title: Cervical Lymph Node Imaging Reporting and Data System for Ultrasound of Cervical Lymphadenopathy: A Pilot Study.
abstract: OBJECTIVE
  The objective of our study was to compare ultrasound (US) and real-time elastography (RTE) features of benign and malignant cervical lymphadenopathies and propose a structured reporting system for lymph nodes.
  
  
  METHODS
  The study population for this retrospective study consisted of 291 consecutive patients who underwent US-guided biopsies for cervical lymphadenopathy between 2013 and 2014. The following imaging features were analyzed: shape, margin, echogenicity, echogenic hilum, gross necrosis, calcification, matting, intranodal vascular pattern, elasticity scores (four categories), and strain ratio. A score was assigned for each significant factor from a logistic regression analysis and was multiplied by the beta coefficient. The fitted probability of malignancy was calculated. The risk of malignancy was determined on the basis of the number of suspicious features. Interobserver agreement of the imaging features was retrospectively analyzed using a coefficient of interrater agreement.
  
  
  RESULTS
  The imaging features that were significantly associated with malignant lymphadenopathy were round shape, noncircumscribed margin, hyperechogenicity, absence of hilum, gross necrosis, calcification, peripheral or mixed vascularity, high elasticity scores, and high level of strain ratio (p < 0.05). The fitted probability and risk of malignancy increased as the number of suspicious features increased. The risk of malignancy according to the Cervical Lymph Node Imaging Reporting and Data System categories was as follows: category 1, 3.3%; category 2, 10.9%; category 3, 26.7%; category 4, 51.8-74.4%; and category 5, 90.6-98.8%. An analysis of the overall interobserver agreement revealed that interobserver agreement was moderate to good.
  
  
  CONCLUSIONS
  We propose the Cervical Lymph Node Imaging Reporting and Data System, which uses the number of suspicious US and RTE features to assess the risk of malignancy in cervical lymph nodes.
authors.affiliation: 1 Department of Radiology, Inje University College of Medicine, Haeundae Paik Hospital, Haeundae-ro 875, Haeundae-gu, Busan 612-030, Republic of Korea.|2 Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea.
authors.forename: Kyeong Hwa
authors.initials: KH
authors.lastname: Ryu
authors.affiliation: 1 Department of Radiology, Inje University College of Medicine, Haeundae Paik Hospital, Haeundae-ro 875, Haeundae-gu, Busan 612-030, Republic of Korea.|3 Department of Radiology, Newoori Namsan Hospital, Busan, Republic of Korea.
authors.forename: Kwang Hwi
authors.initials: KH
authors.lastname: Lee
authors.affiliation: 1 Department of Radiology, Inje University College of Medicine, Haeundae Paik Hospital, Haeundae-ro 875, Haeundae-gu, Busan 612-030, Republic of Korea.
authors.forename: JiHwa
authors.initials: J
authors.lastname: Ryu
authors.affiliation: 4 Department of Radiology, Gyeongsang National University School of Medicine, Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea.
authors.forename: Hye Jin
authors.initials: HJ
authors.lastname: Baek
authors.affiliation: 1 Department of Radiology, Inje University College of Medicine, Haeundae Paik Hospital, Haeundae-ro 875, Haeundae-gu, Busan 612-030, Republic of Korea.
authors.forename: Suk Jung
authors.initials: SJ
authors.lastname: Kim
authors.affiliation: 1 Department of Radiology, Inje University College of Medicine, Haeundae Paik Hospital, Haeundae-ro 875, Haeundae-gu, Busan 612-030, Republic of Korea.
authors.forename: Hyun Kyung
authors.initials: HK
authors.lastname: Jung
authors.affiliation: 5 Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
authors.forename: Sung Mok
authors.initials: SM
authors.lastname: Kim
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D054459:Elasticity Imaging Techniques; D005260:Female; D006801:Humans; D061705:Image-Guided Biopsy; D007256:Information Systems / Q000458:organization & administration*; D000072281:Lymphadenopathy / Q000000981:diagnostic imaging* / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009333:Neck; D015588:Observer Variation; D010865:Pilot Projects; D012189:Retrospective Studies; D018608:Ultrasonography, Doppler; D055815:Young Adult
keywords: interobserver agreement; lymph node; real-time elastography; structured reporting system; ultrasound