Diagnostic value of contrast-enhanced ultrasound in cervical lymph node metastasis from oral and maxillofacial squamous cell carcinoma

doi:10.19438/j.cjoms.2023.02.012

Abstract

Abstract: PURPOSE: To investigate the diagnostic value of contrast-enhanced ultrasound（CEUS） for cervical lymph node metastasis from oral and maxillofacial squamous cell carcinoma. METHODS: Forty-one patients with oral and maxillofacial squamous cell carcinoma who underwent surgery and neck dissection were selected, and all patients were examined preoperatively with both conventional ultrasound and CEUS. The postoperative pathological diagnosis was used to divide the metastatic and non-metastatic group, the differences in conventional ultrasound and CEUS imaging characteristics of lymph nodes between the two groups were evaluated and multifactorial logistic regression models were used to analyze the risk factors associated with metastatic lymph nodes. The receiver operating characteristic(ROC) curve was used to evaluate the diagnostic value of the two tests for cervical lymph node metastasis from oral and maxillofacial squamous cell carcinoma. SPSS 25.0 software package was used for data analysis. RESULTS: Pathological diagnosis was made in 17 patients with a total of 29 metastatic lymph nodes and in 24 patients with a total of 28 non-metastatic lymph nodes. Conventional ultrasound in the metastatic group showed L/S≤2, irregular morphology, abnormal lymphatic hilum, inhomogeneous echo inside, and peripheral or mixed blood flow, which were significantly different from the non-metastatic group (P<0.05). The difference in perfusion pattern and perfusion type between the metastatic and non-metastatic groups was statistically significant(P<0.05). Conventional ultrasound showed irregular morphology, abnormal lymphatic hilum, inhomogeneous echo inside, peripheral type or mixed blood flow. CEUS showed centripetal or mixed type, inhomogeneous enhancement with irregular perfusion defect type or faint enhancement type were associated risk factors for metastatic lymph nodes(P<0.05). The sensitivity of conventional ultrasound and CEUS for the diagnosis of cervical lymph node metastasis from oral and maxillofacial squamous cell carcinoma was 65.5% and 79.3%, respectively; the specificity was 71.4% and 82.1%, respectively; the positive predictive value was 70.4% and 82.1%, respectively; the negative predictive value was 66.7% and 79.3%, respectively; and the area under the ROC curve was 0.685 and 0.807, respectively. CONCLUSIONS: CEUS has higher clinical value than conventional ultrasound in the diagnosis of cervical lymph node metastasis from oral and maxillofacial squamous cell carcinoma.

Key words: Oral and maxillofacial squamous cell carcinoma, Cervical lymph node metastasis, Contrast-enhanced ultrasound, Imaging features, Diagnostic value

CLC Number:

R739.8

LIU Jiang-long, JIA Fang, WANG Xiao-rong, REYILAI Abudukeremu, WUERGULI Alifu, MAIMAITITUXUN Tuerdi. Diagnostic value of contrast-enhanced ultrasound in cervical lymph node metastasis from oral and maxillofacial squamous cell carcinoma[J]. China Journal of Oral and Maxillofacial Surgery, 2023, 21(2): 168-174.

References

[1] Shibahara T.Oral cancer-diagnosis and therapy[J]. Clin Calcium, 2017, 27(10): 1427-1433.
[2] Arun I, Maity N, Hameed S, et al.Lymph node characteristics and their prognostic significance in oral squamous cell carcinoma[J]. Head Neck, 2021, 43(2): 520-533.
[3] Mahieu R, de Maar JS, Nieuwenhuis ER, et al. New developments in imaging for sentinel lymph node biopsy in early-stage oral cavity squamous cell carcinoma[J]. Cancers (Basel), 2020, 12(10): 3055-3081.
[4] 洪玉蓉, 刘学明. 颈部转移性淋巴结的超声造影表现分析[J]. 中国超声医学杂志, 2008, 24(6): 520-522.
Hong YR, Liu XM.Contrast-enhanced ultrasound for evaluation of metastatic cervical lymph nodes[J]. Chinese Journal of Ultrasound in Medicine, 2008, 24(6): 520-522.
[5] 吕彦利, 康秀梅, 王燕, 等. 超声对头颈部转移性淋巴结诊断的Logistic回归分析[J]. 医学影像学杂志, 2018, 28(12): 2111-2114.
Lyu YL, Kang XM, Wang Y, et al.Logistic regression analysis of ultrasonographyic features in diagnosis of lymph node metastasis of head and neck cancer[J]. Journal of Medical Imaging, 2018, 28(12): 2111-2114.
[6] Ricci P, Cantisani V, Ballesio L, et al.Benign and malignant breast lesions: efficacy of real time contrast-enhanced ultrasound vs. magnetic resonance imaging[J]. Ultraschall Med, 2007, 28(1): 57-62.
[7] 张琦, 朱天彤, 庄连婷, 等. 超声造影定量分析在鉴别颈部淋巴结良恶性的应用研究[J].中国临床医学影像杂志, 2021, 32(6): 393-397.
Zhang Q, Zhu TT, Zhang LT, et al.Quantitative analysis of contrast-enhanced ultrasound in differential diagnosis of benign and malignant cervical lymph nodes[J]. Journal of China Clinic Medical Imaging, 2021, 32(6): 393-397.
[8] 于也, 董晓秋, 姚金来, 等. 常规超声联合超声造影对良恶性淋巴结疾病的诊断价值[J]. 中国超声医学杂志, 2022, 38(2): 201-204.
Yu Y, Dong XQ, Yao JL, et al.The value of conventional ultrasound combined with ceus in the diagnosis of benign and malignant lymph node diseases[J]. Chinese Journal of Ultrasound in Medicine, 2022, 38(2): 201-204.
[9] 张雪云,聂芳,吕文豪,等. CEUS鉴别诊断颈部不同大小淋巴结的良恶性[J]. 中国医学影像技术, 2019, 35(4): 530-534.
Zhang XY, Nie F, Lyu WH, et al.CEUS in differential diagnosis of benign and malignant cervical lymph nodes with different size[J]. Chinese Journal of Medical Imaging Technology, 2019, 35(4): 530-534.
[10] Ding Z, Xiao T, Huang J, et al.Elective neck dissection versus observation in squamous cell carcinoma of oral cavity with clinically N0 neck: a systematic review and meta-analysis of prospective studies[J]. J Oral Maxillofac Surg, 2019, 77(1): 184-194.
[11] D'Cruz AK, Vaish R, Kapre N, et al. Elective versus therapeutic neck dissection in node-negative oral cancer[J]. N Engl J Med, 2015, 373(6): 521-529.
[12] Poanta L, Serban O, Pascu I, et al.The place of CEUS in distinguishing benign from malignant cervical lymph nodes: a prospective study[J]. Med Ultrason, 2014, 16(1): 7-14.
[13] Sidhu PS, Cantisani V, Dietrich CF, et al.The EFSUMB guidelines and recommendations for the clinical practice of contrast-enhanced ultrasound (CEUS) in non-hepatic applications: update 2017 (long version)[J]. Ultraschall Med, 2018, 39(2): e2-e44.
[14] Mφlstrφm J, Grφnne M, Green A, et al.Topographical distribution of sentinel nodes and metastases from T1-T2 oral squamous cell carcinomas[J]. Eur J Cancer, 2019, 107: 86-92.
[15] Warshavsky A, Rosen R, Nard-Carmel N, et al.Assessment of the rate of skip metastasis to neck level IV in patients with clinically node-negative neck oral cavity squamous cell carcinoma: a systematic review and meta-analysis[J]. JAMA Otolaryngol Head Neck Surg, 2019, 145(6): 542-548.
[16] Chammas MC, Macedo TAA, Lo VW, et al.Predicting malignant neck lymphadenopathy using color duplex sonography based on multivariate analysis[J]. J Clin Ultrasound, 2016, 44(9): 587-594.
[17] 刘娜香, 唐丽娜, 王瑶琴, 等. 超声造影在侧颈部淋巴结良恶性鉴别诊断中的价值[J].中华医学杂志, 2020, 100(29): 2258-2262.
Liu NX, Tang LN, Wang YQ, et al.Evaluation of contrast-enhanced ultrasound in the differential diagnosis of benign and malignant lateral cervical lymph nodes[J]. National Medical Journal of China, 2020, 100(29): 2258-2262.
[18] Cui QL, Yin SS, Fan ZH, et al.Diagnostic value of contrast‐enhanced ultrasonography and time‐intensity curve in differential diagnosis of cervical metastatic and tuberculous lymph nodes[J]. J Ultrasound Med, 2018, 37(1): 83-92.
[19] Ding Z, Deng C, Wang Z, et al.Comparison of contrast-enhanced ultrasound and contrast-enhanced computed tomography for the diagnosis of cervical lymph node metastasis in squamous cell carcinoma of the oral cavity[J]. Int J Oral Maxillofac Surg, 2021, 50(3): 294-301.