Incorporation of shear wave elastography into a prediction model in the assessment of cervical lymph nodes.

RATIONALE AND OBJECTIVES: To assess the performance of shear wave elastography (SWE) and an extended model in predicting malignant cervical lymph nodes (LNs). MATERIALS AND METHODS: 109 patients who underwent ultrasound (US) and SWE before needle biopsy were enrolled. The optimal cutoff value of elasticity indices (EIs) was determined by receiver operating characteristic (ROC) curves. The c-statistic, net reclassification improvement (NRI) and integrated discrimination improvement (IDI) were used to compare extended model and traditional one. RESULTS: Malignant LNs had higher EIs than benign nodes (p < 0.001). The optimal cutoff point was 42 kilopascal, corresponding to 83.3% sensitivity, 64.7% specificity, and 68.8% overall accuracy. A multivariable logistic regression analysis confirmed that EI was an independent predictor for malignancy. The new extended prediction model had a positive NRI (0.96) and IDI (0.10) for predicting malignant neck LNs. Nevertheless, the c-statistic was not significantly different between the two models. CONCLUSION: The parameter of SWE theoretically improve the model performance. However, its real clinical impact is minor, as the parameters of US-based model is already very robust. SWE can be considered as an adjunctive quantitative tool beyond conventional US examination.

Multilaboratory Assessment of Epstein-Barr Virus Serologic Assays: the Case for Standardization.

IgA antibodies targeting Epstein-Barr virus (EBV) have been proposed for screening for nasopharyngeal carcinoma (NPC). However, methods differ, and the antigens used in these assays differ considerably between laboratories. To enable formal comparisons across a range of established EBV serology assays, we created a panel of 66 pooled serum samples and 66 pooled plasma samples generated from individuals with a broad range of IgA antibody levels. Aliquots from these panels were distributed to six laboratories and were tested by 26 assays measuring antibodies against VCA, EBNA1, EA-EBNA1, Zta, or EAd antigens. We estimated the correlation between assay pairs using Spearman coefficients (continuous measures) and percentages of agreement (positive versus negative, using predefined positivity cutoffs by each assay developer/manufacturer). While strong correlations were observed between some assays, considerable differences were also noted, even for assays that targeted the same protein. For VCA-IgA assays in serum, two distinct clusters were identified, with a median Spearman coefficient of 0.41 (range, 0.20 to 0.66) across these two clusters. EBNA1-IgA assays in serum grouped into a single cluster with a median Spearman coefficient of 0.79 (range, 0.71 to 0.89). Percentages of agreement differed broadly for both VCA-IgA (12% to 98%) and EBNA1-IgA (29% to 95%) assays in serum. Moderate-to-strong correlations were observed across assays in serum that targeted other proteins (correlations ranged from 0.44 to 0.76). Similar results were noted for plasma. We conclude that standardization of EBV serology assays is needed to allow for comparability of results obtained in different translational research studies across laboratories and populations.

Health-related quality of life and utility in head and neck cancer survivors.

BACKGROUND: This study seeks to assess quality of life (QOL) and utility scores of head and neck cancer survivors. METHODS: We compared QOL as indicated by EORTC QLQ-C30, QLQ-H&N35, utility scores by time trade off (TTO) with previous published reference values and tested series characteristics related to global QOL and utility. RESULTS: A total of 127 patients were recruited. Of the patients, 102 (80%) completed the utility assessment. Cancer survivors had lower scores compared with norm values. Patients without a spouse had a lower utility than those with a spouse. Patients with a low annual family income also had lower global QOL and utility scores (p < 0.05). Other factors were not significantly related to QOL and utility scores. CONCLUSION: Disease and treatment of head and neck cancer lead to disability and poor health-related QOL and utility. Economic status may contribute to health-related QOL and utility, while marital status is related to utility for head and neck cancer patients.

The effectiveness of high-resolution ultrasound in the assessment of the carotid intima-media thickness for postirradiated neck.

OBJECTIVE: The carotid intimal-medial thickness (CIMT) is a strong predictor of future cardiovascular events. We assessed the mean CIMT and evaluated associated factors in head and neck cancer (HNC) patients. MATERIALS AND METHODS: Between January 2016 and March 2018, 70 volunteers underwent automatic ultrasound measurement of the common carotid artery CIMT. A mean CIMT ≥ 1.0 mm was regarded as an elevated risk for cardiovascular disease (CVD). We aimed to investigate the risk factors for an increased mean CIMT. RESULTS: We recruited 20 HNC survivors and 50 noncancer control individuals. Multiple linear regression analysis showed that old age (ß = 0.006, 95% confidence interval, CI 0.004-0.008), increased weight (ß = 0.003, 95% CI 0.001-0.005), hypertension (ß = 0.10, 95% CI 0.03-0.17), and prior irradiation (ß = 0.13, 95% CI 0.08-0.19) were positively correlated with the mean CIMT. From logistic regression analysis, it was shown that patients who underwent radiotherapy (OR 13.5, 95% CI 1.48-122.8) and who had higher bodyweight (OR 1.09, 95% CI 1.01-1.18) had a significantly higher risk of developing CVD. CONCLUSION: Measurement of the mean CIMT using ultrasound could be useful for assessing CVD risk in HNC survivors after neck irradiation.

Assessment of pain score and specimen adequacy for ultrasound-guided fine-needle aspiration biopsy of thyroid nodules.

OBJECTIVE: The aim of this study was to evaluate pain scores and specimen adequacy for ultrasound-guided fine-needle aspiration biopsy (US-FNAB) of thyroid nodules without and with local anesthesia (LA). MATERIALS AND METHODS: The US-FNAB procedure was performed on 183 patients with and without LA. One puncture was made for solid nodules, and if patients could tolerate it, a two-puncture technique was used for nodules with a cystic change. Four-point verbal rating scores were assessed by a nursing assistant after completion of US-FNAB. To be an adequate specimen, at least six groups of follicular cells are required, and each group should contain at least 10 cells. RESULTS: Immediately after US-FNAB, 92% of patients with LA and 80% without LA reported no or mild pain (p=0.01). Most patients tolerated the procedure well, with no pain (82.5%) reported 5 minutes after the procedure. In univariate logistic regression, irregular boundary (odds ratio [OR]: 2.52, 95% confidence interval [CI]: 1.04-6.06, p=0.04), calcification (OR: 2.86, 95% CI: 1.06-7.76, p=0.04), and LA (OR: 0.35, 95% CI: 0.15-0.86, p=0.02) were significantly associated with immediate moderate or severe pain. Specimen adequacy was significantly associated with age (OR: 0.95, 95% CI: 0.92-0.97, p<0.01), heterogeneous echo-texture (OR: 1.76, 95% CI: 1.23-5.17, p=0.01), predominate solid architecture (OR: 2.78, 95% CI: 1.42-5.41, p<0.01), and the use of LA (OR: 3.34, 95% CI: 1.70-6.56, p<0.01). In multivariate logistic regression, patients receiving LA had lower risk of moderate or severe pain (OR: 0.25, 95% CI: 0.09-0.67, p=0.01) and higher chances of specimen adequacy (OR: 4.84, 95% CI: 2.17-10.7, p<0.01) compared to patients who did not receive LA. CONCLUSION: US-FNAB is a safe procedure, and most patients report no pain 5 minutes after the procedure. The use of LA was associated with lower immediate pain scales and higher specimen adequacy.