The place of CEUS in distinguishing benign from malignant cervical lymph nodes: a prospective study

Abstract Aims: The aim of the study was to evaluate the ability of contrast-enhanced ultrasonography (CEUS) compared to grayscale B-mode and color Doppler ultrasound in differentiate benign versus malign superficial cervical lymph nodes. Material and methods: In a prospective study ultrasonography (gray scale, color and spectral Dopller, and CEUS) was performed in 61 patients (33 men, 28 women; mean age of 51.2 years, range: 18-81 years), with cervical lymphadenopathy. The nodes were examined and biopsied or surgically removed. CEUS was performed with 2.4 ml intravenous bolus of contrast agent Sono Vue and the results were registered with a special software. Results: Of all the nodes, 32 were benign and 29 were malignant (metastases). Solbiati index was higher in benign nodes (2.23 ± 0.84 vs 1.50 ± 0.48, p<0.05). Doppler parameters (vessel location, vascular pattern, pedicullum number, resistivity index, and pulsatility index) were significantly lower in benign nodes (p<0.001), and ROC analysis returned excellent results. For CEUS, derived peak intensity (DPI %) was higher in benign nodes (17.72 ± 5.43 vs 11.76 ± 4.88, p<0.05); regional blood volume (RBV) was also higher (849.8 ± 467.1 vs 458.3 ± 283.3, p<0.05). The time to peak (TTP, s) and area under the curve (AUC, cm2) were similar in both benign and malignant nodes. Enhancement pattern was the most accurate to characterize benign versus malignant nodes. Sensitivity and specificity were higher for DPI, RBV and enhancement pattern from CEUS, according to ROC analysis, compared to gray scale ultrasound, but lower than color Doppler. Analyzing the place of CEUS in lymph node evaluation we found that CEUS is most useful for the evaluation of the lymph nodes with uncertain aspect at gray scale and Doppler evaluation. Conclusions: ROC analysis confirmed the higher degree of diagnostic accuracy of CEUS in comparison with conventional techniques for some parameters such as enhancement pattern. Evaluation of nodal perfusion with this method can be helpful in the differentiation of benign from malignant nodes but requires further confirmation

The place of CEUS in distinguishing benign from malignant cervical lymph nodes: a prospective study

Abstract Aims: The aim of the study was to evaluate the ability of contrast-enhanced ultrasonography (CEUS) compared to grayscale B-mode and color Doppler ultrasound in differentiate benign versus malign superficial cervical lymph nodes. Material and methods: In a prospective study ultrasonography (gray scale, color and spectral Dopller, and CEUS) was performed in 61 patients (33 men, 28 women; mean age of 51.2 years, range: 18-81 years), with cervical lymphadenopathy. The nodes were examined and biopsied or surgically removed. CEUS was performed with 2.4 ml intravenous bolus of contrast agent Sono Vue and the results were registered with a special software. Results: Of all the nodes, 32 were benign and 29 were malignant (metastases). Solbiati index was higher in benign nodes (2.23 ± 0.84 vs 1.50 ± 0.48, p<0.05). Doppler parameters (vessel location, vascular pattern, pedicullum number, resistivity index, and pulsatility index) were significantly lower in benign nodes (p<0.001), and ROC analysis returned excellent results. For CEUS, derived peak intensity (DPI %) was higher in benign nodes (17.72 ± 5.43 vs 11.76 ± 4.88, p<0.05); regional blood volume (RBV) was also higher (849.8 ± 467.1 vs 458.3 ± 283.3, p<0.05). The time to peak (TTP, s) and area under the curve (AUC, cm2) were similar in both benign and malignant nodes. Enhancement pattern was the most accurate to characterize benign versus malignant nodes. Sensitivity and specificity were higher for DPI, RBV and enhancement pattern from CEUS, according to ROC analysis, compared to gray scale ultrasound, but lower than color Doppler. Analyzing the place of CEUS in lymph node evaluation we found that CEUS is most useful for the evaluation of the lymph nodes with uncertain aspect at gray scale and Doppler evaluation. Conclusions: ROC analysis confirmed the higher degree of diagnostic accuracy of CEUS in comparison with conventional techniques for some parameters such as enhancement pattern. Evaluation of nodal perfusion with this method can be helpful in the differentiation of benign from malignant nodes but requires further confirmation

Comparative multivariate analyses of transient otoacoustic emissions and distorsion products in normal and impaired hearing

ABSTRACT:Background &amp; aim: The clinical utility of otoacoustic emissions as a noninvasive objective test of cochlear function has been long studied. Both transient otoacoustic emissions and distorsion products can be used to identify hearing loss, but the extent that they can be used as predictors for hearing loss is still debated. Most studies agree that multivariate analyses have better test performances than univariate analyses. The study aims to determine transient otoacoustic emissions and distorsion products performance in identifying normal and impaired hearing loss, using the pure tone audiogram as a gold standard procedure and different multivariate statistical approaches.Patients and methods: The study included 105 adult subjects with normal hearing and hearing loss that underwent the same test battery: pure-tone audiometry, tympanometry, otoacoustic emission tests. We chose to use the logistic regression as a multivariate statistical technique. Three logistic regression models were developped to characterize the relations between different risk factors (age, sex, tinnitus, demographic features, cochlear status defined by otoacoustic emissions) and hearing status defined by pure-tone audiometry. The multivariate analyses allow the calculation of the logistic score, which is a combination of the inputs, weighted by coefficients, calculated within the analyses. The accuracy of the each model was assessed using receiver operating characteristics curve analysis. We used the logistic score to generate receivers operating curves curves and to estimate the areas under the curves in order to compare different multivariate analyses.Results: Each of the three multivariate analyses provides high values of the area under the curves. Each otoacoustic emission test presents small differences for the value of the area under the curve, but transient otoacoustic emissions seems to be the most powerful predictive for the hearing level for the right ear and distorsion products for the left ear. Adding demographic variables, the value of the area under the curve is similar for both ears, but we found out that tinnitus is a strong predictive variable only for the left ear. Our multivariate analyses revealed that age is a predictor factor of the auditory status for both ears. In our study, gender had no predictive value for hearing level in any of the multivariate analyses. Our study also confirms that the combination of age and distorsion products can better predict hearing level than distorsion products alone. We have found out that the otoacoustic emissions tests have improved performance for both ears when using the multivariate analysis which combines transient otoacoustic emissions and distortion products data.Conclusion: Like any other audiological test, using otoacoustic emissions to identify hearing loss is not without error. Even when applying multivariate analysis, perfect test performance is never achieved. Although most studies demonstrated the benefit of using the multivariate analysis, it has not been incorporated into clinical decisions maybe because of the idiosyncratic nature of multivariate solutions or because of the lack of the validation studies.Key words: otoacoustic emissions, multivariate analyses, logistic regression, hearing loss, receiver operating curves.</jats:p