title: A Comparison of the Diagnostic Accuracy and Reliability of Subjective Grading and Computer-Aided Assessment of Intranodal Vascularity in Differentiating Metastatic and Reactive Cervical Lymphadenopathy.
abstract: OBJECTIVE
  Ultrasound is a well-established imaging modality in the assessment of malignant cervical lymphadenopathy. With the use of Doppler ultrasound, intranodal vascularity can be evaluated. However, the major limitation of ultrasound is operator dependency. Therefore, this study aimed to evaluate and compare the diagnostic accuracy and reliability of the subjective grading and computer-aided approach in assessing intranodal vascularity for the differentiation of benign and malignant lymph nodes.
  
  
  METHODS
  The present study retrospectively assessed 99 power Doppler ultrasound images of cervical lymph nodes and evaluated the degree of intranodal vascularity using qualitative subjective grading (QSG) and quantitative computer-aided (QCA) methods. The diagnostic accuracy of the two methods in distinguishing metastatic and reactive nodes and their inter- and intra-rater reliability in assessing intranodal vascularity were evaluated and compared.
  
  
  RESULTS
  The results showed that the QCA method was more accurate than the QSG method with a significantly higher sensitivity (67.8 % and 61.9 %, respectively, p < 0.05) and specificity (73.3 % and 57.3 %, respectively, p < 0.05). Using the intranodal vascularity index as determined by the QCA approach, the optimum cut-off to differentiate metastatic and reactive cervical lymph nodes was 32 %. The QCA method showed higher inter- and intra-rater reliability than the QSG method.
  
  
  CONCLUSIONS
  In the assessment of the degree of intranodal vascularity, the QCA method was more accurate and reliable than the QSG method in distinguishing metastatic and reactive lymph nodes.
authors.affiliation: Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hong Kong.
authors.forename: J
authors.initials: J
authors.lastname: Lam
authors.affiliation: Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hong Kong.
authors.forename: M
authors.initials: M
authors.lastname: Ying
authors.affiliation: Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hong Kong.
authors.forename: S Y
authors.initials: SY
authors.lastname: Cheung
authors.affiliation: Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hong Kong.
authors.forename: K H
authors.initials: KH
authors.lastname: Yeung
authors.affiliation: Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hong Kong.
authors.forename: P H
authors.initials: PH
authors.lastname: Yu
authors.affiliation: Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hong Kong.
authors.forename: H C
authors.initials: HC
authors.lastname: Cheng
authors.affiliation: Department of Imaging and Interventional Radiology, The Chinese Univesity of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong.
authors.forename: A T
authors.initials: AT
authors.lastname: Ahuja
mesh_terms: D044963:Biopsy, Fine-Needle; D001783:Blood Flow Velocity; D002983:Clinical Competence; D003937:Diagnosis, Differential; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D008198:Lymph Nodes / Q000098:blood supply* / Q000473:pathology; D000072281:Lymphadenopathy / Q000000981:diagnostic imaging*; D008207:Lymphatic Metastasis / Q000000981:diagnostic imaging* / Q000473:pathology; D009333:Neck / Q000000981:diagnostic imaging; D060787:Neoplasm Grading; D015588:Observer Variation; D010039:Otorhinolaryngologic Neoplasms / Q000098:blood supply* / Q000000981:diagnostic imaging* / Q000473:pathology; D015203:Reproducibility of Results; D012189:Retrospective Studies; D018608:Ultrasonography, Doppler