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World J Gastroenterol. Aug 14, 2013; 19(30): 4850-4860
Published online Aug 14, 2013. doi: 10.3748/wjg.v19.i30.4850
New ultrasound techniques for lymph node evaluation
Xin-Wu Cui, Christian Jenssen, Adrian Saftoiu, Andre Ignee, Christoph F Dietrich
Xin-Wu Cui, Andre Ignee, Christoph F Dietrich, Med. Klinik 2, Caritas-Krankenhaus, 97980 Bad Mergentheim, Germany
Christian Jenssen, Klinik für Innere Medizin, Krankenhaus Märkisch Oderland, 15334 Strausberg, Germany
Adrian Saftoiu, Department of Gastroenterology, Research Center of Gastroenterology and Hepatology, University of Medicine and Pharmacy Craiova, 200349 Craiova, Romania
Author contributions: Cui XW, Jenssen C and Dietrich CF established the design and conception of the paper; Cui XW, Jenssen C, Saftoiu A, Ignee A and Dietrich CF analyzed the literature data; Dietrich CF provided the first draft of the manuscript; Cui XW, Jenssen C, Saftoiu A, Ignee A and Dietrich CF were critically discussed and revised the intellectual content of the manuscript; Jenssen C, Ignee A and Dietrich CF provided figures; all authors discussed the statement and conclusions and approved the final version to be published.
Correspondence to: Christoph F Dietrich, Professor, Head of Med. Klinik 2, Caritas-Krankenhaus, Uhlandstraße 7, 97980 Bad Mergentheim, Germany.
Telephone: +49-7931-582201 Fax: +49-7931-582290
Received: March 4, 2013
Revised: April 4, 2013
Accepted: May 7, 2013
Published online: August 14, 2013

Conventional ultrasound (US) is the recommended imaging method for lymph node (LN) diseases with the advantages of high resolution, real time evaluation and relative low costs. Current indications of transcutaneous ultrasound and endoscopic ultrasound include the detection and characterization of lymph nodes and the guidance for LN biopsy. Recent advances in US technology, such as contrast enhanced ultrasound (CEUS), contrast enhanced endoscopic ultrasound (CE-EUS), and real time elastography show potential to improve the accuracy of US for the differential diagnosis of benign and malignant lymph nodes. In addition, CEUS and CE-EUS have been also used for the guidance of fine needle aspiration and assessment of treatment response. Complementary to size criteria, CEUS could also be used to evaluate response of tumor angiogenesis to anti-angiogenic therapies. In this paper we review current literature regarding evaluation of lymphadenopathy by new and innovative US techniques.

Keywords: Lymph nodes, Ultrasound, Endoscopic ultrasound, Lymph node metastasis, Lymphoma

Core tip: The differentiation of malignant from benign lymph nodes by ultrasound, computed tomography and magnetic resonance imaging traditionally relies mainly on size measurements and topographic distribution. However, sensitivity and specificity in the differentiation of benign and malignant lymph nodes are disappointing using only size parameters. The presented paper is intended to discuss, comment and illustrate the clinical important work-up of lymphadenopathy with respect of recently introduced imaging techniques including contrast enhanced ultrasound and elastography.