujimoto’s disease from tuberculous lymphadenitis on neck CECT

Kim

Lee

et al. 2022

Preprint

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“…Necrosis shows hypoattenuation without enhancement in CT images. The potential mechanism of necrosis in lymphoma is the occlusion of the supplying hilar artery by the tumor (compression or invasion) in addition to lymphatic ow obstruction (21,22). Previous study indicated HIV(-) NHL patients with necrosis had signi cantly higher Ann Arbor stages, greater IPI, and higher serum LDH levels than those without necrosis but in Kaplan-Meier survival analysis, no statistically signi cant difference was noted for necrosis (23).…”

Section: Discussionmentioning

confidence: 99%

CT Imaging Characteristics Correlated with Overall Survival Time in Patients with AIDS-Related non-Hodgkin’s Lymphoma

Pan

Zheng

et al. 2020

Preprint

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Background CT can provide useful information for treatment regimens and prognosis prediction of patients with AIDS-related non-Hodgkin’s lymphoma (AR-NHL). It is necessary to investigate the prediction of CT imaging and clinical characteristics for overall survival (OS) in patients with AR-NHL.Methods Data of 121 AR-NHL patients [median age: 41 (range 22-78), 112 male] between July 2012 and November 2019 were retrospectively reviewed. Patients were divided into two groups by median OS time and data were compared between two groups. K-M survival analysis and Cox proportional hazards regression analysis were used to determine the prognostic risk factors for OS.Results The median OS time was 17 months. In the K-M survival analysis, presence of extracapsular infiltration (p=0.032), necrosis (p=0.005), CD4 ≤ 100 cells/μL (p=0.020), period from finding mass to admission﹥1 month (p=0.013), without chemotherapy (p﹤0.001), liver involved (p﹤0.001), gastrointestinal tract involved (p=0.015) and mediastinal or hilar lymph nodes involved (p=0.022) were associated with shorter OS. In the multivariate Cox regression analysis, liver involved (HR=2.48, 95%CI 1.45–4.25, P=0.001), mediastinal or hilar lymph nodes involved (HR=1.70, 95%CI 1.02–2.83, P=0.042), necrosis in lesion (HR=2.02, 95%CI 1.21–3.36, P=0.007) and CD4 ≤ 100 cells/μL (HR=2.66, 95%CI 1.42–4.98, P=0.002) were independently risk factors for shorter OS. Chemotherapy (HR=0.48, 95%CI 0.26–0.89, P=0.020) was independently protective factor for shorter OS. The predictive models based on Cox regression has good discrimination (Harrell’s C-index=0.716) and good calibration (Hosmer-Lemeshow test, p=0.620). Conclusion When the tumor had necrosis and extracapsular infiltration, involvement of mediastinal or hilar lymph nodes, liver, gastrointestinal tract in CT images, the overall prognosis was poor. And intensive chemotherapy regimens and more frequent follow-up should be considered.

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“…As computed tomography (CT) of the affected area was performed in all patients, we analyzed the number and sites of involved lymph nodes. CT criteria for lymphadenopathy was defined as one of the following criteria was fulfilled: (a) size, short diameter was larger than 1 cm (1.5 cm for neck level II); (b) shape, loss of normal coffee bean shape; or (c) presence of necrosis, calcification, or perinodal infiltration [29]. Cervical lymph node levels were classified according to currently widely accepted classification: Level I, submental (IA) and submandibular (IB); level II, upper internal jugular nodes; level III, middle jugular nodes; level IV, low jugular nodes; level V, posterior triangle nodes; level VI, upper visceral nodes; level VII, superior mediastinal nodes [30].…”

Section: Evaluation and Treatment Of Tbmentioning

confidence: 99%

TB Antigen-Stimulated CXCR3 Ligand Assay for Diagnosis of Tuberculous Lymphadenitis

Chung

Lee

Park

et al. 2021

IJERPH

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The diagnosis of tuberculous lymphadenitis (TB-LAP) is challenging. We evaluated the role of blood CXC chemokine receptor 3 (CXCR3) ligands in its diagnosis. A total of 65 lymphadenopathy patients were enrolled and lymph node sampling was performed. We also recruited 113 control subjects, consisting of 27 with positive results and 86 with negative results, in the interferon (IFN)-γ release assay (IGRA). In all study subjects, whole-blood samples were collected using the IGRA methodology. After incubation, plasma levels of IFN-γ and two CXCR3 ligands, IFN-inducible T-cell a chemoattractant (I-TAC) and monokine induced by IFN-γ (MIG), were measured using immunoassay. Fifty-three TB-LAP patients were enrolled. TB antigen-stimulated IFN-γ, I-TAC, and MIG levels were all significantly higher in the TB-LAP patients than in the controls and non-TB-LAP patients. The levels of I-TAC and MIG, but not IFN-γ, showed significant differences between the TB-LAP patients and IGRA-positive controls. Area under the receiver operating characteristic curves (AUROCs) of IFN-γ, I-TAC, and MIG were 0.955, 0.958, and 0.959, respectively, for differentiating TB-LAP from control group, and were 0.912, 0.956, and 0.936, respectively, for differentiating TB-LAP from non-TB-LAP. In conclusion, the TB antigen-stimulated MIG and I-TAC could be useful biomarkers in the diagnosis of TB-LAP.

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Cervical necrotic lymphadenopathy: a diagnostic tree analysis model based on CT and clinical findings

Cited by 14 publications

References 28 publications

Initial experience of a deep learning application for the differentiation of Kikuchi-Fujimoto’s disease from tuberculous lymphadenitis on neck CECT

Initial experience of a deep learning application for the differentiation of Kikuchi-Fujimoto’s disease from tuberculous lymphadenitis on neck CECT

CT Imaging Characteristics Correlated with Overall Survival Time in Patients with AIDS-Related non-Hodgkin’s Lymphoma

TB Antigen-Stimulated CXCR3 Ligand Assay for Diagnosis of Tuberculous Lymphadenitis

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