Correlation of Sonographic Classification of Neck Adenopathy (A-RADS) and Malignancy

Document Type : Original

Authors

1 Department of Radiology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

2 Sinus and Surgical Endoscopic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.

3 Pathology Cancer Molecular Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.

4 Department of Community Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

Abstract

Introduction:
Cervical adenopathy can be involved in various pathological processes. This study aimed to evaluate the ultrasound classification of cervical adenopathy (A-RADS) to choose the appropriate approach.
Materials and Methods:
This cross-sectional study was conducted among 294 patients with cervical adenopathy at Mashhad University of Medical Sciences during 2020-2021. The data of the long axis diameter, short axis diameter, shape, border, vascular pattern, presence of calcification and changes in cyst/necrosis, cortical echogenicity, hilum visibility, and location of involved lymph nodes were extracted. Lymph nodes was classified into four normal, reactive, suspicious & lymphoid disorders, and metastatic groups, based on ultrasound appearance (Adenopathy-reporting and data system). Diagnostic methods included follow-up, core needle biopsy (CNB), and fine needle aspiration (FNA), and surgical results. After determining the final diagnosis, demographic, sonographic, and pathological data were analyzed at a significance level of p<0.05.
 
Results:
Of 294 patients, 185 were benign, and 109 were malignant. There were no significant differences in the location, long axis diameter, shape, cystic or necrotic changes, calcification, and margins of the lymph nodes between the benign and malignant groups. The enlarged short axis diameter, invisible hilum with isoechoic cortex, and non-hilar vascularity were significantly higher in the malignant group (p<0.001). The malignancy rate was 8.7% in reactive cases, 48.5% in lymphoid disorders, and 90% in metastatic nodes.
Conclusion:
The results of this study shows that cervical lymph nodes can be classified based on short axis diameter, cortex and hilum echo-texture and vascular pattern into normal, reactive, suspicious & lymphoid disorders, and metastatic, which have a high concordance with pathologic results.

Keywords

References

  1. Chen L, Chen L, Liu J, Wang B, Zhang H. Value of Qualitative and Quantitative Contrast-Enhanced Ultrasound Analysis in Preoperative Diagnosis of Cervical Lymph Node Metastasis From Papillary Thyroid Carcinoma. J Ultrasound Med. 2020;39:73-81. doi: 10.1002/ jum.15074.
  2. Gupta A, Rahman K, Shahid M, Kumar A, Qaseem SM, Hassan SA, et al. Sonographic assessment of cervical lymphadenopathy: role of high-resolution and color Doppler imaging. Head Neck. 2011;33:297-302. doi: 10.1002/ hed. 21448.
  3. Ying M, Ahuja A, Brook F. Accuracy of sonographic vascular features in differentiating different causes of cervical lymphadenopathy. Ultrasound Med Biol. 2004;30:441-7. doi: 10. 1016/ j.ultrasmedbio.2003.12.009.
  4. Mazaher H, Sharifian SSH. Triplex ultrasonographic assessment of cervical lymph nodes. Acta Medica Iranica. 2004:441-4.
  5. Ying M, Bhatia KS, Lee YP, Yuen HY, Ahuja AT. Review of ultrasonography of malignant neck nodes: greyscale, Doppler, contrast enhancement and elastography. Cancer Imaging. 2014;13:658-69. doi: 10.1102/1470-7330.2013.0056.
  6. Ahuja AT, Ying M, Ho S, Antonio G, Lee Y, King A, et al. Ultrasound of malignant cervical lymph nodes. Cancer Imaging. 2008;8:48.
  7. Chan JM, Shin LK, Jeffrey RB. Ultrasonography of abnormal neck lymph nodes. Ultrasound Q. 2007;23:47-54. doi: 10.1097/01. ruq. 0000263839. 84937.45.
  8. Teng DK, Wang H, Lin YQ, Sui GQ, Guo F, Sun LN. Value of ultrasound elastography in assessment of enlarged cervical lymph nodes. Asian Pac J Cancer Prev. 2012;13:2081-5. doi: 10.7314/ apjcp. 2012. 13.5.2081.
  9. Naik RM, Pai A, Guruprasad Y, Singh R. Efficacy of colour Doppler ultrasound in diagnosis of cervical lymphadenopathy. J Maxillofac Oral Surg. 2013;12:123-9.doi: 10.1007/s12663-012-0395-1.
  10. Rohan K, Ramesh A, Sureshkumar S, Vijayakumar C, Abdulbasith KM, Krishnaraj B. Evaluation of B-Mode and Color Doppler Ultrasound in the Diagnosis of Malignant Cervical Lymphadenopathy. Cureus. 2020;12: e9819. doi: 10.7759/ cureus.9819.
  11. Pehlivan M, Gurbuz MK, Cingi C, Adapinar B, Değirmenci AN, Acikalin FM, et al. Diagnostic role of ultrasound elastography on lymph node metastases in patients with head and neck cancer. Braz J Otorhinolaryngol. 2019; 85:297-302. doi: 10. 1016/j.bjorl.2018.01.002.
  12. Zhan J, Diao X, Chen Y, Wang W, Ding H. Predicting cervical lymph node metastasis in patients with papillary thyroid cancer (PTC) - Why contrast-enhanced ultrasound (CEUS) was performed before thyroidectomy. Clin Hemorheol Microcirc. 2019;7 2:61-73. doi: 10. 3233/ch-180454.
  13. Van den Brekel MW, Castelijns JA. What the clinician wants to know: surgical perspective and

 

ultrasound for lymph node imaging of the neck. Cancer Imaging. 2005;5 Spec No A:S41-9. doi: 10. 1102/1470-7330.2005.0028.

  1. Farrokh D, Ameri L, Oliaee F, Maftouh M, Sadeghi M, Forghani MN, et al.  Can  ultrasound  be considered as a potential alternative for sentinel lymph node biopsy for axillary lymph node metastasis detection in breast cancer patients? Breast J. 2019;25:1300-2. doi: 10. 1111/ tbj.13475.
  2. Lo CP, Chen CY, Chin SC, Lee KW, Hsueh CJ, Juan CJ, et al. Detection of suspicious malignant cervical lymph nodes of unknown origin: diagnostic accuracy of ultrasound-guided fine-needle aspiration biopsy with nodal size and central necrosis correlate. Can Assoc Radiol J. 2007;58:286-91.
  3. Ryu KH, Lee KH, Ryu J, Baek HJ, Kim SJ, Jung HK, et al. Cervical Lymph Node Imaging Reporting and Data System for Ultrasound of Cervical Lymphadenopathy: A Pilot Study. AJR Am J Roentgenol. 2016;206:1286-91. doi: 10. 2214/ajr. 15. 15381.
  4. Raja Lakshmi C, Sudhakara Rao M, Ravikiran A, Sathish S, Bhavana SM. Evaluation of reliability of ultrasonographic parameters in differentiating benign and metastatic cervical group of lymph nodes. ISRN Otolaryngol. 2014;2014:238740. doi: 10.1155/ 2014/ 238740.
  5. Dangore-Khasbage S, Degwekar SS, Bhowate RR, Banode PJ, Bhake A, Choudhary MS, et al. Utility of color Doppler ultrasound in evaluating the status of cervical lymph nodes in oral cancer. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2009;108:255-63.doi:10.1016/j.tripleo. 2009.01. 003.
  6. Mohseni S, Shojaiefard A, Khorgami Z, Alinejad S, Ghorbani A, Ghafouri A. Peripheral lymphadenopathy: approach and diagnostic tools. Iran J Med Sci. 2014;39:158-70.
  7. Imani Moghaddam M, Davachi B, Mostaan LV, Langaroodi AJ, Memar B, Azimi SA, et al. Evaluation of the sonographic features of metastatic cervical lymph nodes in patients with head and neck malignancy. J Craniofac Surg. 2011;22:2179-84. doi: 10.1097/SCS.0b013e31 82324166.
  8. Ying M, Ahuja A, Brook F, Metreweli C. Vascularity and grey-scale sonographic features of normal cervical lymph nodes: variations with nodal size. Clin Radiol. 2001;56:416-9. doi: 10.1053/ crad. 2000. 0680.
  9. King AD, Tse GM, Ahuja AT, Yuen EH, Vlantis AC, To EW, et al. Necrosis in metastatic neck nodes: diagnostic accuracy of CT, MR imaging, and US. Radiology. 2004;230:720-6. doi: 10.1148/ radiol. 2303030157.
  10. Jayapal N, Ram SKM, Murthy VS, Basheer SA, Shamsuddin SV, Khan AB. Differentiation Between Benign and Metastatic Cervical Lymph Nodes Using Ultrasound. J Pharm Bioallied Sci. 2019;11 (Suppl 2): S338-s46.
Iranian Journal of Otorhinolaryngology
Volume 35, Issue 1
January and February 2023
Pages 39-47

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