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

Accurate assessment of lymph node (LN) involvement is crucial in cutaneous T-cell lymphoma (CTCL), but biopsy-based evaluation carries risks, limiting its use. This study aims to evaluate ultrasound effectiveness in detecting malignant LN involvement and identify optimal ultrasound parameters for prediction.

A retrospective cohort study was conducted with 250 CTCL patients who underwent LN ultrasound evaluations between 2018 and 2024. Ultrasound parameters were compared with histopathological results, and receiver operating characteristic (ROC) analysis was performed to assess diagnostic accuracy.

Ultrasound improves the detection rate of LN enlargement, from 21.6% to 57.6%. Lymphadenopathy on ultrasound was associated with higher disease staging and lower progression-free survival rates in mycosis fungoides. Key parameters, including increased short-axis diameter (p = 0.004) and loss of the echogenic hilum (p = 0.04), were significant indicators of malignant LN involvement. The combination of these two parameters in predicting malignant lymphadenopathy achieved an accuracy of 76.2%, with a sensitivity of 68.4% and a specificity of 82.6%, demonstrating superior diagnostic performance and providing valuable prognostic insights.

Ultrasound is a reliable method for detecting malignant lymphadenopathy in CTCL, aiding clinicians in deciding whether an invasive biopsy is necessary.