Lymphatic drainage patterns of malignant skin tumors in the head and neck region: a single-center retrospective study.

BACKGROUND: This study aimed to clarify the relationship between primary site and lymphatic drainage pattern for malignant skin tumors in the head and neck region. Malignant melanoma and squamous cell carcinoma in the head and neck region are known to have poor prognosis because of lymph node metastasis. Nevertheless, numerous aspects of lymphatic drainage patterns remain elusive. METHODS: We statistically analyzed data of 47 patients with malignant skin tumors in the head and neck region. Information was collected on the patients' clinical characteristics, primary tumor site, and lymphatic drainage patterns. RESULTS: The parotid lymph nodes drained the greatest amount of lymph from skin tumors of the head and neck. Important lymphatic drainage pathways were the superficial cervical nodes for primary tumors in the buccal/nasal region, level IA and level IB nodes for primary tumors in the lip region, the occipital nodes, posterior auricular nodes, and level VA nodes in the parietal/occipital region, and the preauricular nodes in the auricular region. CONCLUSION: These findings have considerable significance in terms of understanding lymphatic drainage patterns for malignant skin tumors in the head and neck and may be useful for clinical decision-making and when planning treatment. Further research and clinical applications are expected to contribute to an improved prognosis in patients with cutaneous head and neck malignancies.

Multiparametric Ultrasound of Cervical Lymph Node Metastases in Head and Neck Cancer for Planning Non-Surgical Therapy.

BACKGROUND: We aimed to evaluate multiparametric ultrasound, to achieve a better understanding of the baseline characteristics of suspected cervical lymph node metastases in head and neck cancer before induction chemotherapy or chemoradiation. METHODS: From February 2020 to April 2021, our complete ultrasound examination protocol was carried out on clinically evident malignant lymph nodes of histologically proven HNSCC in the pre-therapeutic setting. RESULTS: A total of 13 patients were eligible for analysis. Using elastography, irregular clear hardening in areas in the center of the lymph node could be detected in all cases. Elastographic Q-analysis showed a significantly softer cortex compared to the center and surrounding tissue. The time-intensity curve analysis showed high values for the area under the curve and a short time-to-peak (fast wash-in) in all cases compared to the surrounding tissue. A parametric evaluation of contrast enhanced the ultrasound in the early arterial phase and showed an irregular enhancement from the margin in almost all investigated lymph nodes. These results show that the implementation of comprehensive, multiparametric ultrasound is suitable for classifying suspected lymph node metastasis more precisely than conventional ultrasound alone in the pre-therapeutic setting of HNSCC. Thus, these parameters may be used for improvements in the re-staging after chemoradiation or neoadjuvant therapy monitoring, respectively.

The value of contrast-enhanced ultrasound versus shear wave elastography in differentiating benign and malignant superficial lymph node lesions.

OBJECTIVE: To analyze the value of contrast-enhanced ultrasound (CEUS) versus shear wave elastography (SWE) in differentiating benign and malignant superficial lymph node lesions. METHODS: In this retrospective study, a total of 140 superficial lymph nodes from 140 patients pathologically confirmed to have an enlargement of their superficial lymph nodes were examined using CEUS and SWE. The results and diagnostic efficacy were analyzed. RESULTS: Among the 67 benign lymph nodes, there were 38 cases of type I, 17 of type II, and 12 of types III and IV. Among the 73 malignant lymph nodes, there were 53 cases of type III, 11 of type IV, and 9 of types I and II. Among the patients with lymph nodes <1 cm, there were 20, 4, 8, and 5 cases of types I, II, III, and IV, respectively. Among the patients with 1-2 cm lymph nodes, there were 15, 10, 26 and 7 cases of types I, II, III, and IV, respectively. There were 6, 10, 27, and 2 cases of types I, II, III, and IV in the >2 cm lymph nodes, respectively. The accuracy, sensitivity, and specificity of CEUS in the diagnosis of malignant lymph nodes were 85.00%, 87.67%, and 82.09%, respectively, and those of SWE were 89.29%, 80.82%, and 98.51%, respectively. SWE showed higher specificity than CEUS (P<0.05). SWE showed mean shear wave velocity (SWV) values of (2.11±0.41) m/s for the benign lymph nodes and (3.22±0.79) m/s for the malignant lymph nodes (P<0.05). The receiver operating characteristic (ROC) curves of the SWV values for the benign and malignant lymph nodes showed AUC=0.9948. CONCLUSION: Both CEUS and SWE are valuable in the differentiation of benign and malignant lymph node lesions, but SWE has a higher specificity. The SWV value of SWE is superior in the differentiation of benign and malignant lymph nodes. The combination of the two methods can achieve a higher accuracy.

Application of multimodal ultrasonography for differentiating benign and malignant cervical lymphadenopathy.

OBJECTIVES: The purpose of this study was to evaluate the diagnostic value of multimodal ultrasonography, including SWE and CEUS, for the differentiation of benign and malignant cervical lymphadenopathy. METHODS: A total of 103 patients with 109 enlarged neck lymph nodes underwent SWE and CEUS. There were 25 hyperplastic lymph nodes, 66 metastatic lymph nodes, and 18 cases of lymphoma. RESULTS: Using 31.6 kPa as the Emax cutoff, the sensitivity, specificity and accuracy of measurements on both benign and malignant cervical lymph nodes were 55.95%, 96%, and 65.2%, respectively. CEUS showed that lymph nodes with reactive hyperplasia mainly exhibited uniform perfusion via the lymphatic hilum (18/25; 72%; P < 0.01). The main manifestation of lymphoma was uniform perfusion through the lymphatic hila (10/18; 55.6%; P < 0.01). Metastatic lymph nodes mainly exhibited uneven perfusion (57/66; 86.4%; P < 0.01). The sensitivity, specificity, and accuracy of multimodal ultrasonography for the diagnosis of benign and malignant cervical lymphadenopathies were 90.5%, 72%, and 86.2%, respectively. CONCLUSIONS: Our findings suggest that multimodal ultrasonography can detect the stiffness (elasticity), perfusion pattern, and characteristics of lymph nodes and is a valuable tool for differentiating between benign and malignant lymphadenopathies.

Value of Shear Wave Elastography Versus Contrast-Enhanced Sonography for Differentiating Benign and Malignant Superficial Lymphadenopathy Unexplained by Conventional Sonography.

OBJECTIVES: This study aimed to compare the efficacy of shear wave elastography (SWE) and contrast-enhanced sonography in the differential diagnosis of superficial lymphadenopathy with abnormal imaging findings, which could not be otherwise confirmed by conventional sonography. METHODS: Forty-two enlarged superficial lymph nodes in 42 patients who met the screening criteria for this study were evaluated by both contrast-enhanced sonography and SWE. All lymph nodes underwent both methods using biopsy pathologic findings as a reference standard. RESULTS: The maximum elastic modulus, mean elastic modulus, and standard deviation of the elastic modulus were the main distinguishing features on SWE; they were significantly higher in malignant lesions than benign ones. The threshold value for the maximum elastic modulus was set at 37.9 kPa, and the sensitivity, specificity, and accuracy of differential diagnosis of superficial lymph nodes were 81.8%, 80.0%, and 81.0%, respectively. The diagnosis of benignity and malignancy by this index was statistically significant (P < .001). The lymph nodes were divided into benign and malignant groups according to different types based on the degree and range of intensity on contrast-enhanced sonography: intense or moderate homogeneous enhancement (n = 26) and heterogeneous, low homogeneous, or absent enhancement (n = 16). The sensitivity, specificity, and accuracy of contrast-enhanced sonography were 27.3%, 50.0%, and 38.1%. There was no statistically significant difference in the values between the benign and malignant groups (χ2 = 2.295; P = .130). CONCLUSIONS: Compared with contrast-enhanced sonography, SWE has better diagnostic value and efficiency in differentiation of superficial lymph nodes unexplained by conventional sonography. When conventional sonography cannot differentiate malignant superficial lymph nodes from benign ones, SWE is a useful adjunctive tool for assessment of lymph nodes.

Ocorrência e fatores de risco associados à infecção por Corynebacterium pseudotuberculosis em caprinos e ovinos do semiárido paraibano / Occurrence and risk factors associated with the Corynebacterium pseudotuberculo sis infection in sheep and goats from the semiarid region of the Paraiba state, Northeastern Brazil

Este trabalho teve como objetivo determinar a ocorrência e os fatores de risco associados à infecção por Corynebacterium pseudotuberculosis em caprinos e ovinos do semiárido da Paraiba. De 640 animais examinados, 7,7% (49/640) apresentavam evidências clínicas de linfadenite caseosa. Em 59,2% (29/49) destes animais havia apenas as cicatrizes de abscessos anteriormente rompidos; em 40,8% (20/49) dos animais, os abscessos estavam intactos. Desses 20 animais, 13 (65%) caprinos apresentaram 14 abscessos, enquanto que sete (35%) ovinos apresentaram oito abscessos. Em ambas as espécies, o linfonodo pré-escapular foi o mais acometido. No exame microbiológico, constatou-se que C. pseudotuberculosis foi o agente mais frequentemente isolado, em 15 (68,2%) amostras; em uma (4,5%) foi isolado Staphylococcus coagulase negativa; uma (4,5%) Enterococcus sp.; uma (4,5%) o Proteus mirabilis e Pseudomonas aeruginosa; e em quatro (18,2%) amostras não houve crescimento bacteriano. O modelo final de regressão logística mostrou que animais provenientes de rebanhos em que seus proprietários deixavam os abscessos romperem naturalmente tiveram maior chance de apresentar linfadenite caseosa (odds ratio =8,19; IC 95% =1,75-38,25; p=0,008). Conclui-se que os caprinovinocultores da região devem adotar medidas profiláticas em seus rebanhos, como abertura e drenagem precoce dos abscessos superficiais e destino adequado do conteúdo. Tais medidas, associadas à inspeção periódica do rebanho, descarte de animais doentes e não introdução de animais infectados, contribuirão significativamente para o controle desta infecção.

This study aimed to determine the occurrence and risk factors associated with Cory nebacterium pseudotuberculosis infection in goats and sheep in semiarid region of Paraiba State, Northeastern Brazil. Of the 640 animals examined, 7.7% (49/640) had clinical evidence of caseous lymphadenitis. In 59.2% (29/49) of these animals there was only the scars of previously ruptured abscesses and in 40.8% (20/49) of the animals abscesses were intact. Of these 20 animals 13 (65%) goats had 14 abscesses, whereas seven (35%) sheep had eight abscesses. In both species, pre-scapular lymph node was the most involved. C. pseudotuberculosis was the agent most frequently isolated, in 15 (68.2%) samples, and in one (4.5%) coagulase-negative Staphylococcus was isolated, one (4.5%) Enterococ cus sp., one (4.5%) Proteus mirabilis and Pseudomonas aeruginosa, and in four (18.2%) samples there was no bacterial growth. The final logistic regression model showed that animals from herds where their owners let the abscesses break naturally presented larger odds of caseous lymphadenitis (odds ratio = 8.19, 95% CI = 1.75 - 38.25, p = 0.008). We conclude that goat/sheep owners of the region should adopt preventive measures in their herds, such as early opening and drainage of superficial abscesses, and appropriate destination of the content. Such measures, in addition to regular inspection of the flock, disposal of diseased animals and introduction of non-infected animals will contribute to the control of this infection.