To explore the value of multi-modal ultrasound in the diagnosis of cervical lymphoma.

A retrospective analysis was performed on the ultrasonographic data of 98 patients with suspected cervical lymphoma at Hangzhou Red Cross Hospital from June 2016 to April 2018, including conventional ultrasound (US), real-time elastography (RTE), and contrast-enhanced ultrasound (CEUS) data. Puncture biopsy or surgical pathological results were obtained in all patients. Pathologic results were used as the gold standard to evaluate the performance of multi-modal ultrasound in the diagnosis of cervical lymphoma.

The pathologic results of 98 cases of cervical lymph nodes were: lymphoma in 58 cases, metastatic lymph nodes in 14, lymph node tuberculosis in 13, and hyperplasia of reactivity lymph nodes in 13. The sensitivity, specificity, and accuracy of US, RTE, and CEUS for diagnosis of lymphoma were 63.80%, 60.00%, and 62.20%, 53.40%, 45.00%, and 50.00%, and 72.40%, 72.50%, and 76.50%, respectively. The sensitivity, specificity, and accuracy of multi-modal ultrasound in the diagnosis of lymphoma were 79.30%, 82.50%, and 80.60%, which were higher than those of either method alone. On conventional US, cervical lymphoma showed stripe- or grid-like echo (38/58, 65.5%); on contrast-enhanced ultrasound (47/58,81.0%), diffuse enhancement was observed, and homogeneous enhancement was noted at peak value (53/58, 91.4%), which was significantly different form that of the non-lymphoma group (P<0.05); on RTE, the elastic score ≤2 accounted for 46.6% (27/58), and the elastic score ≥3 accounted for 53.4% (31/58), and there was no significant difference compared with the non-lymphoma group (P>0.05). The elastic score could not effectively distinguish lymphoma.

The application of multi-mode ultrasound can provide more information for the diagnosis of cervical lymphoma and avoid the limitation of single-mode ultrasound. Especially, the features of stripe- or grid-like echo under the background of low echo on conventional US and snowstorm enhancement on CEUS are more helpful for the ultrasonic diagnosis of cervical lymphoma.