A probability prediction rule for malignant cervical lymphadenopathy using sonography

• Published in: Head & neck Vol. 22; no. 3; pp. 223 - 228
• Main Authors: Wu, Chih-Hsiu, Lee, May Meei-Shyuan, Huang, Kuo-Chin, Ko, Jenq-Yuh, Sheen, Tzung-Shiahn, Hsieh, Fon-Jou
• Format: Journal Article
• Language: English
• Published: New York John Wiley & Sons, Inc 01-05-2000; John Wiley & Sons
• Subjects: Adolescent; Adult; Age; Age Factors; Aged; Aged, 80 and over; Biological and medical sciences; Carcinoma - diagnostic imaging; Carcinoma - secondary; cervical lymphadenopathy; Color; Ent, orbit; Female; Geriatrics; Head; Humans; Investigative techniques, diagnostic techniques (general aspects); Logistic Models; Lymph nodes; Lymph Nodes - diagnostic imaging; Lymphadenopathy; Lymphatic Metastasis; Male; Malignancy; Medical sciences; Middle Aged; Multivariate Analysis; Neck; Otorhinolaryngology (head neck, general aspects and miscellaneous); Otorhinolaryngology. Stomatology; prediction rule; Predictive Value of Tests; Prognosis; Regression analysis; Sarcoma - diagnostic imaging; Sarcoma - secondary; Sensitivity and Specificity; Sex; Sex Factors; sonography; Tumors; Ultrasonic investigative techniques; Ultrasonography, Doppler, Color; Sonography; Human; Exploration; Malignant tumor; Metastasis; Prospective; Accuracy; Adenopathy; Echography; ENT disease; Parameter; Neck; Diagnosis; Predictive factor; Bibliographic review
• ISSN: 1043-3074; 1097-0347
• DOI: 10.1002/(SICI)1097-0347(200005)22:3<223::AID-HED3>3.0.CO;2-D

Background
Our purpose was to weigh various sonographic parameters as predicting malignant cervical lymphadenopathy and build a reliable prediction rule.
Methods
One hundred and eighty‐nine cervical lymph node lesions from 125 consecutive patients were used for building the prediction model. Sonographic variables, including 15 morphologic features of B‐mode, 5 vascular parameters of color Doppler mode, along with age and sex, were analyzed with multivariate logistic regression to evaluate the joint effect of a set of independent variables. A prediction rule for malignant lymphadenopathy was established, and prospective validation was assessed on a new group consisting of 100 lymph nodes from another 60 consecutive patients.
Results
The association of heterogeneous content, long transverse diameter, pathologic vascular pattern, high vascular density, and older age provided the most robust prediction value. Scoring scale was designed as 1x (age) + 2x (vascularity index) + 3x (short axis) + 4x (vascular pattern) + 4x (internal echo) according to the parameter estimates of multivariate logistic regression analysis. Cut‐off value of score ≧10 as malignancy resulted in 89.2% sensitivity and 85.2% specificity. Prospective validation also showed satisfactory results (sensitivity, 82.9%; specificity, 86.2%).
Conclusions
By measuring only 4 sonographic parameters and age, this prediction rule could provide the physician a nonconfusing and reliable probability reference for managing cervical lymphadenopathy. © 2000 John Wiley & Sons, Inc. Head Neck 22: 223–228, 2000.