Improved diagnosis of small cervical lymph node metastasis using postvascular phase perfluorobutane CEUS in cancer patients
Abstract Background Accurate identification of small metastatic lymph nodes (LNs) remains a significant challenge with conventional ultrasound (US) due to its limitations in sensitivity for smaller LNs. The use of contrast-enhanced ultrasound (CEUS), especially with perfluorobutane in the postvascul...
Saved in:
| Main Authors: | , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2025-01-01
|
| Series: | BMC Cancer |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12885-025-13535-z |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1832585655750754304 |
|---|---|
| author | Naxiang Liu Zhaoming Zhong Wenrong Lin Zhongshi Du Zhougui Wu Songsong Wu Lina Tang |
| author_facet | Naxiang Liu Zhaoming Zhong Wenrong Lin Zhongshi Du Zhougui Wu Songsong Wu Lina Tang |
| author_sort | Naxiang Liu |
| collection | DOAJ |
| description | Abstract Background Accurate identification of small metastatic lymph nodes (LNs) remains a significant challenge with conventional ultrasound (US) due to its limitations in sensitivity for smaller LNs. The use of contrast-enhanced ultrasound (CEUS), especially with perfluorobutane in the postvascular phase of CEUS, may improve the diagnosis of metastatic LNs in cancer patients. We sought to investigate the diagnostic accuracy of the postvascular phase of CEUS with perfluorobutane in identifying suspected small cervical LNs in cancer patients. Methods This prospective study enrolled consecutive cancer patients with small cervical LNs suspected to be malignant on US from May 2023 to January 2024. All patients underwent CEUS with perfluorobutane injection, followed by observation during the vascular (6–60 s) and postvascular (10–30 min) phases before biopsy. The reference standard was histological assessment of the LNs through biopsy. The US and CEUS features were analyzed to assess the diagnostic performance of the US, vascular phase-CEUS, and postvascular phase-CEUS features, as well as their association with LN size. Results The final dataset included 229 participants (mean age, 57 years ± 11 [SD] [range, 28–80]; 121 women) with 229 suspected LNs, including 125 metastatic and 104 benign LNs. Hypo-enhancement or no enhancement in the postvascular phase of CEUS show excellent sensitivity (97%) and a high negative predictive value (93%). The area under the receiver operating characteristic (ROC) curve of postvascular phase-CEUS is 0.763, significantly higher than that for US (0.574; P < 0.001). Compared to US and vascular phase-CEUS, postvascular phase-CEUS demonstrates superior sensitivity (P = 0.022, and < 0.001, respectively) and accuracy (P < 0.001, all) for diagnosing LNs, irrespective of LN size. Conclusions Postvascular phase-CEUS exhibited excellent diagnostic performance in identifying suspected small LNs in cancer patients. Hyper- or isoenhancing small LNs in the postvascular phase of CEUS were unlikely to be malignant, possibly obviating biopsy. |
| format | Article |
| id | doaj-art-a5e203c54c7c44d089100ac75e3cf447 |
| institution | Kabale University |
| issn | 1471-2407 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Cancer |
| spelling | doaj-art-a5e203c54c7c44d089100ac75e3cf4472025-01-26T12:38:17ZengBMCBMC Cancer1471-24072025-01-0125111210.1186/s12885-025-13535-zImproved diagnosis of small cervical lymph node metastasis using postvascular phase perfluorobutane CEUS in cancer patientsNaxiang Liu0Zhaoming Zhong1Wenrong Lin2Zhongshi Du3Zhougui Wu4Songsong Wu5Lina Tang6Department of Ultrasonography, Clinical Oncology School of Fujian Medical University, Fujian Cancer HospitalDepartment of Ultrasonography, Clinical Oncology School of Fujian Medical University, Fujian Cancer HospitalDepartment of Ultrasonography, Clinical Oncology School of Fujian Medical University, Fujian Cancer HospitalDepartment of Ultrasonography, Clinical Oncology School of Fujian Medical University, Fujian Cancer HospitalDepartment of Ultrasonography, Clinical Oncology School of Fujian Medical University, Fujian Cancer HospitalDepartment of Ultrasonography, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou University Affiliated Provincial HospitalDepartment of Ultrasonography, Clinical Oncology School of Fujian Medical University, Fujian Cancer HospitalAbstract Background Accurate identification of small metastatic lymph nodes (LNs) remains a significant challenge with conventional ultrasound (US) due to its limitations in sensitivity for smaller LNs. The use of contrast-enhanced ultrasound (CEUS), especially with perfluorobutane in the postvascular phase of CEUS, may improve the diagnosis of metastatic LNs in cancer patients. We sought to investigate the diagnostic accuracy of the postvascular phase of CEUS with perfluorobutane in identifying suspected small cervical LNs in cancer patients. Methods This prospective study enrolled consecutive cancer patients with small cervical LNs suspected to be malignant on US from May 2023 to January 2024. All patients underwent CEUS with perfluorobutane injection, followed by observation during the vascular (6–60 s) and postvascular (10–30 min) phases before biopsy. The reference standard was histological assessment of the LNs through biopsy. The US and CEUS features were analyzed to assess the diagnostic performance of the US, vascular phase-CEUS, and postvascular phase-CEUS features, as well as their association with LN size. Results The final dataset included 229 participants (mean age, 57 years ± 11 [SD] [range, 28–80]; 121 women) with 229 suspected LNs, including 125 metastatic and 104 benign LNs. Hypo-enhancement or no enhancement in the postvascular phase of CEUS show excellent sensitivity (97%) and a high negative predictive value (93%). The area under the receiver operating characteristic (ROC) curve of postvascular phase-CEUS is 0.763, significantly higher than that for US (0.574; P < 0.001). Compared to US and vascular phase-CEUS, postvascular phase-CEUS demonstrates superior sensitivity (P = 0.022, and < 0.001, respectively) and accuracy (P < 0.001, all) for diagnosing LNs, irrespective of LN size. Conclusions Postvascular phase-CEUS exhibited excellent diagnostic performance in identifying suspected small LNs in cancer patients. Hyper- or isoenhancing small LNs in the postvascular phase of CEUS were unlikely to be malignant, possibly obviating biopsy.https://doi.org/10.1186/s12885-025-13535-zCancerContrast-enhanced ultrasoundMetastasisLymph nodeDiagnostic accuracy |
| spellingShingle | Naxiang Liu Zhaoming Zhong Wenrong Lin Zhongshi Du Zhougui Wu Songsong Wu Lina Tang Improved diagnosis of small cervical lymph node metastasis using postvascular phase perfluorobutane CEUS in cancer patients BMC Cancer Cancer Contrast-enhanced ultrasound Metastasis Lymph node Diagnostic accuracy |
| title | Improved diagnosis of small cervical lymph node metastasis using postvascular phase perfluorobutane CEUS in cancer patients |
| title_full | Improved diagnosis of small cervical lymph node metastasis using postvascular phase perfluorobutane CEUS in cancer patients |
| title_fullStr | Improved diagnosis of small cervical lymph node metastasis using postvascular phase perfluorobutane CEUS in cancer patients |
| title_full_unstemmed | Improved diagnosis of small cervical lymph node metastasis using postvascular phase perfluorobutane CEUS in cancer patients |
| title_short | Improved diagnosis of small cervical lymph node metastasis using postvascular phase perfluorobutane CEUS in cancer patients |
| title_sort | improved diagnosis of small cervical lymph node metastasis using postvascular phase perfluorobutane ceus in cancer patients |
| topic | Cancer Contrast-enhanced ultrasound Metastasis Lymph node Diagnostic accuracy |
| url | https://doi.org/10.1186/s12885-025-13535-z |
| work_keys_str_mv | AT naxiangliu improveddiagnosisofsmallcervicallymphnodemetastasisusingpostvascularphaseperfluorobutaneceusincancerpatients AT zhaomingzhong improveddiagnosisofsmallcervicallymphnodemetastasisusingpostvascularphaseperfluorobutaneceusincancerpatients AT wenronglin improveddiagnosisofsmallcervicallymphnodemetastasisusingpostvascularphaseperfluorobutaneceusincancerpatients AT zhongshidu improveddiagnosisofsmallcervicallymphnodemetastasisusingpostvascularphaseperfluorobutaneceusincancerpatients AT zhouguiwu improveddiagnosisofsmallcervicallymphnodemetastasisusingpostvascularphaseperfluorobutaneceusincancerpatients AT songsongwu improveddiagnosisofsmallcervicallymphnodemetastasisusingpostvascularphaseperfluorobutaneceusincancerpatients AT linatang improveddiagnosisofsmallcervicallymphnodemetastasisusingpostvascularphaseperfluorobutaneceusincancerpatients |