{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,27]],"date-time":"2026-09-27T04:57:50Z","timestamp":1790485070356,"version":"4.1.0"},"reference-count":61,"publisher":"MDPI AG","issue":"19","license":[{"start":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T00:00:00Z","timestamp":1790294400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001659","name":"Deutsche Forschungsgemeinschaft","doi-asserted-by":"publisher","award":["WA 5500\/1-1"],"award-info":[{"award-number":["WA 5500\/1-1"]}],"id":[{"id":"10.13039\/501100001659","id-type":"DOI","asserted-by":"publisher"}]},{"award":["WA 5500\/1-1"],"award-info":[{"award-number":["WA 5500\/1-1"]}],"id":[{"id":"https:\/\/ror.org\/018mejw64","id-type":"ROR","asserted-by":"publisher"}]},{"name":"Charit\u00e9\u2013Universit\u00e4tsmedizin Berlin"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background\/Objectives: Accurate differentiation between benign and malignant cervical lymphadenopathy is a central task in head and neck imaging. This distinction is relevant in oncologic follow-up and in the general evaluation of enlarged cervical lymph nodes (CLNs), as nodal status influences prognosis, further diagnostic work-up, and treatment planning, including invasive diagnostic procedures or surgery. Current cross-sectional imaging approaches show variable diagnostic performance. This study aimed to compare the diagnostic accuracy of multiparametric ultrasound (mpUS) and cross-sectional imaging for the differentiation of benign and malignant CLNs. Methods: Data from a consecutive series of patients who underwent mpUS examination of a CLN, including B-mode, color-coded duplex sonography (CCDS), shear-wave elastography (SWE) and contrast-enhanced ultrasonography (CEUS) were retrospectively analyzed at the lymph-node level. Patients were eligible if complete mpUS and cross-sectional imaging documentation before tissue sampling was available. Histopathologic reports served as the reference standard. Accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were analyzed. Results: A total of 97 CLNs from 92 patients were analyzed; 33 CLNs were benign. Compared with cross-sectional imaging, mpUS showed higher accuracy by 15.5% (95% CI, 6.0\u201324.9%), higher sensitivity by 12.5% (95% CI, 2.5\u201323.4%), with higher PPV and NPV. In the exploratory analysis, CEUS and SWE improved the discriminatory power of B-mode and CCDS, with the complete mpUS protocol providing the best overall discrimination. Conclusions: MpUS showed higher accuracy, sensitivity, PPV and NPV than cross-sectional imaging. These findings suggest that mpUS may help characterize enlarged CLNs during diagnostic work-up and oncologic follow-up.<\/jats:p>","DOI":"10.3390\/diagnostics16193115","type":"journal-article","created":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T08:09:02Z","timestamp":1790323742000},"page":"3115","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Diagnostic Accuracy of Multiparametric Ultrasound Versus Cross-Sectional Imaging for Differentiating Benign and Malignant Cervical Lymph Nodes: A Histopathology-Referenced Retrospective Study"],"prefix":"10.3390","volume":"16","author":[{"given":"Inva","family":"Mu\u00e7i","sequence":"first","affiliation":[{"name":"Charit\u00e9\u2014University Medical Center Berlin, Corporate Member of Freie Universit\u00e4t Berlin and Humboldt-Universit\u00e4t zu Berlin, Department of Otorhinolaryngology, Charit\u00e9platz 1, 10117 Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"data-curation","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"visualization","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7769-0634","authenticated-orcid":false,"given":"Steffen","family":"Dommerich","sequence":"additional","affiliation":[{"name":"Charit\u00e9\u2014University Medical Center Berlin, Corporate Member of Freie Universit\u00e4t Berlin and Humboldt-Universit\u00e4t zu Berlin, Department of Otorhinolaryngology, Charit\u00e9platz 1, 10117 Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"resources","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7579-1300","authenticated-orcid":false,"given":"Philipp","family":"Arens","sequence":"additional","affiliation":[{"name":"Charit\u00e9\u2014University Medical Center Berlin, Corporate Member of Freie Universit\u00e4t Berlin and Humboldt-Universit\u00e4t zu Berlin, Department of Otorhinolaryngology, Charit\u00e9platz 1, 10117 Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"investigation","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1151-9935","authenticated-orcid":false,"given":"Markus Herbert","family":"Lerchbaumer","sequence":"additional","affiliation":[{"name":"Charit\u00e9\u2014University Medical Center Berlin, Corporate Member of Freie Universit\u00e4t Berlin and Humboldt-Universit\u00e4t zu Berlin, Department of Radiology, Charit\u00e9platz 1, 10117 Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Fischer","sequence":"additional","affiliation":[{"name":"Charit\u00e9\u2014University Medical Center Berlin, Corporate Member of Freie Universit\u00e4t Berlin and Humboldt-Universit\u00e4t zu Berlin, Department of Radiology, Charit\u00e9platz 1, 10117 Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"resources","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9422-7788","authenticated-orcid":false,"given":"Erin","family":"Spr\u00fcnken","sequence":"additional","affiliation":[{"name":"Charit\u00e9\u2014University Medical Center Berlin, Corporate Member of Freie Universit\u00e4t Berlin and Humboldt-Universit\u00e4t zu Berlin, Institute of Biometry and Clinical Epidemiology, Charit\u00e9platz 1, 10117 Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"methodology","vocabulary":"credit"},{"role":"formal-analysis","vocabulary":"credit"}]},{"given":"Heidi","family":"Olze","sequence":"additional","affiliation":[{"name":"Charit\u00e9\u2014University Medical Center Berlin, Corporate Member of Freie Universit\u00e4t Berlin and Humboldt-Universit\u00e4t zu Berlin, Department of Otorhinolaryngology, Charit\u00e9platz 1, 10117 Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"resources","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1915-9583","authenticated-orcid":false,"given":"Katharina Margherita","family":"Wakonig","sequence":"additional","affiliation":[{"name":"Charit\u00e9\u2014University Medical Center Berlin, Corporate Member of Freie Universit\u00e4t Berlin and Humboldt-Universit\u00e4t zu Berlin, Department of Otorhinolaryngology, Charit\u00e9platz 1, 10117 Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"},{"role":"software","vocabulary":"credit"},{"role":"data-curation","vocabulary":"credit"},{"role":"funding-acquisition","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"validation","vocabulary":"credit"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"},{"role":"resources","vocabulary":"credit"},{"role":"supervision","vocabulary":"credit"},{"role":"project-administration","vocabulary":"credit"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,25]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"371","DOI":"10.1002\/hed.21742","article-title":"Histologic diagnoses in persistently swollen cervical lymph nodes","volume":"34","author":"Laffers","year":"2012","journal-title":"Head 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