Sulfur Exafluoride Contrast-Enhanced Ultrasound Showing Early Wash-Out of Marked Degree Identifies Lymphoma Invasion of Spleen with Excellent Diagnostic Accuracy: A Monocentric Study of 260 Splenic Nodules
Abstract
:Simple Summary
Abstract
1. Introduction
2. Materials and Methods
2.1. Study Design
2.2. Participants
2.2.1. Splenic CEUS Examination Methods
2.2.2. Splenic CEUS Patterns
2.2.3. Splenic CEUS Test Positivity
2.2.4. Immunohistochemical Study of the Tumoral Angiogenesis of Splenic Nodules
2.3. Statistical Analysis
3. Results
3.1. Participants
3.1.1. Spleen Status According to the Reference Standard
3.1.2. Spleen Status According to CEUS
3.2. Diagnostic Accuracy of CEUS
3.3. Distribution of CEUS Perfusional Patterns within the Three Clinical Categories of Lymphomas
3.4. Features of Tumoral Angiogenesis of Splenic Nodules
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Variable | Patients (n = 77) | Nodules (n = 260) |
---|---|---|
Patients’ gender: male | 43 (57%) | |
Patients’ age: median, years (range) | 48 (22–72) | |
Lymph node biopsy-proven lymphoma | ||
Non-Hodgkin lymphoma | 44 (57%) | |
Hodgkin lymphoma | 33 (43%) | |
Timing of the discovery of nodules | ||
Staging for lymphoma | 56 (72%) | |
Follow-up for lymphoma | 21 (28%) | |
Anti-lymphomatous therapy administered * | ||
R-CHOP-21 | 37 (48%) | |
CHOP-21 | 4 (5%) | |
R-Bendamustin | 3 (4%) | |
ABVD | 33 (43%) | |
Nodule size: median, cm (range) | 1.5 (0.5–7) | |
Aetiology of nodules | ||
Malignancy ** | 204 (78%) | |
a-NHL | 122 (60%) | |
DLBCL | 108 (53%) | |
TRBCL | 10 (5%) | |
ATCL | 4 (2%) | |
c-HL | 65 (32%) | |
NS-HL | 50 (25%) | |
MC-HL | 11 (5%) | |
LR-HL | 4 (2%) | |
i-NHL | 17 (8%) | |
FL | 17 (8%) | |
Benignity *** | 56 (22%) | |
Sarcoidosis | 20 (36%) | |
Hemangiomas | 20 (36%) | |
Abscess | 10 (17%) | |
Myeloid metaplasia | 4 (7%) | |
Hamartoma | 1 (1%) | |
Splenic infarction | 1 (1%) |
Aetiology | Median Size, cm (Range) | CEUS Patterns | Reference Standard | |
---|---|---|---|---|
Arterial Phase | Portal Phase | |||
Sarcoidosis, n = 20 | 1.5 (0.5–2.2) | Globally, hypoechoic compared to the surrounding parenchyma | Globally, hypoechoic (without later washout) compared to the surrounding parenchyma | Lymph nodes biopsy plus imaging follow-up after treatment, n = 20 |
Hemangiomas, n = 20 | 1.5 (1.1–6) | Isoenhancement (n = 10), capillary hemangiomas Discontinuous globular peripheral enhancement (n = 10), cavernous hemangiomas | With or without later washout of mild degree as intensity (n = 10), capillary hemangiomas Progressive centripetal fill-in or very late (>3 min) washout of mild degree (n = 10), cavernous hemangiomas | Clinical and imaging follow-up, n = 20 |
Abscesses, n = 10 | 1.1 (0.7–1.5) | Thin rim hyperenhancement pattern | Washout | Blood culture, n = 10 (positive test for fungus, n = 8; positive test for bacteria, n = 2) plus imaging monitoring after anti-microbial therapy |
G-CSF-related myeloid metaplasia, n = 4 | 2.5 (2–3.2) | Relative hypoenhancement of the periphery of nodule and normal enhancement in the remaining portion of lesion compared to the surrounding parenchyma (reversed rim-enhancement) | Isoenhancement | Clinical and imaging follow-up, n = 4 |
Hamartoma, n = 1 | 7 | Hyperenhancement | Hyperenhancement | Clinical and imaging follow-up, n = 1 |
Infarction, n = 1 | 6 | Hypo-enhancement (triangular-shaped) | Hypo-enhancement (triangular-shaped) | Clinical and imaging follow-up, n = 1 |
Accuracy Measurement | Results |
---|---|
Reference standard * | 100% (260/260 nodules) |
Sensitivity | 95% (95% CI, 91–98) |
Specificity | 100% (95% CI, 94–100) |
Positive predictive value | 100% (95% CI, 98–100) |
Negative predictive value | 85% (95% CI, 74–92) |
False-negative finding | 5% (10/260 nodules) |
False-positive finding | – |
Overall diagnostic accuracy | 96% (95% CI, 93–98) |
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Picardi, M.; Giordano, C.; Trastulli, F.; Leone, A.; Della Pepa, R.; Pugliese, N.; Iula, R.; Delle Cave, G.; Rascato, M.G.; Esposito, M.; et al. Sulfur Exafluoride Contrast-Enhanced Ultrasound Showing Early Wash-Out of Marked Degree Identifies Lymphoma Invasion of Spleen with Excellent Diagnostic Accuracy: A Monocentric Study of 260 Splenic Nodules. Cancers 2022, 14, 1927. https://doi.org/10.3390/cancers14081927
Picardi M, Giordano C, Trastulli F, Leone A, Della Pepa R, Pugliese N, Iula R, Delle Cave G, Rascato MG, Esposito M, et al. Sulfur Exafluoride Contrast-Enhanced Ultrasound Showing Early Wash-Out of Marked Degree Identifies Lymphoma Invasion of Spleen with Excellent Diagnostic Accuracy: A Monocentric Study of 260 Splenic Nodules. Cancers. 2022; 14(8):1927. https://doi.org/10.3390/cancers14081927
Chicago/Turabian StylePicardi, Marco, Claudia Giordano, Fabio Trastulli, Aldo Leone, Roberta Della Pepa, Novella Pugliese, Rossella Iula, Giuseppe Delle Cave, Maria Gabriella Rascato, Maria Esposito, and et al. 2022. "Sulfur Exafluoride Contrast-Enhanced Ultrasound Showing Early Wash-Out of Marked Degree Identifies Lymphoma Invasion of Spleen with Excellent Diagnostic Accuracy: A Monocentric Study of 260 Splenic Nodules" Cancers 14, no. 8: 1927. https://doi.org/10.3390/cancers14081927