RESUMO
PURPOSE: To select the best predictors of cervical lymph node malignancy based on gray-scale and power Doppler sonography using multivariate analysis. METHODS: We evaluated sonographically a total of 97 lymph nodes in the neck that were subjected to fine-needle aspiration biopsy. The gray-scale and power Doppler sonography parameters that we analyzed using multivariate logistic regression included size, shape, echogenicity, echotexture, margins, hilum, presence of microcalcifications or necrosis, vascularization, and resistance index (RI). RESULTS: The three variables with a diagnostic accuracy exceeding 80% were an altered vascularization, heterogeneous echotexture, and abnormal hilum. Malignant nodes exhibited higher RI and larger sizes than benign nodes, and the best cutoff values to distinguish malignant from benign lymph nodes were an RI of 0.77 and a short axis ≥ 0.9 cm. Altered vascularization, a short axis ≥ 0.9 cm, and abnormal hilum were the best predictors of malignancy. CONCLUSIONS: The best sonographic predictors of lymph node malignancy are, in descending order, an altered vascularization, a short axis ≥ 0.9 cm, an abnormal hilum, and a heterogeneous echotexture. © 2016 Wiley Periodicals, Inc. J Clin Ultrasound 44:587-594, 2016.
Assuntos
Carcinoma de Células Escamosas/patologia , Carcinoma/patologia , Linfonodos/diagnóstico por imagem , Linfonodos/patologia , Linfadenopatia/diagnóstico por imagem , Linfadenopatia/patologia , Neoplasias da Glândula Tireoide/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Biópsia por Agulha Fina , Carcinoma Papilar , Diagnóstico Diferencial , Feminino , Humanos , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Pescoço , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Câncer Papilífero da Tireoide , Ultrassonografia Doppler em Cores , Adulto JovemAssuntos
Humanos , Glândula Tireoide/anatomia & histologia , Ultrassom , Adenoma , Doenças Transmissíveis , Doença de Hashimoto , Linfoma , TireoiditeRESUMO
We propose the design of a teaching system named Interpretation and Diagnosis of Mammograms (INDIAM) for training students in the interpretation of mammograms and diagnosis of breast cancer. The proposed system integrates an illustrated tutorial on radiology of the breast, that is, mammography, which uses education techniques to guide the user (doctors, students, or researchers) through various concepts related to the diagnosis of breast cancer. The user can obtain informative text about specific subjects, access a library of bibliographic references, and retrieve cases from a mammographic database that are similar to a query case on hand. The information of each case stored in the mammographic database includes the radiological findings, the clinical history, the lifestyle of the patient, and complementary exams. The breast cancer tutorial is linked to a module that simulates the analysis and diagnosis of a mammogram. The tutorial incorporates tools for helping the user to evaluate his or her knowledge about a specific subject by using the education system or by simulating a diagnosis with appropriate feedback in case of error. The system also makes available digital image processing tools that allow the user to draw the contour of a lesion, the contour of the breast, or identify a cluster of calcifications in a given mammogram. The contours provided by the user are submitted to the system for evaluation. The teaching system is integrated with AMDI-An Indexed Atlas of Digital Mammograms-that includes case studies, e-learning, and research systems. All the resources are accessible via the Web.