| Objective: To explore the value of conventional ultrasound,ultrasound elastography including strain elastography(SE),virtual touch tissue imaging(VTI)and virtual touch tissue quantification(VTQ)in the differential diagnosis of superficial enlarged lymph nodes and the correlation between conventional ultrasound imaging features,ultrasound parameters and expression of Ki67.Methods: From March 2017 to August 2018,93 superficial enlarged lymph nodes confirmed by pathology were collected from 90 patients who underwent conventional ultrasound and ultrasound elastography before ultrasound-guided biopsy or surgery in the First Hospital of Lanzhou University.According to the pathological results,there were 23 benign lymph nodes,55 metastatic lymph nodes and 15 lymphomas.The diagnostic value of conventional ultrasound and ultrasound elastograpyh in superficial enlarged lymph nodes and the correlation between conventional ultrasound imaging features,ultrasound parameters and expression of Ki67 were analyzed retrospectively.Results:1.The sensitivity,specificity,accuracy and Youden index of conventional ultrasound in differentiating benign and malignant superficial enlarged lymph nodes were 78.6%,69.6%,76.3% and 0.481,respectively.In conventional ultrasound,short-axis diameter,the ratio of the long-axis diameter to short-axis diameter,the resistance index of blood flow,whether mixed or peripheral blood flow,whether lymphatic hilum disappears or not were significantly correlated with the benign and malignant lymph nodes.The sensitivity,specificity and Youden index for differential diagnosis of benign and malignant lymph nodes were 74.3%,78.3%,0.525,80.0%,65.2%,0.452,56.9%,77.8% and 0.347,respectively,when the short-axis diameter was 11.75 mm,the ratio of long-axis diameter to short-axis diameter was 1.808,and the resistance index of blood flow was 0.715.Routine ultrasonography showed that there were significant differences in the proportion of mixed or peripheral blood flow between benign and malignant lymph nodes,and whether lymphatic hilum disappeared or not.However,there was no significant difference between benign and malignant lymph nodes in the presence of normal cortical echoes.2.The best VTQ value for differentiating benign and malignant lymph nodes was 2.329m/s.The sensitivity,specificity,accuracy and Youden index were 88.6%,82.6%,87.1% and 0.712,respectively.The area under receiver operating characteristic(ROC)curve was 0.900.2.1 The best VTQ value to distinguish benign lymph nodes from metastatic lymph nodes was 2.467m/s.The sensitivity,specificity and Youden index were 85.5%,87.0% and 0.724,respectively.The area under the ROC curve was 0.913.2.2 The best VTQ value to distinguish benign lymph nodes from lymphomas was 2.351m/s.The sensitivity,specificity and Youden index were 86.7%,82.6% and 0.693,respectively.The area under the ROC curve was 0.852.2.3 There was no significant difference in VTQ between lymphomas and metastatic lymph nodes.3.The best VTI value for differentiating benign and malignant lymph nodes was 3.5.The sensitivity,specificity,accuracy and Youden index were 75.7%,82.6%,77.4% and 0.583,respectively.The area under ROC curve was 0.838.3.1 The best VTI value for differentiating benign and metastatic lymph nodes was 3.5.The sensitivity,specificity and Youden index were 90.9%,82.6% and 0.735,respectively.The area under the ROC curve was 0.879.3.2 There was no significant difference in VTI score between benign lymph nodes and lymphomas.3.3 The best VTI value for differentiating metastatic lymph nodes and lymphomas was 3.5.The sensitivity,specificity and Youden index were 90.9%,80.0% and 0.709,respectively.The area under the ROC curve was 0.863.4.The best threshold value of strain elastography in differentiating benign and malignant lymph nodes was 2.5.The sensitivity,specificity,accuracy and Youden index were 87.1%,78.3%,84.9% and 0.654,respectively.The area under ROC curve was 0.893.4.1 The best threshold value of strain elastography in differentiating benign and metastatic lymph nodes was 2.5.The sensitivity,specificity,accuracy and Youden index were 83.6%,78.3% and 0.619,respectively.The area under the ROC curve was 0.888.4.2 The best threshold value of strain elastography in differentiating benign lymph nodes and lymphomas was 2.5.The sensitivity,specificity,accuracy and Youden index were 100%,78.3% and 0.783,respectively.The area under the ROC curve was 0.913.4.3There was no significant difference in strain elastography score in differentiating metastatic lymph nodes from lymphomas(P>0.05).5.The expression of Ki67 in malignant lymph nodes was significantly higher than that in benign lymph nodes(Z=-2.486,P =0.013).The expression of Ki67 was positively correlated with the size of long-axis diameter,short-axis diameter,cortical thickness,peripheral or mixed blood flow and VTQ in two-dimensional ultrasound images.The R values were 0.244,0.384,0.511,0.350,0.328,and the P values were 0.018,0.000,0.000,0.001 and 0.001,respectively.However,the blood resistance index,VTI score,strain elastography score,normal cortical echoes,disappearance of lymphatic hilum,clear boundary and the ratio of long-axis diameter to short-axis diameter of lymph nodes were not correlated with the expression of Ki67(P>0.05).Conclusion:1.In conventional ultrasound the size of short-axis diameter,the ratio of long-axis diameter to short-axis diameter,blood flow resistance index,whether lymphatic hilum disappears,whether peripheral or mixed blood flow are helpful in differentiating benign from malignant lymph nodes.Ultrasonography of malignant lymph nodes shows enlargement of short-axis diameter,round shape,disappearance or eccentricity of lymphatic hilum,peripheral or mixed blood flow,and high resistance index of blood flow.In traditional ultrasound,the benign lymph nodes are oval,the lymphatic hilum is hyperechoic,the cortex and medulla are clearly demarcated,the cortex can be uniformly thickened,showing lymphatic hilum blood flow or no blood flow,and the resistance of blood flow is low.2.Ultrasound elastography is helpful in differentiating benign from malignant lymph nodes.VTQ can be used to differentiate benign and malignant lymph nodes.The sensitivity,specificity and Youden index of diagnosis are higher than those of conventional ultrasound.VTQ can be used to differentiate benign lymph nodes from metastatic lymph nodes,benign lymph nodes from lymphomas,but it can not differentiate metastatic lymph nodes from lymphomas.VTI can be used to differentiate benign lymph nodes from malignant lymph nodes,benign lymph nodes from metastatic lymph nodes,metastatic lymph nodes from lymphomas,but it can not differentiate benign lymph nodes from lymphomas.Strain elastography score can effectively differentiate benign from malignant lymph nodes.Strain elastography score can be used to differentiate benign lymph nodes from metastatic lymph nodes,benign lymph nodes from lymphomas,but it can not differentiate metastatic lymph nodes from lymphomas.3.The expression of Ki67 in lymph nodes is correlated with the benign or malignant nature of lymph nodes.Ki67 expression in malignant nodes is higher.In two-dimensional ultrasound images,the size of long-axis diameter,the size of short-axis diameter,cortical thickness,peripheral or mixed blood flow and VTQ value are positively correlated with the expression of Ki67.These parameters measured by ultrasound are expected to reflect the value-added status of leukomonocytes in a non-invasive way and indirectly judge the disease development direction and prognosis of patient. |
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