Background: Enlarged cervical lymph nodes (CLNs) can result from infection or malignancies, and a definitive diagnosis requires histological examination. Ultrasound (US) remains the first-line imaging modality for detection, and new US techniques may improve characterization. The aim of our study was to investigate whether the qualitative assessment of multiparametric US (mpUS) can improve diagnostic performance in the differentiation of benign and malignant CLNs. Methods: 107 CLNs in 105 patients were examined by preoperative mpUS consisting of B-mode US, color-coded duplex sonography (CCDS), shear wave elastography (SWE) and contrast-enhanced US (CEUS). US images were evaluated in consensus by two experienced US operators. Histopathological examination was used as reference standard. Results: SWE and CEUS combined showed the highest overall diagnostic performance (91% sensitivity, 77% specificity, 87% positive predictive value (PPV), 83% negative predictive value (NPV), 90% accuracy, χ2(1) = 51.485,p< 0.001) compared to B-mode US and CCDS (87% sensitivity, 44% specificity, 73% PPV, 65% NPV, 73% accuracy χ2(1) = 12.415,p< 0.001). In terms of individual techniques, SWE had higher specificity than B-mode and CCDS (71% sensitivity, 90% specificity, 92% PPV, 64% NPV, 78% accuracy, χ2(1) = 36.115,p< 0.001), while qualitative CEUS showed the best diagnostic performance of all investigated US techniques (93% sensitivity, 85% specificity, 91% PPV, 87% NPV, 90% accuracy, χ2(1) = 13.219,p< 0.001). Perfusion patterns, homogeneity, presence of necrosis, and malignancy differed significantly between malignant and benign CLNs (p< 0.001). Conclusions: SWE and CEUS can facilitate the differentiation of inconclusive CLNs when performed to supplement B-mode US and CCDS. MpUS may thus aid the decision between surgery and a watch-and-scan strategy in enlarged CLNs.
背景：颈部淋巴结肿大可由感染或恶性肿瘤引起，明确诊断需依靠组织学检查。超声仍是首选的影像学检测手段，新型超声技术可能提升其表征能力。本研究旨在探讨多参数超声的定性评估是否能提高鉴别良恶性颈部淋巴结的诊断效能。 方法：对105例患者的107个颈部淋巴结进行术前多参数超声检查，包括B型超声、彩色编码双功能超声、剪切波弹性成像及超声造影。超声图像由两位经验丰富的超声医师共同评估。以组织病理学检查作为参考标准。 结果：与B型超声联合彩色编码双功能超声相比，剪切波弹性成像联合超声造影显示出最高的整体诊断效能（敏感性91%、特异性77%、阳性预测值87%、阴性预测值83%、准确率90%，χ²(1)=51.485，p<0.001）。就单项技术而言，剪切波弹性成像较B型超声和彩色编码双功能超声具有更高特异性（敏感性71%、特异性90%、阳性预测值92%、阴性预测值64%、准确率78%，χ²(1)=36.115，p<0.001），而定性超声造影在所有研究的超声技术中表现最佳（敏感性93%、特异性85%、阳性预测值91%、阴性预测值87%、准确率90%，χ²(1)=13.219，p<0.001）。良恶性淋巴结在灌注模式、均匀性、坏死存在及恶性特征方面均存在显著差异（p<0.001）。 结论：当作为B型超声和彩色编码双功能超声的补充检查时，剪切波弹性成像和超声造影有助于鉴别诊断不明确的颈部淋巴结。因此，多参数超声可为肿大淋巴结的手术治疗与观察随访策略的选择提供决策依据。
肿瘤(癌症)患者之家