Contrast-enhanced endoscopic ultrasound features of tubercular lymphadenopathy

2021 ◽  
pp. 004947552110280
Author(s):  
Surinder S Rana ◽  
Nikhil Bush ◽  
Saurabh Dawra ◽  
Ravi Sharma ◽  
Radhika Srinivasan ◽  
...  
Keyword(s):  
Lymph Node ◽  
Lymph Nodes ◽  
Retrospective Analysis ◽  
Endoscopic Ultrasound ◽  
Great Majority ◽  
Contrast Enhanced ◽  
Heterogeneous Enhancement ◽  
Ultrasound Features

There is lack of data on the contrast-enhanced endoscopic ultrasound features of tubercular lymph node; our retrospective analysis of 37 patients with enlarged mediastinal and abdominal lymph nodes showed heterogeneous enhancement in the great majority (70%).

scholarly journals Multi-factorial considerations for intra-thoracic lymph node evaluations of healthy cats on computed tomographic images

2021 ◽  
Vol 17 (1) ◽  
Author(s):  
Ninlawan Thammasiri ◽  
Chutimon Thanaboonnipat ◽  
Nan Choisunirachon ◽  
Damri Darawiroj
Keyword(s):  
Lymph Node ◽  
Lymph Nodes ◽  
Ct Images ◽  
Slice Thickness ◽  
Maximum Width ◽  
Post Contrast ◽  
Computed Tomographic ◽  
Contrast Enhanced Ct ◽  
Contrast Enhanced ◽  
Enhanced Ct

Abstract Background It is difficult to examine mild to moderate feline intra-thoracic lymphadenopathy via and thoracic radiography. Despite previous information from computed tomographic (CT) images of intra-thoracic lymph nodes, some factors from animals and CT setting were less elucidated. Therefore, this study aimed to investigate the effect of internal factors from animals and external factors from the CT procedure on the feasibility to detect the intra-thoracic lymph nodes. Twenty-four, client-owned, clinically healthy cats were categorized into three groups according to age. They underwent pre- and post-contrast enhanced CT for whole thorax followed by inter-group evaluation and comparison of sternal, cranial mediastinal, and tracheobronchial lymph nodes. Results Post contrast-enhanced CT appearances revealed that intra-thoracic lymph nodes of kittens were invisible, whereas the sternal, cranial mediastinal, and tracheobronchial nodes of cats aged over 7 months old were detected (6/24, 9/24 and 7/24, respectively). Maximum width of these lymph nodes were 3.93 ± 0.74 mm, 4.02 ± 0.65 mm, and 3.51 ± 0.62 mm, respectively. By age, lymph node sizes of these cats were not significantly different. Transverse lymph node width of males was larger than that of females (P = 0.0425). Besides, the detection score of lymph nodes was affected by slice thickness (P < 0.01) and lymph node width (P = 0.0049). Furthermore, an irregular, soft tissue structure, possibly the thymus, was detected in all juvenile cats and three mature cats. Conclusions Despite additional information on intra-thoracic lymph nodes in CT images, which can be used to investigate lymphatic-related abnormalities, age, sex, and slice thickness of CT images must be also considered.

A single-center retrospective analysis to evaluate the prognostic role of lymph node density in patients with lymph node-positive cervical cancer.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e17013-e17013
Author(s):  
Arkadius A. Polasik ◽  
Wolfgang Janni ◽  
Christoph Scholz ◽  
Nikolaus De Gregorio ◽  
Fabienne Schochter ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Retrospective Analysis ◽  
Prognostic Role ◽  
Node Density ◽  
Lymph Node Density ◽  
Lymph Node Positive ◽  
Positive Lymph Nodes

e17013 Background: The aim of this retrospective analysis is to evaluate the prognostic role of lymph node density (LND), i.e. the ratio of positive lymph nodes to the total number of lymph nodes removed during surgery, in nodal-positive cervical cancer patients. Methods: Out of 266 patients with cervical cancer that underwent surgery including lymphonodectomy between 2000 and 2017 at the Department for Gynecology and Obstetrics of the University Hospital Ulm, 86 patients with positive lymph nodes were included in the analysis. According to former study results, patients were divided into two groups with LND < 10% vs. ≥ 10%. Univariable and multivariable cox-regression models (adjusted for age, histological subtype, grading, body mass index, R-status, lymphangiosis, histologically confirmed FIGO-status and chemotherapy) were used to evaluate the association between LND and both overall survival (OS) and disease-free survival (DFS). Results: In the 86 patients, a median of 42 lymph nodes were removed (range 11 – 107), and a median of 2 lymph nodes (range 1 – 25) were found positive. 57 (66.3%) patients had a LND < 10% and 29 (33.7%) patients had a LND ≥ 10%. There was no significant association between LND (≥ 10% vs. < 10%) and OS in both univariable (hazard ratio[HR] 1.49, 95% CI 0.72 – 3.07, p = 0.280) and multivariable survival analysis (HR 1.46, 95% CI 0.64 – 3.32, p = 0.372), respectively. However, LND was significantly associated with DFS in univariable analysis (HR 2.11, 95% CI 1.10 – 4.03, p = 0.024) and was found to be an independent predictor for DFS in adjusted multivariable analysis (HR 2.30, 95% CI 1.08 – 4.91, p = 0.031). Conclusions: LND ≥ 10% in patients with lymph node-positive cervical cancer is associated with a worsened DFS compared to patients with a LND < 10%. Thus, LND may be used as an independent prognostic marker and/or for risk stratification in these patients.

scholarly journals Contrast-enhanced endoscopic ultrasound for the differential diagnosis between benign and malignant lymph nodes: a meta-analysis

2019 ◽  
Vol 07 (04) ◽  
pp. E504-E513 ◽  
Author(s):  
Andrea Lisotti ◽  
Claudio Ricci ◽  
Marta Serrani ◽  
Claudio Calvanese ◽  
Sandro Sferrazza ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Lymph Nodes ◽  
Likelihood Ratio ◽  
Endoscopic Ultrasound ◽  
Odds Ratio ◽  
Meta Analysis ◽  
Diagnostic Odds Ratio ◽  
Significant Heterogeneity ◽  
Contrast Enhanced ◽  
Malignant Lymph Nodes

Abstract Background The differential diagnosis between benign and malignant lymph nodes (LNs) is crucial for patient management and clinical outcome. The use of contrast-enhanced endoscopic ultrasound (EUS) has been evaluated in several studies with diverse results. The aim of this meta-analysis was to evaluate the pooled diagnostic accuracy of contrast-enhanced EUS (CE-EUS) and contrast-enhanced harmonic EUS (CH-EUS) in this setting. Methods A systematic electronic search was performed, including all original papers dealing with assessment of the nature of the LNs using CE-EUS or CH-EUS. A meta-analysis was performed to obtain pooled sensitivity, specificity, positive and negative likelihood ratio, and diagnostic odds ratio. The Summary Receiver Operating Characteristic (ROC) Curve method was used to calculate the area under the curve. Statistical analysis was carried out using Meta-Disc V.1.4, Stata V.12.0 and Review Manager V.5.2. Results Among 210 pertinent studies, four (336 patients) were included in the analysis. The pooled sensitivity was 82.1 % (75.1 – 87.7 %) and pooled specificity was 90.7 % (85.9 – 94.3 %) with significant heterogeneity found in sensitivity; the positive-likelihood ratio (LR) was 7.77 (5.09 – 11.85) and the negative-LR was 0.15 (0.05 – 0.46); the pooled diagnostic odds ratio (DOR) was 54 (15 – 190). Subgroup analysis including studies performed using CH-EUS (two studies, 177 LNs) showed a pooled sensitivity of 87.7 % (77.0 – 93.9 %) and a pooled specificity of 91.8 % (84.5 % – 96.4 %) with no significant heterogeneity; the pooled positive-LR was 9.51 (4.95 – 18.28) and the pooled negative-LR was 0.14 (0.06 – 0.35); pooled DOR was 68.42 (15.5 – 301.4). Conclusions From these data, CE-EUS is not recommended due to inadequate sensitivity. On the other hand, CH-EUS studies showed optimal accuracy (pooled sensitivity 87.7 % and specificity 91.8 %), comparable to elastography and even EUS-guided fine needle aspiration (EUS-FNA), suggesting a role in the diagnostic algorithm.

Trans-lymphatic contrast-enhanced ultrasound with sentinel lymph node biopsy for detecting cervical skip metastasis to lymph nodes in early-stage oral tongue squamous cell carcinoma

2021 ◽  
Author(s):  
Jian Huang ◽  
Song-song Wu ◽  
Song Zheng ◽  
Hong Gao ◽  
Zhi-yuan Wu ◽  
...  
Keyword(s):  
Lymph Node ◽  
Sentinel Lymph Node ◽  
Sentinel Lymph Node Biopsy ◽  
Lymph Nodes ◽  
Early Stage ◽  
Lymph Node Biopsy ◽  
Skip Metastasis ◽  
Oral Tongue ◽  
Node Biopsy ◽  
Contrast Enhanced

Objectives: The purpose of this study was to assess whether trans-lymphatic contrast-enhanced ultrasound (CEUS) combined with sentinel lymph node biopsy can be used to assess the status of cervical lymph nodes and skip metastasis in patients with early squamous cell carcinoma (SCC) of the oral tongue. Methods: This study included 21 subjects with early oral tongue SCC who received multiple intramucosal peritumoral injections of Sonazoid. CEUS examinations were performed immediately after Sonazoid injection to identify sentinel lymph nodes (SLNs). The SLNs were excised for histological examination to determine if the lymph nodes has metastases. Results: Thirty-five SLNs were detected by CEUS after Sonazoid injection in the subjects. SLNs were identified in 20 of the total 21 subjects. Four participants had metastasis to lymph nodes, and one had skip metastasis in level Ⅲ. In one subject, SLNs were successfully detected in level Ⅳ without skip metastasis. Conclusions: Trans-lymphatic CEUS combined with sentinel lymph node biopsy showed high accuracy for evaluating cervical lymph node status. This could be a reliable approach for detecting cervical skip metastases of lymph nodes in early-stage oral cancer patients.

Endoscopic Ultrasound Features Associated with Malignancy and Aggressiveness of Nonhypovascular Solid Pancreatic Lesions: Results from a Prospective Observational Study

2019 ◽  
Author(s):  
Stefano Francesco Crinó ◽  
Alessandro Brandolese ◽  
Filippo Vieceli ◽  
Salvatore Paiella ◽  
Maria Cristina Conti Bellocchi ◽  
...  
Keyword(s):  
Observational Study ◽  
Lymph Nodes ◽  
Endoscopic Ultrasound ◽  
Prospective Observational Study ◽  
Distant Metastases ◽  
Cross Sectional ◽  
Surgical Specimen ◽  
Contrast Enhanced ◽  
Cross Sectional Imaging ◽  
Tissue Acquisition

Abstract Background and Study Aims On contrast-enhanced imaging studies, nonhypovascular (i. e., isovascular and hypervascular) patterns can be observed in solid pancreatic lesions (SPLs) of different nature, prognosis, and management. We aimed to identify endoscopic ultrasound (EUS) features of nonhypovascular SPLs associated with malignancy/aggressiveness. The secondary aims were EUS tissue acquisition (EUS-TA) outcome and safety in this setting of patients. Patients and Methods This prospective observational study included patients with nonhypovascular SPLs detected on cross-sectional imaging and referred for EUS-TA. Lesion features (size, site, margins, echotexture, vascular pattern, and upstream dilation of the main pancreatic duct) were recorded. Malignancy/aggressiveness was determined by evidence of carcinoma at biopsy/surgical pathology, signs of aggressiveness (perineural invasion, lymphovascular invasion, and/or microscopic tumor extension/infiltration or evidence of metastatic lymph nodes) in the surgical specimen, radiologic detection of lymph nodes or distant metastases, and/or tumor growth > 5 mm/6 months. Uni- and multivariate analyses were performed to assess the primary aim. Results A total of 154 patients with 161 SPLs were enrolled. 40 (24.8 %) lesions were defined as malignant/aggressive. Irregular margins and size > 20 mm were independent factors associated with malignancy/aggressiveness (p < 0.001, OR = 5.2 and p = 0.003, OR = 2.1, respectively). However, size > 20 mm was not significant in the subgroup of other-than-neuroendocrine tumor (NET) lesions. The EUS-TA accuracy was 92 %, and the rate of adverse events was 4 %. Conclusion Irregular margins on EUS are associated with malignancy/aggressiveness of nonhypovascular SPLs. Size > 20 mm should be considered a malignancy-related feature only in NET patients. EUS-TA is safe and highly accurate for differential diagnosis in this group of patients.

scholarly journals Adding contrast-enhanced ultrasound markers to conventional axillary ultrasound improves specificity for predicting axillary lymph node metastasis in patients with breast cancer

2020 ◽  
pp. 20200874
Author(s):  
Li-Wen Du ◽  
Hong-Li Liu ◽  
Hai-Yan Gong ◽  
Li-Jun Ling ◽  
Shui Wang ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Axillary Lymph ◽  
Breast Cancer Patients ◽  
Axillary Ultrasound ◽  
Contrast Enhanced ◽  
Conventional Ultrasound ◽  
Maximum Signal Intensity ◽  
Better Than ◽  
Ultrasound Features

Objective: To evaluate the diagnostic performance of contrast-enhanced ultrasound (CEUS) combined with conventional ultrasound of axillary lymph nodes (ALNs) in predicting metastatic ALNs in patients with breast cancer. Methods: This retrospective study included 259 patients with breast cancer who underwent conventional ultrasound and CEUS. The parameters and patterns evaluated on conventional ultrasound included short axis diameter (S), long axis/short axis (L/S) ratio, cortical thickness, resistive index (RI), lymph node (LN) morphology of greyscale ultrasound, hilum and vascular pattern. Meanwhile, enhancement pattern, wash-in time, time to peak (TP), maximum signal intensity, and duration of contrast enhancement were evaluated on CEUS. Univariate and multiple logistic regression analyses were performed to identify independent factors of ALN status. Three models (conventional ultrasound, CEUS, and combined parameters) were established. Receiver operating characteristic (ROC) curves were applied to evaluate the accuracy of the three predictive models. Results: On conventional axillary ultrasound, LN morphology and vascular pattern were independent factors in predicting metastatic ALNs. On CEUS, maximum signal intensity, duration of contrast enhancement, and TP were independent factors in predicting metastatic ALNs. When combining conventional ultrasound and CEUS features, five independent factors obtained from the conventional ultrasound and CEUS were associated with ALN status. ROC curve analysis showed that the use of CEUS markers combined with conventional ultrasound features (AUC = 0.965) was superior to the use of CEUS markers (AUC = 0.936) and conventional ultrasound features alone (AUC = 0.851). Conclusion: Combining conventional ultrasound and CEUS features can enable discrimination of ALN status better than the use of CEUS and conventional ultrasound features alone. Advances in knowledge: The axillary lymph node status in breast cancer patients impacts the treatment decision. Our ultrasonic data demonstrated that CEUS features of ALNs in breast cancer patients could be image markers for predicting ALN status. Combining conventional ultrasound and CEUS features of ALNs can improve specificity discrimination of ALN status better than the use of CEUS and the conventional ultrasound features alone, which will help the treatment planning optimization.

scholarly journals Meta-analysis of contrast-enhanced ultrasound and contrast-enhanced harmonic endoscopic ultrasound for the diagnosis of gallbladder malignancy

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Xue Liang ◽  
Xiang Jing
Keyword(s):  
Sensitivity And Specificity ◽  
Endoscopic Ultrasound ◽  
Meta Analysis ◽  
High Sensitivity ◽  
Accurate Method ◽  
Contrast Enhanced Ultrasound ◽  
Summary Receiver Operating Characteristic ◽  
Contrast Enhanced ◽  
Heterogeneous Enhancement ◽  
Gallbladder Malignancy

Abstract Background The diagnosis between benign and malignant gallbladder lesions is sometimes difficult. The objective of this study is to assess whether contrast-enhanced ultrasound (CEUS) and contrast-enhanced harmonic endoscopic ultrasound (CH-EUS) can be an accurate method for detecting gallbladder malignancy and to determine which imaging signs can be indicative of malignancy. Methods A study search of PubMed, Elsevier, and Sciencedirect was performed in May 2019. The pooled sensitivity, specificity, diagnostic odds ratio (DOR), and summary receiver operating characteristic (SROC) curve were used to examine the accuracy of CEUS and CH-EUS. Results Twenty-one studies were included in the meta-analysis. The pooled sensitivities of CEUS and CH-EUS were 0.81 (0.75–0.86) and 0.92 (0.86–0.95); the specificities were 0.94 (0.90–0.96) and 0.89 (0.69–0. 97); the DORs were 64 (32–127) and 89 (22–354); and the area under the SROC curves were 0.90 (0.87–0.92) and 0.92 (0.90–0.94). On CEUS, the diagnostic criterion for gallbladder malignancy according to four features were analyzed. Sensitivity and specificity were 0.75 (0.65–0.83) and 0.98 (0.85–1.00) for integrity of gallbladder wall; 0.69 (0.55–0.81) and 0.89 (0.77–0.95) for heterogeneous enhancement; 0.81 (0.71–0.88) and 0.88 (0.76–0.94) for irregular vessels; and 0.81 (0.66–0.91) and 0.75 (0.59–0.86) for washout time within 28 s. On CH-EUS, heterogeneous enhancement could be indicative of malignant lesions with a sensitivity of 0.94 (0.85–0.97); and the specificity was 0.92 (0.71–0.98). Conclusions CEUS and CH-EUS are promising and reliable imaging modalities with a high sensitivity and specificity for the diagnosis of gallbladder malignancy. CH-EUS might be more sensitive than CEUS with a higher sensitivity. In addition, irregular tralesional vessels and washout time within 28 s on CEUS and heterogeneous enhancement on CH-EUS are indicative of malignancy. However, larger scale and well-designed studies are warranted to verify our results.

scholarly journals Endoscopic ultrasound in the diagnosis of mediastinal diseases

Open Medicine ◽  
2015 ◽  
Vol 10 (1) ◽  
Author(s):  
Zhiguo Wang ◽  
Chunmeng Jiang
Keyword(s):  
Lung Cancer ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Endoscopic Ultrasound ◽  
Mediastinal Lymph Node ◽  
Lymph Node Status ◽  
Mediastinal Lymph Nodes ◽  
Mediastinal Diseases ◽  
Mediastinal Lymphoma ◽  
Tissue Acquisition

AbstractEUS is a useful tool for diagnosis of mediastinal diseases. EUS-FNA plays an important role in staging of lung cancer and in tissue acquisition in patients with mediastinal masses. In this review, the following issues will be addressed: EUS-FNA and EBUS-TBNA, metastatic mediastinal lymph nodes diagnosed by EUS, EUS in assessment of mediastinal lymph node status for staging of lung cancer, mediastinal lymphoma diagnosed by EUS, sarcoidosis and tuberculosis diagnosed by EUS.

Radiologic Appearance of Nonpalpable Intramammary Lymph Nodes

1993 ◽  
Vol 34 (6) ◽  
pp. 577-580 ◽  
Author(s):  
G. Svane ◽  
S. Franzén
Keyword(s):  
Lymph Node ◽  
Lymph Nodes ◽  
Central Area ◽  
Great Majority ◽  
The Other ◽  
Low Density ◽  
Peripheral Part ◽  
Outer Quadrant ◽  
Nonpalpable Lesions

Sixty-four well circumscribed nonpalpable lesions, mammographically evaluated as benign and cytomorphologically verified as lymph nodes, were studied concerning mammographic appearance, size and location within the breast. The great majority, 72%, were situated within the upper-outer quadrant, but lymph nodes were also diagnosed in other areas of the breast. Of the verified lymph nodes 50 (78%) had a lower density at the center than at the periphery. These were the only well circumscribed nodules with a low density center observed in a total of 3 623 nonpalpable lesions stereotaxically needled during the same period. Three of the lymph nodes were verified histopathologically. Till now, none of the other 61 lesions has turned out to be a malignant tumor during a follow-up time from 9 to 15 years. Thus a lesion presenting roentgenologically as a well circumscribed nodule with a central area of decreased density compared to the peripheral part can be confidentially diagnosed as a lymph node by the mammograms alone and no further investigation is indicated.

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