Evaluation of supplementary diagnostic value of contrast-enhanced ultrasound for lymph node puncture biopsy

Abstract

Background: Contrast enhanced ultrasound (CEUS) is an effective way to evaluate the distribution of micro vessels in organs with little invasiveness. The qualitative evaluation and differential diagnosis of lymph node is essential for a number of clinical situations, including appropriate examination selection, oncologic staging, therapy and prognosis beyond diagnosis itself. The purpose of this study is to investigate the contribution of characterization of cervical lymphadenopathies on CEUS as an indication for lymph node puncture biopsy.Methods: Records of 157 lymph nodes from 103 patients who had undergone CEUS examination were studied retrospectively, and enhancement patterns and characteristics were evaluated. The diagnoses obtained by means of core-needle biopsy examination or surgical removal, or patients were closely followed-up for at least 6 months. Of the lymph nodes examined, 94 were benign (48 lymphadenitis and 46 tuberculosis) and 63 were malignant (55 metastases and 8 lymphomas). The vascular characterization of lymph nodes was compared with results obtained by pathologic examination. Results:The study using CEUS showed 55 (54.5%) cases of "peripheral" enhancement in group A and 47 (83.9%) cases of "hilar normal or activated" in group B. Inhomogeneous "spotted or cycle-like" enhancement in the equilibrium phase was seen in 80 (79.2%) cases of group A and only 11 (19.6%) cases of group B. The specificity, sensitivity and accuracy of CEUS examination result as an indication for puncture biopsy were 80.4%, 81.2% and 80.9%, respectively.Conclusions: Centripetal perfusion in the early arterial phase or inhomogeneous spotted or cycle-like enhancement in the equilibrium phase of the cervical lymph nodes during CEUS can be used as an indication for core-needle biopsy with a high degree of accuracy. Conversely, for lymph nodes with more variable appearances, surgical removal or closely followed-up of nodes may be more appropriate.

Contrast-enhanced ultrasound of the small organs in children

“…A global hypoechoic (i.e. pseudocystic) appearance of a lymph node is seen in cases of lymphoma infiltration [ 37 ]. Infection can appear similar to malignant nodes because of necrosis and abscess formation, which appears as hypoechoic regions on gray-scale US.…”

“…In lymphoma, new capillary circulation increases the blood flow to the node, producing a hyperenhancing CEUS appearance. Increased flow through normal hilar vessels in reactive lymph nodes results in hyperemia that can be difficult to distinguish from lymphoma [ 14 , 37 ].…”

“…In clinical practice, lymphadenitis can be observed with serial US imaging, and metastatic disease and tuberculosis can be diagnosed after core-needle biopsy, whereas lymphoma requires histological evaluation following surgical excision. One study in adults suggested that the intranodal contrast enhancement pattern could guide selection of which nodes should be biopsied, excised or observed with serial imaging [ 37 ]. This study demonstrated that CEUS can distinguish metastatic and tuberculous lymph nodes from lymphoma, which helps to guide the choice between biopsy and excision [ 37 ].…”

“…One study in adults suggested that the intranodal contrast enhancement pattern could guide selection of which nodes should be biopsied, excised or observed with serial imaging [ 37 ]. This study demonstrated that CEUS can distinguish metastatic and tuberculous lymph nodes from lymphoma, which helps to guide the choice between biopsy and excision [ 37 ]. Two enhancement characteristics on CEUS were more indicative for the diagnosis of tuberculous or metastatic lymph nodes: peripheral perfusion in the early arterial phase and inhomogeneous spotted/cycle-like enhancement in the equilibrium phase.…”

Reassessing the Value of Contrast-Enhanced Ultrasonography in Differential Diagnosis of Cervical Tuberculous Lymphadenitis and Lymph Node Metastasis of Papillary Thyroid Carcinoma

“…It is a new ultrasonic diagnostic technique for normal and enhanced lesions, which can effectively evaluate intratissue perfusion and microcirculation. Previous studies have shown that the CEUS yields superior results in the diagnosis of cervical benign lymph node diseases and tumor lymph node metastasis, with higher accuracy compared with the conventional ultrasound (12,13). However, data on the use of CEUS in differential diagnosis of cervical lymph node metastasis from PTC and tuberculous lymphadenitis remain scant.…”