Ying Zhang,1,* Peijun Chen,1,* Tianzhuo Yu,1 Yuehui Yu,2 Xinyi Yan,2 Jie Chu,1 Gaoyi Yang3 

1Department of Ultrasonography, Hangzhou Red Cross Hospital (Zhejiang Tuberculosis Diagnosis and Treatment Center), Hangzhou, Zhejiang, People’s Republic of China; 2Division of Health Sciences, Hangzhou Normal University, Hangzhou, Zhejiang, People’s Republic of China; 3Department of Ultrasonography, Hangzhou First People’s Hospital, Hangzhou, Zhejiang, People’s Republic of China

*These authors contributed equally to this work

Correspondence: Gaoyi Yang, Department of Ultrasonography, Hangzhou First People’s Hospital, Hangzhou, Zhejiang, People’s Republic of China, Email yanggaoyi8@163.com

Purpose: To explore the relationship between the initial size and the necrotic rate of lymph nodes evaluated by ultrasound in patients with cervical tuberculous lymphadenitis (CTL) and therapeutic response.
Methods: Overall, 55 patients were included in this study. Conventional ultrasound and contrast-enhanced ultrasound examination were performed before anti-tuberculosis chemotherapy. Based on the different therapeutic outcomes, they were divided into responder groups (n = 39) and non-responder groups (n = 16). The relationship between the initial size (maximum area, length diameter, short diameter), rate of necrosis, and therapeutic response were compared and analyzed between two groups.
Results: There was a significant difference in maximum area, short diameter and rate of necrosis of lymph nodes between the responder groups and the non-responder groups (P < 0.05). The receiver-operating-characteristic (ROC) curve analysis was used to differentiate the two groups, it showed that the area under the curve was 0.746 for maximum area and 0.721 for short diameter, respectively. The cut-off value for the lymph node maximum area and short diameter based on ROC curve analysis was determined as 3.94cm2 (sensitivity 76.9%, specificity 68.7%) and 1.15cm (sensitivity 59.0%, specificity 93.7%), respectively. A negative correlation was observed between maximum area, short diameter, and therapeutic response.
Conclusion: The initial maximum area and short diameter of lymph nodes were found to have a negative correlation with chemotherapy response in patients with CTL. The treatment outcomes are typically unsatisfactory for lymph nodes exhibiting an initial necrosis rate of 50% or higher. These findings may be helpful for evaluating therapeutic response.
Plain Language Summary: In this study, we evaluated the relationship between the initial size and the necrotic rate by ultrasound with cervical tuberculous lymphadenitis (CTL) and therapeutic response. We found that the initial maximum area and short diameter of lymph nodes have a negative correlation with chemotherapy response in patients with CTL. The treatment outcomes are typically unsatisfactory for lymph nodes exhibiting an initial necrosis rate of 50% or higher. These findings may be helpful for evaluating therapeutic response in the early stages.

Keywords: ultrasound, tuberculous lymphadenitis, cervical, anti-tuberculosis chemotherapy, response