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Sonographic differentiation between lymphatic and metastatic diseases in cervical lymphadenopathy
Author(s) -
Strassen Ulrich,
Geisweid Christina,
Hofauer Benedikt,
Knopf Andreas
Publication year - 2018
Publication title -
the laryngoscope
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.181
H-Index - 148
eISSN - 1531-4995
pISSN - 0023-852X
DOI - 10.1002/lary.26837
Subject(s) - medicine , lymph , retrospective cohort study , cervical lymphadenopathy , lymphatic system , radiology , lymphoma , lymph node , vascularity , lymphadenectomy , dissection (medical) , melanoma , cervical lymph nodes , surgery , metastasis , pathology , disease , cancer , cancer research
Objectives/Hypothesis The spectrum of differential diagnosis in cervical lymphadenopathy is extremely broad. In lymphoma and inflammatory diseases, surgical approaches are restricted to diagnostic lymph extirpation, whereas metastatic outgrowth into regional lymph nodes usually requires neck dissection. Lymph node surgery has to manage the balancing act between sufficient radicality and preservation of functional structures. The current study, therefore, aimed to identify parameters to differentiate between lymph nodes of lymphatic and metastatic origin. Study Design Single‐center, retrospective cohort study. Methods Clinical and sonographic parameters from all patients who underwent diagnostic cervical lymphadenectomy from 2010 to 2015 (N = 262) were included in this retrospective analysis. Parameters with significant differences between the two subgroups were utilized to create a clinical algorithm to distinguish between cervical lymphadenopathy of lymphatic and metastatic genesis. Results Statistically significant differences between the two subgroups could be shown for clinical (gender, age, nicotine/alcohol abuse, B symptoms, history of cutaneous melanoma, or lymphoma) and ultrasonographic parameters (string‐of‐beads confirmation, bilaterality, homogenous echostructure, localization in level I, long‐to‐short axis ratio, and hilar vascularity). The proposed algorithm yielded a sensitivity of 92.4% for metastatic disease. Conclusions The implemented algorithm based on ultrasonographic and clinical criteria contributes to one‐step surgical approaches that guarantee a sufficient radicality with a minimum of functional loss. Level of Evidence 4. Laryngoscope , 128:859–863, 2018