Ultrasound as a robust tool for lymph node staging in cutaneous T-cell lymphoma

Area of Science:

• Oncology
• Medical Imaging
• Dermatology

Background:

• Accurate assessment of lymph node (LN) involvement is critical for staging and managing cutaneous T-cell lymphoma (CTCL).
• Current biopsy-based LN evaluation methods carry inherent risks and limitations, prompting the need for less invasive diagnostic tools.
• Ultrasound's utility in detecting malignant LN involvement in CTCL requires further investigation to identify optimal predictive parameters.

Purpose of the Study:

• To evaluate the effectiveness of ultrasound in identifying malignant lymph node involvement in CTCL patients.
• To identify specific ultrasound parameters that accurately predict malignant LN involvement.
• To assess the diagnostic accuracy of ultrasound in comparison to histopathological findings.

Main Methods:

• A retrospective cohort study involving 250 CTCL patients who underwent LN ultrasound examinations between 2018 and 2024.
• Comparison of ultrasound findings with histopathological results to determine diagnostic accuracy.
• Receiver operating characteristic (ROC) analysis was employed to assess the diagnostic performance of ultrasound parameters.

Main Results:

• Ultrasound significantly increased the detection rate of LN enlargement from 21.6% to 57.6%.
• Ultrasound-detected lymphadenopathy correlated with advanced disease staging and reduced progression-free survival in mycosis fungoides.
• Increased short-axis diameter (p=0.004) and loss of the echogenic hilum (p=0.04) were significant predictors of malignant LN involvement, achieving 76.2% accuracy (68.4% sensitivity, 82.6% specificity).

Conclusions:

• Ultrasound is a reliable and effective tool for detecting malignant lymphadenopathy in CTCL.
• Specific ultrasound parameters can accurately predict malignancy, offering valuable prognostic insights.
• Ultrasound findings can assist clinicians in determining the necessity of invasive lymph node biopsies.