Purpose or Case Report: To evaluate the diagnostic performance of ultrasound (US) features for differentiating malignant from benign cervical lymphadenopathy in children.
Methods & Materials: The PubMed and EMBASE databases were searched for articles published up to January 30, 2024 that reported the diagnostic performance of various US features to differentiate benign and malignant in children presented with cervical lymphadenopathy. The quality of the articles was evaluated by the QUADAS-2 tool. The sensitivity and specificity were pooled using a bivariate random-effects model. Further sensitivity analysis and meta-regression were performed to find potential source of heterogeneity. The area under the receiver operating characteristic curve were calculated with the hierarchical summary receiver operating characteristic (HSROC) model.
Results: Ten articles (1,077 children) were included. Among the retrieved US features, abnormal vascularity, heterogeneous echogenicity, abnormal hilum echogenicity, and long-axis/short-axis(L/S) ratio were significantly associated with malignant lymphadenopathy with pooled diagnostic odds ratio being 36 (95% confidence interval [CI], 14-92), 17 (95% CI, 3-91), 16 (95% CI, 5-54), and 7 (95% CI,5-9), respectively. The abnormal hilum echogenicity (0.86, 95% CI [0.66-0.95]) and heterogeneous echogenicity (0.84, 95% CI [0.25-0.99]) were the most sensitive US features, whereas abnormal vascularity (0.91, 95% CI [0.82-0.97]) were the most specific. Substantial heterogeneity was found in both sensitivity and specificity (I2 > 50%; p < 0.01), but the source of heterogeneity were not revealed after subgroup analysis and sensitivity analysis.
Conclusions: Among the various US features, abnormal vascularity, heterogeneous echogenicity, abnormal hilum echogenicity, and L/S ratio are useful for differentiating malignant from benign cervical lymphadenopathy in children, showing good diagnostic performance.