Review of the relationship between tumor receptor subtypes and preference for visceral and/or serosal metastasis in breast cancer patients.

In this study, we investigated the molecular phenotype-cancer relationship that may favor the main metastatic tendencies of cancer by comparing the association of receptor subtypes with the presence of metastasis, serosal metastasis, and/or visceral metastases in patients diagnosed with breast cancer. In this study, we retrospectively evaluated 853 patients who were diagnosed with breast cancer and followed up at our hospital between 2017 and 2022. The probability of metastasis in the most common tumor group, the non-special type of invasive carcinoma was significantly higher than that in other tumor groups. We formed our groups according to estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2 (HER2), and Ki67 status. In addition, when we compared the receptor groups, no significant difference was found between the receptor groups (Table 1). When the entire breast cancer cohort was considered, the association of serosal metastasis was statistically significantly higher in the ER and/or PR (+) and, HER2 (-) receptor subgroup than in all other receptor groups (P < .006), and the association of visceral metastasis/visceral + serosal metastasis with the ER and/or PR (+) and, HER2 (-) receptor subgroup was significantly higher than that in all other receptor groups (P < .001) (Table 2). In this study, we aimed to investigate the possible relationship between molecular markers of the primary tumor and the preference for serosal and visceral metastases over distant metastases in a large cohort of patients to contribute to the improvement of the diagnosis and treatment of breast cancer, a heterogeneous disease group. To the best of our knowledge, our study is the first to statistically investigate the association between receptor subgroups and visceral, serosal, and serosal + visceral metastases as a group and to reach some conclusions.

Computerized Tomography Texture Analysis in the Differential Diagnosis of Intracranial Epidermoid and Arachnoid Cysts.

PURPOSE: This study evaluated the differences between arachnoid and epidermoid cysts in computerized tomography (CT) texture analysis (TA). MATERIAL AND METHODS: The study included 12 patients with intracranial epidermoid cysts and 26 patients with intracranial arachnoid cysts who were diagnosed with diffusion-weighted magnetic resonance imaging (DW-MRI) and who had undergone an unenhanced CT examination before treatment. The LIFEx application software was used to obtain texture features. Eighty-two texture features from 38 lesions were automatically calculated for each lesion. The Shapiro-Wilk test was used to test the normality of the scores, and the Mann-Whitney U Test was used to test the difference between the groups. Receiver operating characteristic (ROC) curves and multivariate logistic regression modeling examined the parameters' diagnostic performances. RESULTS: The median age of the patients was 53 years (range: 19-88 years). Eighty-two texture parameters were evaluated in the first order: gray-level co-occurrence matrix (GLCM), gray-level run length matrix (GLRLM), neighbor gray-tone difference matrix (NGTDM), and gray-level size zone matrix (GLSZM) groups. There was a statistically significant difference between the arachnoid cyst and the epidermoid cyst in the variables of compacity, compactness 1, compactness 2, sphericity, asphericity, sum average, coarseness, and low gray-level zone (p<0.05). According to the multiple logistic regression model, it was determined that the sum average in the GLCM group (B=-0.11; p=0.015), coarseness (B= 869.5; p=0.044) in the NGTDM group, and morphological sphericity (B=24.18; p=0.047) were the radiomics variables that increased the probability of epidermoid diagnosis. According to the classification table of the model, the sensitivity rate was found to be 83%, and the specificity rate was found to be 96%. Therefore, the probability of accurate model classification was 92%. CONCLUSION: CT TA is a method that can be applied with high diagnostic accuracy in the differential diagnosis of intracranial epidermoid and arachnoid cysts, especially in patients who cannot undergo an MRI examination.

Value of the newly developed pelvic dimension index/prostate volume ratio in predicting positive surgical margin in prostate cancer.

PURPOSE: To evaluate the diagnostic performance of pelvimetric measurements, in particular the pelvic dimension index (PDI)/prostate volume (PV) ratio (PDI/PV), in predicting positive surgical margin (PSM) in prostate cancer (PC). MATERIALS AND METHODS: 127 patients who had pre-operative pelvic imaging were included in this study. Demographic and clinical data were recorded. Apical depth (AD), interspinous distance (ISD), intertuberous distance (ITD), bony femoral width (BFW), soft-tissue width (SW), symphysis angle (SA), anteroposterior diameter of the pelvic inlet (API), anteroposterior diameter of the pelvic mid-plane (APM), anteroposterior diameter of the pelvic outlet (APO), pelvic depth (PD), bony width index (BWI), soft tissue width index (SWI), pelvic cavity index (PCI), PDI and PV were measured on MRI or CT. Using PDI and PV, we developed a new parameter of "PDI to PV ratio" (PDI/PV). Logistic regression analysis was used to determine the predictive potential of variables in detection of PSM. RESULTS: The AD, PV, SA and total prostate specific antigen (PSA) were significantly higher in PSM( +), while PDI, BWI, SWI, API, PDI/PV and PD were significantly lower in PSM( +) (p < 0.05). In multivariate analysis, PDI/PV ratio and clinical stage were all significant predictor of PSM, where PDI/PV ratio was the strongest predictor, followed by clinical stage. CONCLUSION: Pelvimetric measurements indicating deep location of the prostatic apex rather than pelvic width are more effective in predicting PSM. Prediction of PSM with pelvimetric measurements, in particular PDI/PV ratio, may be helpful for surgical planning in preoperative period.

The relationship of T2 hypointensity and diffusion restriction of brain metastases with the presence and amount of vasogenic edema in MRI.

AIM: Brain metastases are seen in 15-40% of patients diagnosed with cancer. We aimed to search the relationship between the T2 hypointensity, diffusion-weighted imaging characteristics, and the presence and amount of vasogenic edema of brain metastasis in magnetic resonance imaging (MRI). METHODS: A total of 292 patients with brain metastasis were included in the study. T2 signals of metastatic lesions, accompanying diffusion restriction and perilesional vasogenic edema findings, were investigated. In metastases accompanied by vasogenic edema, the largest dimension of the vasogenic edema-mass complex on T2-weighted sequences and the largest dimension of the mass in contrast-enhanced T1-weighted series were measured and the edema-mass ratio (EMR) was calculated by comparing these two values. RESULTS: The frequency of vasogenic edema was statistically significantly higher in T2 hypointense metastases (89.1% vs 58.8%, χ2 = 18.949, p = <.001) and metastases accompanied by diffusion restriction(81% vs 61.5%, χ2 = 6.971, p = .008). EMR values were found to be statistically significantly higher in T2 hypointense metastases (EMR→ Z = -4.507, p = <.001) and metastases with diffusion restriction(EMR→ Z = -3.819, p = .001). CONCLUSIONS: The frequency of vasogenic edema and EMR rates were higher in patients in T2 hypointense metastases and metastases accompanied by diffusion restriction in MRI.

Vasogenic Edema Pattern in Brain Metastasis.

OBJECTIVE: To determine the relationship of the presence and amount of vasogenic edema with origin, type, and grade of primary cancer. STUDY DESIGN: Cross-sectional study. PLACE AND DURATION OF STUDY: Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Radiology Clinic, Ankara, Turkey, from July 2017 to October 2021. METHODOLOGY: Brain MRI scans of 292 patients were retrospectively evaluated. Age, gender, origin, type, and grade of primary cancer were determined. Metastasis type, and presence of vasogenic edema accompanying metastatic lesion were questioned. In cases of vasogenic edema accompanying metastatic lesions, the largest diameter of the vasogenic edema mass complex was measured in T2 sequences. In the contrast-enhanced series, the largest diameter of the metastatic lesion was measured, and the edema-mass ratio (EMR) was calculated by proportioning the diameter of the edema mass complex to the diameter of the mass. RESULTS: The frequency of vasogenic edema was found higher in patients with lung cancer compared to other primaries. The EMR was found statistically significantly higher in patients with primary lung cancer (p=0.001). This was particularly evident in the adenocarcinoma group. In the patient group with primary breast cancer, EMR was found significantly lower in patients with invasive ductal carcinoma. (IDC→1.95±0.66 vs. Other→2.48±0.52, Z=-2.301, p=0.021). CONCLUSION: The amount and presence of vasogenic edema in patients with brain metastases may differ according to the origin and type of primary tumour. KEY WORDS: Brain edema, Metastatic disease, Magnetic resonance imaging.

Estimating the optimal entry point of the antegrade femoral nailing: Previous and novel morphometric measurements.

OBJECTIVE: This anatomical study aimed to investigate the possible relationships between the proximal femur parameters and verify the optimal entry point in line with the medullary canal. METHODS: Both in single image series and 3D-MPR views, 63 femur bones were evaluated. One-millimeter multidetector computed tomography scans were collected and assessed by OsiriX-Lite version 8 and Horos v3.3.5. Entry point locations, projected and true femoral neck-shaft, anteversion, and newly defined nail entrance angles were measured. RESULTS: The entry points of 16 femurs were placed at the tip of the greater trochanter, and the remaining 47 femurs were in the trochanteric fossa (i.e., piriformis fossa). Thirty-three of the entry points found in the trochanteric fossa were overlapped by the greater trochanter. When the parameters of the right and left sides were compared, it was found that; projected neck angle, nail entrance angle, and the differences between true neck angle and nail entrance angle were found significantly different. The relationship between nail entrance angle and entry point localization was assessed, and the probability of the entry point being at the tip of the greater trochanter is 63 times greater when the NEA is below 90. CONCLUSION: This study has demonstrated that the ideal entry point for straight nails, which is based on the anatomic axis of the femur, is found mainly at the trochanteric fossa, and the greater trochanter overlapped 70.21% of them. LEVEL OF EVIDENCE: Level IV, Diagnostic Study.

The Effects of Septorhinoplasty Techniques and Poly-P-Dioxanone Plate Use on Maxillofacial Growth: An Experimental Study.

ABSTRACT: Since the septum plays a key role in maxillofacial growth, the effect of septorhinoplasty maneuvers and the use of poly-p-dioxanone plate during growth on maxillofacial growth was investigated in our study. Thirty-three New Zealand rabbits each with an age of 8 weeks were included in the study. Maxillofacial computed tomography was performed on all 8-weeks old rabbits. Then, the rabbits were divided into 5 groups randomly. No intervention was done on the rabbits in group 1. Nasal dorsum of the rabbits in the 2nd group were opened, and the mucosae were bilaterally elevated. In the third group underwent limited cartilage resection by preserving the nasal dorsum. Removed cartilage was crushed and placed back between the mucoperichondrial flaps for the rabbits in the 4th group. Crushed cartilage with Poly-P-Dioxanone plate was used for the rabbits in the 5th Group. Maxillofacial computed tomography was performed at the end of the 20th week and growth parameters were investigated. When the group 2 was compared with the control group, the nasal bone length was observed to be significantly shorter (P < 0.05). Group 5 compared with group 4, incisive bone volume remained significantly low (P < 0.05) and malocclusion developed. Nasal bone length was affected negatively in the group that underwent osteotomy and mucosa elevation. Although positive results related to poly-p-dioxanone plate use have been reported for adults, incisive bone development retarded in noses that had not yet reached adult size in our study and the maxillofacial development was affected adversely.

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.

Magnetic Resonance Imaging Findings in Childhood Period Nasopharynx Cancer.

BACKGROUND: Nasopharyngeal carcinoma is a rarely seen tumor in childhood. It is mostly detected late as the clinical features are similar to other childhood tumors which affect the nasopharynx and adenoidal hypertrophy. Therefore, the radiological features of childhood tumors of the nasopharynx must be well known. The aim of this study was to investigate the contribution of MR imaging features of childhood nasopharynx cancer. MATERIAL/METHODS: The study included 10 nasopharyngeal carcinoma patients under the age of 18 years who presented at hospital between February 2008 and March 2014 and who had tissue diagnosis and MRI of the nasopharynx region. The MRI scans were evaluated by two radiologists. Loco-regional spread, asymmetry, signal intensity of the tumors, and lymph nodes were evaluated. RESULTS: In all the patients there was a mass which narrowed the nasopharynx. In all cases, unilateral mastoid opacification was observed. In 9 cases (90%), parapharyngeal extension was found. In 8 cases (80%), the mass showed an extension into the nasal cavity or oropharynx. In 5 cases (50%), there was an involvement of the skull base. In 3 patients (30%), an extension to the masticator space and pterygopalatine fossa was found. There were enlarged cervical lymph nodes bilaterally in 10 cases (100%). In 4 cases (40%), a lateral retropharyngeal lymph node was detected. CONCLUSIONS: Childhood nasopharyngeal cancers are often diagnosed at an advanced stage. MR imaging can be helpful in diagnosis and differential diagnosis of childhood nasopharynx cancer from other diseases of the nasopharynx.

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.

Pancreatic schwannoma: A case report and review of the literature.

Schwannoma or neurilemmoma is a well-defined, benign tumor, which arises from neural crest cells and surrounds the nerve sheath. It is rare neoplasm that is typically found in the extremities, such as the thorax, head, neck, pelvis and rectum. Schwannoma localized to the pancreas is particularly rare and only a limited number of cases have been reported in the literature to date. The present study reports the case of a 30-year-old male with pancreatic schwannoma presenting with weight loss and abdominal pain. Pancreatic schwannoma was diagnosed using magnetic resonance imaging and ultrasonography-guided biopsy, which was followed by a duodenopancreatectomy. Although pancreatic schwannomas are rare, they must be considered during the differential diagnoses of cystic pancreatic masses.

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.

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.