Tunneled Uncuffed Pigtail Drainage Catheter Placement in Patients with Refractory Ascites or Pleural Effusion: A Single-Center Experience.

PURPOSE: No evidence exists to support the use of tunneled non-cuffed pigtail drainage catheters in patients with refractory ascites or pleural effusion. The purpose of this study was to determine the feasibility of non-cuffed tunneled pigtail drainage catheters in patients with refractory ascites or pleural effusions. MATERIALS AND METHODS: Between October 5, 2020 and May 25, 2021, 34 pigtail catheters were implanted in 27 patients (17 males, 10 females; average age: 65.66 ± 12.04 years) under either ultrasound or computed-tomography guidance (19 catheters for ascites, 15 catheters for pleural effusion). Twenty-eight catheters (82.35%) were implanted for malignant etiologies, and 6 catheters (17.65%) were implanted for benign etiologies. The catheters (size: 8-14 French) were implanted through a subcutaneous tunnel. Complication rate and factors related to complications were analyzed. Catheter lifetime was analyzed with Kaplan-Meier method. RESULTS: Patency ranged from 3 to 211 days. None of the patients experienced a major complication (e.g., peritonitis and empyema). Meanwhile, 8 minor complications were observed including 3 catheter occlusion, 3 ascites leakage, 1 peri-catheter local skin infection, 1 peri-catheter local skin reaction. None of the etiologies were related to the catheter complications. However, the 8-F catheter was associated with a significantly higher complication rate (odds = 5.5, p = 0.044). The estimated mean [CI] dwelling time of a catheter was 59.18 [32.97, 85.39] days. CONCLUSIONS: Image-guided insertion of tunneled peritoneal or pleural pigtail external drainage catheters achieved with a 100% technical success rate and resulted in an acceptable complication rate and catheter lifetime for the management of refractory ascites or pleural effusion.

The effect of chemotherapy type and timing among the other factors on patency of totally implantable vascular access devices in colorectal carcinoma.

PURPOSE: Catheter-related complications are observed in infusion of chemotherapy, and these were encountered with targeted therapies. Our principle is to study non-mechanical effects of type and initiation time of chemotherapy among the other factors on patency of totally implantable vascular access devices (TIVAD) inserted in patients with colorectal carcinoma. METHODS: This is a one-center retrospective cohort study. We analyzed TIVAD related complications in 624 patients with colorectal carcinoma. The patients were categorized by chemotherapy type (non-target-directed chemotherapy agents (Group A), bevacizumab (Group B), and cetuximab (Group C)). Additionally, we divided the patients into groups by the time interval between TIVAD insertion and chemotherapy initiation. According to our study, a 3-day period was optimal. Therefore, we named the groups as within 3 days and beyond 3 days, and called this process 3 days cut-off. Age, gender, jugular-subclavian access, platelet count, INR, the types of chemotherapy, and the initiation time of chemotherapy were investigated by survival tests. We compared chemotherapy type groups both one-by-one and combined into one group. RESULTS: The TIVADs were removed due to the complications in 11 patients of Group A, 6 patients of Group B, and 3 patients of Group C. Only chemotherapy type was significant (p = 0.011) in Cox regression test. A clear difference (p = 0.010) was detected between the catheter patency of Group A and combination of Groups B and C, because of skin necrosis and thrombosis. Within 3 days of their first chemotherapy day, an important difference between Group A and Group C (p = 0.013) was observed in the TIVAD patency. The same observation was made between Group A and Group B (p = 0.007). Beyond this period, no major difference was detected (p = 0.341). CONCLUSION: A major effect on catheter patency was detected by using the target-directed chemotherapy agent within 3 days, which should be considered in target-directed chemotherapy.

The importance of diffusion apparent diffusion coefficient values in the evaluation of soft tissue sarcomas after treatment.

PURPOSE: In our study, we aimed to show the efficiency of diffusion-weighted images at different b-values and apparent diffusion coefficient (ADC) values in the differentiation of recurrent tumours from post-treatment tissue changes. MATERIAL AND METHODS: The conventional and diffusion magnetic resonance images (MRIs) of 42 patients operated for soft tissue sarcomas between June 2012 and March 2015 followed up with MRIs that were evaluated by 2 radiologists retrospectively. Diffusion MRIs were acquired at 4 different b-values (50, 400, 800, 1000 s/mm2). The lesions were classified according to conventional MRI findings as post-treatment changes and recurrent tumours. RESULTS: When the patient group with recurrent tumours was compared with the patient group with postoperative changes the ADC calculations were statistically significantly lower for the recurrent tumours at all b-levels (p < 0.001 for all b-levels). The sensitivity of b-50 values lower than 3.01 × 103 mm2/s in showing recurrent tumours was 100% and the specificity was 77.78%. The sensitivity of b-400 values lower than 2.1 × 103 mm2/s in showing recurrent tumours was 80% and the specificity was 96.3%. The sensitivity of b-800 values lower than 2.26 × 103 mm2/s in showing recurrent tumours was 100% and the specificity was 88.89%. The sensitivity of b-1000 values lower than 2 × 103 mm2/s in showing recurrent tumours was 93.3% and the specificity was 92.5%. CONCLUSIONS: The ADC values obtained from diffusion-weighted images have high sensitivity and specificity in differentiating recurring soft tissue sarcomas during monitoring after treatment from postoperative changes.

Radiologic Findings of a Rare Subtype of Invasive Breast Cancer with Poor Prognosis: Metaplastic Carcinoma of the Breast.

BACKGROUND AND OBJECTIVES: The purpose of this study was to evaluate the mammographic, sonographic and MRI findings of metaplastic breast carcinoma. METHODS: In this retrospective review study, we analyzed the medical files of 9600 patients who were treated for invasive breast cancers. Clinical information, histopathologic and radiologic findings of 65 patients were included in this study. All existing radiologic images and medical reports were reviewed retrospectively. Thirty-three patients had MG, 58 patients had US and 7 patients had MRI imaging results. RESULTS: Mammographically, the most frequent presentations of MPBC were round shape, microlobulated margin and high density masses. Calcifications with or without masses were not a frequent finding. The most common sonographic findings were round shape, partially indistinct angular margin, hypoechoic and heterogeneous echo patterns and no posterior feature masses. All lesions were presented as masses rather than non-mass enhancements on magnetic resonance imaging. Features of masses had more malignant feature on MRI than other modalities in all 7 patients. CONCLUSION: Metaplastic breast carcinoma is one of the rarest poorly differentiated invasive breast carcinomas. Interestingly, these aggressive tumors demonstrate benign or moderately malign features on imaging methods. This appearance of MPBC can cause it to be misdiagnosed as a benign breast lesion especially in young women. MPBC should be kept in mind in the differential diagnosis of large palpable breast masses. Therefore, follow-up at short intervals and/or multimodality imaging studies which include breast MRI are important for the diagnosis of MPBC.

Is there any relationship between adc values of diffusion-weighted imaging and the histopathological prognostic factors of invasive ductal carcinoma?

OBJECTIVE: MRI is being used increasingly as a modality that can provide important information about breast cancer. Diffusion-weighted imaging (DWI) is an imaging technique from which apparent diffusion coefficient (ADC) values can be calculated in addition to obtaining important structural information which cannot be obtained from other imaging studies. We did not find any significant relationships between ADC values and prognostic factors, but did provide some explanations for conflicting results in the literature. METHODS: The ADC results of 61 females with invasive ductal carcinomas were evaluated. DWI was performed and ADC values were calculated from the area in which restriction of diffusion was the highest in ADC mapping. B value was 500 and region of interest (ROI) was designated between 49 and 100 mm2. Calculations were performed automatically by the device. Tissue samples were obtained for prognostic factor evaluation. The relationships between ADC and prognostic factors were investigated. Comparisons between groups were made with one-way ANOVA and Kruskal Wallis test. Pairwise comparisons were made with Dunn's test. Analyses of categorical variables were made with Chi-square test. RESULTS: We found a weak negative correlation between ADC and Ki-67 values (r = -0.279; p = 0.029). When we compared ADC values in regard to tumour type, we found no significant differences for tumour grade, Ki-67 positivity, estrogen receptor positivity, progesterone receptor positivity, C-erb B2, lymphovascular invasion and ductal carcinoma in situ or lobular carcinoma in situ component. On a side note, we found that mean ADC values decreased as tumour grade increased; however, this was not statistically significant. CONCLUSION: The literature contains studies that report conflicting results which may be caused by differences in B values, ROI area and magnetic field strength. Multicentre studies and systematic reviews of these findings may produce crucial data for the use of DWI in breast cancer. Advances in knowledge: To determine if any significant relationship exists between DWI findings and prognostic factors of breast cancer.

Diffusion weighted magnetic resonance imaging in the diagnosis of parotid masses. Preliminary results.

OBJECTIVE: To demonstrate the diagnostic potentials of MRI, diffusion weighted imaging (DWI), and apparent diffusion coefficient (ADC) mapping in the detection of parotid masses correlated to the histopathological results. Methods: Study design was retrospective. Fifteen patients with parotid gland masses were included as the study group and contralateral normal parotis glands of same patients were taken as the control group. Patients with bilateral parotid gland tumors were excluded, 7 right-sided and 8 left-sided parotid masses were included in the research. The study took place at the Department of Radiology, Ankara, Turkey, between May 2012 and September 2014. Results: Apparent diffusion coefficient measurements of 15 parotis tumors in 1000 and 750 sec/mm2 b-values with comparison to the contralateral normal gland  parenchyma were demonstrated. Neurofibromas was predicted as the highest, and lipomas as the lowest ADC values. Pleomorphic adenomas, Warthin's tumor, and normal parotid parenchyma indicate significant statistical differences from each other on the basis of mean ADC values (p less than 0.05). Conclusion: The DWI and ADC mapping of parotis gland could aid in the differential diagnosis  of benign and malignant masses.

Diagnostic value of diffusion-weighted magnetic resonance imaging: differentiation of benign and malignant lymph nodes in different regions of the body.

INTRODUCTION: To evaluate the value of diffusion-weighted magnetic resonance imaging compared with conventional magnetic resonance imaging (C-MRI) for the differentiation of benign from malignant lymph nodes in different regions of the body. PATIENTS AND METHODS: A total of 31 patients ranging in age from 18 to 75 years (mean age: 53 years) were included in this study. The patients were examined using a 1.5-T magnetic resonance imaging system with coils chosen according to lymph node locations. Diffusion-weighted images were obtained using the single-shot echo planar sequence and had b values of 50, 500, and 1000 s/mm(2.) The apparent diffusion coefficient (ADC) values were measured from ADC maps. The correlation between the pathological diagnoses and mean ADC values in the benign and malignant lymph node groups were compared using the Mann-Whitney U-test with Bonferroni correction. Receiver operating characteristic (ROC) analysis was performed to evaluate the diagnostic performance of the method. RESULTS: The mean ADC value for benign lymph nodes was 0.97×10(-3) mm(2)/s (range: 0.6-1.2×10(-3) mm(2)/s), and the mean ADC value for malignant lymph nodes was 0.76×10(-3) mm(2)/s (range: 0.3-1.2×10(-3) mm(2)/s) (P<.001). In ROC analysis, the cut-off ADC value for malignant versus benign lymph node differentiation was 0.8×10(-3) mm(2)/s. Using an ADC value of 0.8×10(-3) mm(2)/s, the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of the method for differentiating between benign and malignant lymph nodes were 76.4%, 85.7%, 86.6%, 75%, and 80.6%, respectively. The sensitivity, specificity, PPV, NPV, and accuracy of C-MRI were 88.2%, 78.5%, 83.3, 84.6%, and 83.8%, respectively. The sensitivity, specificity, PPV, NPV, and accuracy of C-MRI findings suspicious for malignancy combined with the ADC values were 76.4%, 64.2%, 100%, 81.8%, and 91.6%, respectively. CONCLUSIONS: C-MRI alone remained superior to diffusion-weighted imaging (DWI) and combination C-MRI and DWI for differentiating malignant from benign lymph nodes; however, DWI and ADC calculation may play a role in lymph node characterization.

MRI analysis of coracohumeral interval width and its relation to rotator cuff tear.

OBJECTIVE: Coracoid impingement is an uncommon cause of the shoulder pain. It is stimulated by adduction, internal rotation and forward flexion. These positions decrease the width of the coracohumeral interval. Owing to restriction of movement, rotator cuff tendons may be overloaded. Thus, in this study, we aimed to determine whether coracoid impingement increase the tendency of rotator cuff tears. MATERIALS AND METHODS: Routine clinical MRI sequences of 117 shoulders were reviewed, and axial coracohumeral interval measurements were taken. Rotator cuff tendon integrity was evaluated. Relation between rotator cuff tear and coracohumeral interval width was commented statically. RESULTS: Seventy-nine of the patients were women, 38 of them men. The average age was 44.8 ± 14.2 (14-75). The mean age of patients with rotator cuff tear was significantly higher than patients without tear (p = 0.001). The mean value of coracohumeral interval width was 8.853 ± 2.491 mm (min: 2.9-max: 15.8). There were no significant differences between coracohumeral interval width of women and men (p = 0.139). The mean value of coracohumeral interval width with rotator cuff tear was 8.362 ± 2.382, and without tear was 9.351 ± 2.520. There was a significant differences between them (p = 0.031). CONCLUSION: According to our study, there was a relationship between coracohumeral interval width and rotator cuff tear, so decreasing coracohumeral interval width may increase tendency of rotator cuff tear.

Midgut malrotation presenting with left-sided acute appendicitis and CT inversion sign.

In patients presenting with abdominal pain, appendicitis is the most common surgical disorder. Appendicitis causing pain in the left lower quadrant is extremely rare and can occur with congenital abnormalities that include true left-sided appendix or as an atypical presentation of right-sided long appendix, which projects into the left lower quadrant. We report a case of a 69-year-old man showing midgut malrotation with acute appendicitis presenting as left lower quadrant abdominal pain.

Assessment of hepatic steatosis on contrast enhanced computed tomography in patients with colorectal cancer.

AIMS: Non-alcoholic fatty liver disease is often seen in patients with colorectal cancer. Insulin resistance and metabolic syndrome are related to increased risk of colorectal cancer. The aim of this study was to quantitatively determine the relationship between non-alcoholic fatty liver disease and colorectal cancer with the examination of routine abdominopelvic computed tomography images taken for staging. METHODS: A retrospective evaluation was made of the colonoscopy and histopathology reports of 1630 patients who presented for a scanning or diagnostic colonoscopy examination. Colorectal cancer was determined histopathologically in 129 cases. Colorectal cancer patients with distant metastasis or additional malignancies were excluded from the study. A total of 105 patients met the criteria and were included in the study. A control group was formed of 94 patients with no history of cancer. The liver density on abdominopelvic computed tomography and serum transaminase values were recorded for the patients and compared with those of the control group. RESULTS: The groups were similar in respect of age, gender and aspartate aminotransferase levels. Although not statistically significant, the alanine aminotransferase levels of the patient group were high compared to the control group. The liver density on computed tomography was statistically significantly lower in the patient group than in the control group. CONCLUSION: The liver density measurement on contrast abdominopelvic computed tomography of colorectal cancer patients was low, which is consistent with non-alcoholic fatty liver disease.

Chronic eosinophilic leukemia with monosomy 8 in a five-year-old girl: a rare case.

A 5-year-old girl was admitted to our hospital due to fatigue and fever lasting for six months. She had systolic murmur in the mesocardiac and apex regions and hepatosplenomegaly. Laboratory evaluation revealed leukocyte and eosinophil counts of 176 and 144.32 x 10(9)/L, 3.4% blasts in bone marrow and monosomy 8. She developed pulmonary, cardiac, nervous system, ocular and bone involvement. Upon diagnosis of "chronic eosinophilic leukemia, not otherwise specified" (WHO 2008 classification), she received methylprednisolone, vincristine, cytarabine and 6-thioguanine. After hematopoietic stem cell transplantation from a full-matched sibling was performed, the patient expired due to graft failure and septicemia.

A pilot study on real-time transvaginal ultrasonographic elastography of cystic ovarian lesions.

BACKGROUND & OBJECTIVES: This study was carried out to determine the appearance of various cystic ovarian lesions on transvaginal real-time ultrasonographic elastography and to investigate its potential in the differential diagnosis of cystic ovarian lesions. METHODS: Twenty six women (age range, 27-71 yr; mean age 42 ± 16 yr) with cystic ovarian masses underwent transvaginal B-mode and Doppler ultrasonography, and transvaginal real-time ultrasonographic elastography. Those having ovarian cysts with solid components underwent to biopsy or surgical excision. The elasticity colour code (pattern 1-5), and strain index of cystic ovarian lesions were analyzed and associated with histopathological diagnosis. RESULTS: Eleven of 26 ovarian cysts (42%) (diameter range, 3.2-4.5 cm) without solid component were not colour coded with blue or colour coded with blue-red-green heterogenous mosaic pattern. Fifteen of 26 cystic ovarian lesions (58%) (diameter range, 3.5-6.5 cm) had solid components. Among these, two had colour pattern 5, their strain indexes were 3.7 and 4, and their histopathologic diagnosis were germ cell carcinoma. One had colour pattern 5, with strain index 13.6, and histopathologic diagnosis was clear cell carcinoma. INTERPRETATION & CONCLUSIONS: Transvaginal real-time ultrasonographic elastography has potential role in the differential diagnosis of cystic ovarian lesions and this technique may be useful in differentiation of the benign lesions from those of malignant.

Quantitative assessment of the elasticity values of liver with shear wave ultrasonographic elastography.

BACKGROUND & OBJECTIVES: Tissue stiffness in liver is related to tissue composition, which is changed by cirrhosis, hepatocellular carcinoma or metastases. Shear wave ultrasonographic elastography is a new imaging technique by which the elasticity of soft tissue can be measured quantitatively. The aim of this study was to measure the elasticity values of liver segments in healthy volunteers. METHODS: One hundred twenty seven healthy volunteers (89 women, 38 men; mean age 37, 72 ± 9.11 yr, range 17-63 yr) were examined on shear wave elastography and ultrasonography by using convex probe with a frequency of 3 MHz. Individuals with liver hepatosteatosis, cirrhosis, chronic liver disease, or focal liver lesions were excluded from the study. RESULTS: The mean elasticity values of right posterior, right anterior, left medial and left lateral segments of the liver was determined as 4 (±2.2), 3.3 (±2.1), 3.8 (±2.1), and 3.7 (±1.9) kPa for each segments, respectively. There was no significant difference in liver elasticity values between men and women. INTERPRETATION & CONCLUSIONS: In this preliminary study the elasticity values of liver segments were measured by shear wave ultrasonographic elastography in normal healthy volunteers. Further studies, comparing elasticity values of normal and pathologic tissues are needed to detect the diagnostic role of this new technique.

Comparison of subcutaneous central venous port via jugular and subclavian access in 347 patients at a single center.

The purpose of the present study was to examine whether patency times, including complications of subcutaneous venous chest port insertion using ultrasonography (US) guidance, differ between jugular and subclavian venous access. Between December 2008 and July 2010, subcutaneous venous chest ports were placed in 347 patients by an experienced team. All single-lumen port catheters were placed into jugular and subclavian veins under US and fluoroscopy guidance. Patency times and complication rates of ports via these routes were compared and the variables were age, gender, access, site of malignancy and coagulation parameters. The success of the jugular and subclavian groups was compared by univariate Kaplan-Meier survival analysis and the multivariable Cox regression test. A total of 15 patients underwent port removal due to complications. As a rate per 100 catheter days, ports were explanted in 7 (0.0092) due to thrombosis, 4 (0.0053) for catheter malposition, one each (0.0013) of port reservoir flip-over, bleeding, port pocket infection, skin necrosis and incision dehiscence, for a total of 15 patients (0.0197). Patency times were not different in the jugular and subclavian veins. Factors were not significant, with the exception of platelet count. There was no significant difference in patency times, including complications, between jugular vein access and subclavian vein access using US. This should be considered when selecting the access method.

Imaging of Cystic and Cyst-like Lesions of the Mediastinum with Pathologic Correlation.

Cystic masses of the mediastinum are a heterogenous group of asymptomatic or symptomatic, congenital, infectious, or neoplastic lesions. For early and correct diagnosis, evaluation, and optimal patient management of cystic mediastinal masses in infants, children, or adults imaging plays an important role. A non-invasive and sensitive imaging modality is an efficient and cost-effective tool. Multidetector computed tomography (MDTC) with volumetric acquisition provides fast acquisition of high resolution images and multiplanar reconstruction. Both 2D and 3D imaging in mediastinal imaging help in surgical planning and assessing resectability of mediastinal lesions. MR imaging has many advantages over other modalities for detecting and identifying cystic, or fluid-filled mediastinal masses, because of its intrinsic high soft tissue contrast and direct multiplanar imaging capabilities. However, histological tissue analysis may be required to differentiate a cystic lesion from other cyst-like or low-attenuation lesions.

The utility of ultrasound elastography and MicroPure imaging in the differentiation of benign and malignant thyroid nodules.

OBJECTIVE: The aim of this study was to evaluate the utility of ultrasound elastography and MicroPure imaging in the differential diagnosis of benign and malignant thyroid nodules. SUBJECTS AND METHODS: A total of 74 consecutive patients (65 women and nine men; age range, 21-80 years; mean [± SD] age, 51 ± 12.7 years) with thyroid nodules, who were referred for fine-needle aspiration biopsy by endocrinology or general surgery clinics, were prospectively examined using B-mode ultrasound, ultrasound elastography, and MicroPure imaging. The strain value ratio (strain index) of thyroid nodules was calculated. Patients with malignant or intermediate fine-needle aspiration biopsy results underwent thyroid surgery. RESULTS: Using MicroPure imaging, 17 of 65 benign thyroid nodules (26.6%) and three of nine malignant thyroid nodules (33.3%) were found to contain microcalcifications. The sensitivity, specificity, negative predictive value, positive predictive value, and the accuracy rate of MicroPure imaging were 42.9%, 80.6%, 93.1%, 18.8%, and 77%, respectively. By using receiver operating characteristic analysis, the best cutoff point (2.31) was computed (area under the curve, 0.87; p < 0.001). The sensitivity, specificity, negative predictive value, positive predictive value and accuracy rate of the strain index values were 85.7%, 82.1%, 98.2%, 33.3%, and 82.4%, respectively, when the best cutoff point of 2.31 was used (p = 0.001). The p value (x = malign) was 0.96 for a strain index value higher than 2.31. CONCLUSION: This preliminary study indicated that ultrasound elastography and MicroPure imaging can be used for the differentiation of benign and malignant thyroid nodules.

The role of multidetector computed tomography in the early diagnosis of invasive pulmonary aspergillosis in patients with febrile neutropenia undergoing hematopoietic stem cell transplantation.

OBJECTIVE: To evaluate vessel involvement and the role of multidetector computed tomography (MDCT) in the earlydiagnosis of invasive pulmonary aspergillosis (IPA) in patients with febrile neutropenia and antibiotic-resistant feverundergoing autologous bone morrow transplantation. MATERIAL AND METHODS: In all, 74 pulmonary MDCT examinations in 37 consecutive hematopoietic stem celltransplantation patients with febrile neutropenia and clinically suspected IPA were retrospectively evaluated. RESULTS: Diagnosis of IPA was based on Fungal Infections Cooperative Group, and National Institute of Allergy andInfectious Diseases Mycoses Study Consensus Group criteria. In all, 0, 14, and 11 patients were diagnosed as proven,probable, and possible IPA, respectively. Among the 25 patients accepted as probable and possible IPA, all had pulmonaryMDCT findings consistent with IPA. The remaining 12 patients were accepted as having fever of unknown origin (FUO)and had patent vessels based on MDCT findings.In the patients with probable and possible IPA, 72 focal pulmonary lesions were observed; in 41 of the 72 (57%) lesionsvascular occlusion was noted and the CT halo sign was observed in 25 of these 41 (61%) lesions. Resolution of feveroccurred following antifungal therapy in 19 (76%) of the 25 patients with probable and possible IPA. In all, 6 (25%)of the patients diagnosed as IPA died during follow-up. Transplant-related mortality 100 d post transplant in patientswith IPA and FUO was 24% and 0%, respectively. CONCLUSION: In conclusion, MDCT has a potential role in the early diagnosis of IPA via detection of vessel occlusion.

Predictive factors for detecting malignancy in central and lateral cervical lymph nodes in papillary carcinoma of the thyroid.

AIM: To determine the factors for predicting malignant diagnosis and limitations in ultrasonography guided fine-needle aspiration cytology of central and lateral cervical lymph nodes in patients with primary differentiated thyroid papillary carcinoma. METHODS: Biopsies of cervical lymph nodes were performed in 120 patients, 31 of whom had subsequent surgical diagnoses. Factors examined were patient's age and gender of the patients, location (central and lateral compartments), hypoechogenicity with loss of hilum, microcalcification, cystic feature, minimum and maximum diameters and index value (minimum/maximum diameter). RESULTS: The mean minimum diameter and index value of the lymph nodes were 9.9 ± 4.9 mm and 0.60 ± 0.19, respectively. Microcalcifications and cystic parts were specific findings with rates of 93.9% and 95.1%, respectively. Microcalcification, cystic feature, minimum diameter and index value were poor predictors of malignancy. The predictors were central location (P = 0.031) and hypoechogenicity with loss of hilum in lateral neck (P = 0.019). Central nodes led to a major problem for biopsy success due to postoperative changes and anatomic position. Nondiagnostic (30%) nodes were therefore mostly central. CONCLUSION: The involvement of the central neck should be a major indication of lymph node biopsy and pathological diagnosis regardless of the imaging findings. In the lateral compartment, hypoechogenicity with loss of hilum, microcalcifications, cystic parts and an index value ≥ 0.51 are indications of a lymph node biopsy to rule out malignancy.