ABSTRACT
OBJECTIVES: Differentiation of benign and malignant changes in lymph nodes is extremely important. We aimed to identify the ultrasound and clinical diagnostic criteria permitting this differentiation. METHODS: Clinical and ultrasound data were collected at Beijing Friendship Hospital from May 2019 to November 2020. Univariate and multivariate analysis were performed using statistical methods, and a mathematical model was established to evaluate benign and malignant lymph nodes. RESULTS: A total of 1343 LNs (person) with US-guided core needle or fine needle biopsy (CNB or FNB) were evaluated in the analysis. Variables with a high predictive power were sex (odds ratio, OR: 3.360, p<0.001), short diameter (OR: 4.660, p<0.001), short/long diameter (S/L) ratio (OR: 1.515, P=0.007), border (OR: 1.626, p=0.002), cortex echogenicity (OR: 2.089, P<0.001), fusion (OR: 2.313, p=0.002), vascularity (peripheral vascularity, OR: 3.424, p<0.001; mixed vascularity, OR: 4.127, p<0.001), and medical history (fever/local pain, OR: 0.316, p<0.001; tumor history in the drainage area, OR: 4.595, p<0.001; both, OR: 5.554, p<0.001). The cut-off score on receiver operating characteristic (ROC) curve analysis using these eight variables was 2.5. The largest area under the ROC curve (Az) value was 82.3% (95% confidence interval (CI), 0.805-0.851), and the sensitivity (79.4%), specificity (72.3%), and accuracy (74.8%) were higher than those for nearly all the single indices. CONCLUSION: The model of combination of ultrasound and clinical symptoms can preliminarily evaluate the benign and malignant of lymph nodes.
ABSTRACT
AIM: To study the ultrasonographic (US) differences between "mummified" thyroid nodules and malignant thyroid nodules in order to achieve a more accurate imaging-based diagnosis and to avoid unnecessary biopsy. MATERIAL AND METHODS: We retrospectively reviewed the US features of mummified thyroid nodules, as confirmed by fine-needle aspiration cytology (FNAC), in 193 cases. The US features included content, echo, shape, margin, microcalcification, suspicious lymph nodes and some characteristic features, including the cystic wall shrinkage sign, the concentric configuration or finger sign, calcification and halo. All of these features were classified and compared with those of 109 malignant lesions. The changes of these mummified nodules during the follow-up period were also examined. RESULTS: The cystic wall shrinkage sign and the concentric configuration or finger sign were highly specific indicators of mummified thyroid nodules and could be used to distinguish mummified nodules from thyroid cancer with a specificity of 91.7% and 99.9%, respectively. A continuous decrease in the cyst size was observed during follow-up. CONCLUSIONS: Mummified thyroid nodules are characterized by the cystic wall shrinkage sign and the concentric configuration or finger sign on US and a continuous decrease in size during follow-up. These features may be useful for the differential imaging-based diagnosis of mummified versus malignant thyroid nodules.
