{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T22:21:49Z","timestamp":1788387709331,"version":"build-2803163510"},"reference-count":31,"publisher":"MDPI AG","issue":"20","license":[{"start":{"date-parts":[[2021,10,10]],"date-time":"2021-10-10T00:00:00Z","timestamp":1633824000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Ultrasound-guided fine needle aspiration cytology (USgFNAC) is commonly used for nodal staging in head and neck squamous cell cancer (HNSCC). Peripheral vascularity is a described feature for node metastasis. Micro-flow imaging (MFI) is a new sensitive technique to evaluate micro-vascularization. Our goal is to assess the additional value of MFI to detect malignancy in lymph nodes. A total of 102 patients with HNSCC were included prospectively. USgFNAC was performed with the Philips eL18\u20134 transducer. Cytological results served as a reference standard to evaluate the prediction of cytological malignancy depending on ultrasound features such as resistive index (RI), absence of fatty hilum sign, and peripheral vascularization. Results were obtained for all US examinations and for the subgroup of clinically node-negative neck (cN0). USgFNAC was performed in 211 nodes. Peripheral vascularization had a positive predictive value (PPV) of 83% (cN0: 50%) and the absence of a fatty hilum had a PPV of 82% (cN0 50%) The combination of peripheral vascularization and absent fatty hilum had a PPV of 94% (cN0: 72%). RI (threshold: 0.705) had a PPV of 61% (cN0: RI-threshold 0.615, PPV 20%), whereas the PPV of short axis diameter (threshold of 6.5mm) was 59% for all patients and 19% in cN0 necks (threshold of 4 mm). Peripheral vascularization assessed by MFI and absent hilum has a high predictive value for cytological malignancy in neck metastases. Next to size, both features should be used as additional selection criteria for USgFNAC.<\/jats:p>","DOI":"10.3390\/cancers13205071","type":"journal-article","created":{"date-parts":[[2021,10,10]],"date-time":"2021-10-10T21:19:32Z","timestamp":1633900772000},"page":"5071","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["Value of Assessing Peripheral Vascularization with Micro-Flow Imaging, Resistive Index and Absent Hilum Sign as Predictor for Malignancy in Lymph Nodes in Head and Neck Squamous Cell Carcinoma"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9370-6026","authenticated-orcid":false,"given":"Petra K.","family":"de Koekkoek-Doll","sequence":"first","affiliation":[{"name":"Department of Radiology, The Netherlands Cancer Institute, 1066 CX Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sander","family":"Roberti","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Biostatistics, The Netherlands Cancer Institute, 1066 CX Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6338-6743","authenticated-orcid":false,"given":"Michiel W.","family":"van den Brekel","sequence":"additional","affiliation":[{"name":"Department of Head and Neck Surgery and Oncology, The Netherlands Cancer Institute, 1066 CX Amsterdam, The Netherlands"},{"name":"Department of Maxillofacial Surgery, Amsterdam University Medical Center, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Monique","family":"Maas","sequence":"additional","affiliation":[{"name":"Department of Radiology, The Netherlands Cancer Institute, 1066 CX Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Smit","sequence":"additional","affiliation":[{"name":"Department of Pathology, The Netherlands Cancer Institute, 1066 CX Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Regina","family":"Beets-Tan","sequence":"additional","affiliation":[{"name":"Department of Radiology, The Netherlands Cancer Institute, 1066 CX Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonas","family":"Castelijns","sequence":"additional","affiliation":[{"name":"Department of Radiology, The Netherlands Cancer Institute, 1066 CX Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,10,10]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1016\/S0092-8674(00)81683-9","article-title":"The hallmarks of cancer","volume":"100","author":"Hanahan","year":"2000","journal-title":"Cell"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"298","DOI":"10.1016\/j.oraloncology.2011.11.001","article-title":"Prognostic significance of radiologically determined neck node volume: A systematic review","volume":"48","author":"Lodder","year":"2012","journal-title":"Oral Oncol."},{"key":"ref_3","first-page":"1","article-title":"Prognostic factors in advanced pharyngeal and oral cavity cancer; Significance of multimodality imaging in terms of 7th edition of TNM","volume":"14","year":"2014","journal-title":"Cancer Imaging"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"S41","DOI":"10.1102\/1470-7330.2005.0028","article-title":"What the clinician wants to know: Surgical perspective and ultrasound for lymph node imaging of the neck","volume":"5","author":"Castelijns","year":"2005","journal-title":"Cancer Imaging"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"712","DOI":"10.1093\/jnci\/djn125","article-title":"18F-Fluorodeoxyglucose Positron Emission Tomography to Evaluate Cervical Node Metastases in Patients with Head and Neck Squamous Cell Carcinoma: A Meta-analysis","volume":"100","author":"Kyzas","year":"2008","journal-title":"JNCI J. 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