{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,13]],"date-time":"2026-09-13T04:39:50Z","timestamp":1789274390871,"version":"build-2803163510"},"reference-count":30,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2022,6,4]],"date-time":"2022-06-04T00:00:00Z","timestamp":1654300800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background. In IWCLL guidelines, progressive splenomegaly and lymphadenopathy are signs of active disease. In this study, we have tested the hypotheses if US could be a reliable tool for both superficial lymphnodes (SupLNs) and splenic assessment in chronic lymphocytic leukemia (CLL) patients. Methods. We enrolled N = 75 patients. SupLN and the spleen were assessed by two independent physicians (M1 and M2) by palpation and by a third physician (M3) with ultrasound sonography (US) using two different sonographers (US1 and US2). The results of M1 vs. M2 assessment, US1 vs. US2, palpation vs. US were compared. The echostructure of N = 1037 SupLN and of the spleen was also investigated. Results. The dimensions of SupLNs assessed by MD1 vs. MD2 were statistically discordant. Splenic size was concordant. There was concordance between US1 and US2 SupLN and splenic assessment. US found a higher number of pathological SupLN (Cohen\u2019s Kappa &lt; 0.1) than palpation, which misses remarkable-sized SupLNs. LN echostructure and splenic involvement patterns were described. Conclusions. US is a reliable, radiation-free tool useful in clinical practice to assess SupLN and splenic involvement in CLL.<\/jats:p>","DOI":"10.3390\/jcm11113206","type":"journal-article","created":{"date-parts":[[2022,6,4]],"date-time":"2022-06-04T09:42:32Z","timestamp":1654335752000},"page":"3206","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["A Prospective Cross-Sectional Study on the Comparison of Ultrasound Assessment vs. Palpation in Chronic Lymphocytic Leukemia Patients in the Era of Targeted Therapy"],"prefix":"10.3390","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5295-2087","authenticated-orcid":false,"given":"Edoardo","family":"Benedetti","sequence":"first","affiliation":[{"name":"Azienda Ospedaliero Universitaria Pisana, Department of Clinical and Experimental Medicine, UO Hematology, University of Pisa, 56126 Pisa, Italy"},{"name":"Italian School of Basic and Emergency Ultrasound (SIUMB), 56100 Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabrizio","family":"Mavilia","sequence":"additional","affiliation":[{"name":"Azienda Ospedaliero Universitaria Pisana, Department of Clinical and Experimental Medicine, UO Hematology, University of Pisa, 56126 Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1006-2400","authenticated-orcid":false,"given":"Claudia","family":"Barat\u00e8","sequence":"additional","affiliation":[{"name":"Azienda Ospedaliero Universitaria Pisana, Department of Clinical and Experimental Medicine, UO Hematology, University of Pisa, 56126 Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8478-7370","authenticated-orcid":false,"given":"Emilia","family":"Bramanti","sequence":"additional","affiliation":[{"name":"Institute of Chemistry of Organometallic Compounds (ICCOM), Italian National Research Council (CNR), Via G Moruzzi 1, 56124 Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7783-0262","authenticated-orcid":false,"given":"Riccardo","family":"Morganti","sequence":"additional","affiliation":[{"name":"Section of Statistics, Azienda Ospedaliero Universitaria Pisana, 56126 Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giulia","family":"Cervetti","sequence":"additional","affiliation":[{"name":"Azienda Ospedaliero Universitaria Pisana, Department of Clinical and Experimental Medicine, UO Hematology, University of Pisa, 56126 Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3643-5861","authenticated-orcid":false,"given":"Enrico","family":"Capochiani","sequence":"additional","affiliation":[{"name":"Azienda USL Toscana Nord Ovest, Hematology, 57124 Livorno, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benedetto","family":"Bruno","sequence":"additional","affiliation":[{"name":"Department of Molecular Biotechnology and Health Sciences, University of Turin, 10126 Turin, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matteo","family":"Pelosini","sequence":"additional","affiliation":[{"name":"Azienda Ospedaliero Universitaria Pisana, Department of Clinical and Experimental Medicine, UO Hematology, University of Pisa, 56126 Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Salvatore Massimo","family":"Stella","sequence":"additional","affiliation":[{"name":"Italian School of Basic and Emergency Ultrasound (SIUMB), 56100 Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara","family":"Galimberti","sequence":"additional","affiliation":[{"name":"Azienda Ospedaliero Universitaria Pisana, Department of Clinical and Experimental Medicine, UO Hematology, University of Pisa, 56126 Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,6,4]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2745","DOI":"10.1182\/blood-2017-09-806398","article-title":"iwCLL guidelines for diagnosis, indications for treatment, response assessment, and supportive management of CLL","volume":"131","author":"Hallek","year":"2018","journal-title":"Blood"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"417","DOI":"10.7863\/jum.1985.4.8.417","article-title":"Sonographic appearance of normal lymph nodes","volume":"4","author":"Marchal","year":"1985","journal-title":"J. Ultrasound Med."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"215","DOI":"10.1148\/radiology.183.1.1549675","article-title":"Differentiation of benign from malignant superficial lymphadenopathy: The role of high-resolution US","volume":"183","author":"Vassallo","year":"1992","journal-title":"Radiology"},{"key":"ref_4","unstructured":"Weskott, H.-P., and Ioanitescu, E.S. (2012). Diagnostic approach to lymph node disease in ultrasound. EFSUMB Course Book on Ultrasound, Central Ultrasound Department."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1016\/j.annonc.2020.09.019","article-title":"Chronic lymphocytic leukaemia: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up","volume":"32","author":"Eichhorst","year":"2021","journal-title":"Ann. Oncol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"4877","DOI":"10.2147\/OTT.S249586","article-title":"Ibrutinib in Chronic Lymphocytic Leukemia: Clinical Applications, Drug Resistance, and Prospects","volume":"13","author":"Zhou","year":"2020","journal-title":"OncoTargets Targets Ther."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"2517","DOI":"10.1056\/NEJMoa1812836","article-title":"Ibrutinib Regimens versus Chemoimmunotherapy in Older Patients with Untreated CLL","volume":"379","author":"Woyach","year":"2018","journal-title":"N. Engl. J. Med."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"666","DOI":"10.1111\/bjh.15080","article-title":"Optimising outcomes for patients with chronic lymphocytic leukaemia on ibrutinib therapy: European recommendations for clinical practice","volume":"180","author":"Gribben","year":"2018","journal-title":"Br. J. Haematol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1421","DOI":"10.1182\/blood.2019002841","article-title":"How I manage CLL with venetoclax-based treatments","volume":"135","author":"Wierda","year":"2020","journal-title":"Blood"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1910","DOI":"10.1182\/blood-2017-10-810044","article-title":"Single-agent ibrutinib in treatment-na\u00efve and relapsed\/refractory chronic lymphocytic leukemia: A 5-year experience","volume":"131","author":"Furman","year":"2018","journal-title":"Blood"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"106488","DOI":"10.1016\/j.leukres.2020.106488","article-title":"Response assessment to venetoclax in relapsed\/refractory chronic lymphocytic leukemia by ultrasonography","volume":"100","author":"Benedetti","year":"2021","journal-title":"Leuk. Res."},{"key":"ref_12","unstructured":"Tuma, J., Badea, R., and Dietrich, C.F. (2015). Ultrasound of the spleen. EFSUMB Course Book, EFSUMB. [2nd ed.]. e-book."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Benedetti, E., Tavarozzi, R., Morganti, R., Bruno, B., Bramanti, E., Barate, C., Balducci, S., Iovino, L., Ricci, F., and Ricchiuto, V. (2020). Organ Stiffness in the Work-Up of Myelofibrosis and Philadelphia-Negative Chronic Myeloproliferative Neoplasms. J. Clin. Med., 9.","DOI":"10.3390\/jcm9072149"},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Benedetti, E., Bruno, B., Martini, F., Morganti, R., Bramanti, E., Caracciolo, F., Galimberti, S., Lippolis, P., Neri, E., and Arena, C. (2021). Early Diagnosis of Neutropenic Enterocolitis by Bedside Ultrasound in Hematological Malignancies: A Prospective Study. J. Clin. Med., 10.","DOI":"10.3390\/jcm10184277"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1016\/j.jus.2009.06.001","article-title":"Contrast-enhanced ultrasonography in nodular splenomegaly associated with type B Niemann-Pick disease: An atypical hemangioma enhancement pattern","volume":"12","author":"Benedetti","year":"2009","journal-title":"J. Ultrasound"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1421","DOI":"10.1038\/bmt.2013.65","article-title":"Prospective qualitative and quantitative non-invasive evaluation of intestinal acute GVHD by contrast-enhanced ultrasound sonography","volume":"48","author":"Benedetti","year":"2013","journal-title":"Bone Marrow Transplant."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1016\/j.jus.2008.05.001","article-title":"Ultrasound findings guided a successful hemicolectomy in a leukemic patient with neutropenic enterocolitis","volume":"11","author":"Benedetti","year":"2008","journal-title":"J. Ultrasound"},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Benedetti, E., Mavilia, F., Barat\u00e8, C., Bramanti, E., Morganti, R., Bruno, B., Pelosini, M., Capochiani, E., Stella, M.S., and Galimberti, S. (2022). Prospective Cross-Sectional Study for the Comparison Between Palpation and Ultrasound of Lymph Node and Splenic Assessment in Chronic Lymphocytic Leukemia Patients. J. Ultrasound, submitted.","DOI":"10.3390\/jcm11113206"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"5446","DOI":"10.1182\/blood-2007-06-093906","article-title":"Guidelines for the diagnosis and treatment of chronic lymphocytic leukemia: A report from the International Workshop on Chronic Lymphocytic Leukemia updating the National Cancer Institute\u2013Working Group 1996 guidelines","volume":"111","author":"Hallek","year":"2008","journal-title":"Blood"},{"key":"ref_20","first-page":"294","article-title":"Ultrasonography of superficial lymph nodes: Benign vs. malignant","volume":"14","author":"Dudea","year":"2012","journal-title":"Med. Ultrason."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"132","DOI":"10.11152\/mu.2013.2066.152.smd1cbj2","article-title":"Differentiating benign from malignant superficial lymph nodes with sonoelastography","volume":"15","author":"Dudea","year":"2013","journal-title":"Med. Ultrason."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"658","DOI":"10.1102\/1470-7330.2013.0056","article-title":"Review of ultrasonography of malignant neck nodes: Greyscale, Doppler, contrast enhancement and elastography","volume":"13","author":"Ying","year":"2014","journal-title":"Cancer Imaging"},{"key":"ref_23","first-page":"8","article-title":"Ultrasound in portal hypertension\u2014Part 2\u2014and EFSUMB recommendations for the performance and reporting of ultrasound examinations in portal hypertension","volume":"33","author":"Berzigotti","year":"2012","journal-title":"Ultraschall Med."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"610","DOI":"10.2214\/ajr.112.3.610","article-title":"\u201cLipoplastic\u201d lymphadenopathy","volume":"112","author":"Wolfel","year":"1971","journal-title":"Am. J. Roentgenol. Radium Ther. Nucl. Med."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"535","DOI":"10.1259\/0007-1285-55-655-535","article-title":"Disseminated lipoplastic lymphadenopathy","volume":"55","author":"Parsons","year":"1982","journal-title":"Br. J. Radiol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1017","DOI":"10.1016\/j.ultrasmedbio.2005.04.012","article-title":"Fatty changes as a misleading factor in the evaluation with ultrasound of superficial lymph nodes","volume":"31","author":"Giovagnorio","year":"2005","journal-title":"Ultrasound Med. Biol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"369","DOI":"10.1016\/j.cult.2011.05.005","article-title":"Lymph Node Sonography","volume":"6","author":"Whitman","year":"2011","journal-title":"Ultrasound Clin."},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Quaia, E. (2005). Contrast Media in Ultrasonography. Medical Radiology, Springer.","DOI":"10.1007\/b138764"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"183","DOI":"10.1001\/archderm.141.2.183","article-title":"Ultrasonography using simple diagnostic criteria vs palpation for the detection of regional lymph node metastases of melanoma","volume":"141","author":"Saiag","year":"2005","journal-title":"Arch. Dermatol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"827","DOI":"10.1016\/0277-5379(90)90163-N","article-title":"Sonography versus palpation in the detection of regional lymph-node metastases in patients with malignant melanoma","volume":"26","author":"Prayer","year":"1990","journal-title":"Eur. J. Cancer Clin. Oncol."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/11\/11\/3206\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T23:24:31Z","timestamp":1760138671000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/11\/11\/3206"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,6,4]]},"references-count":30,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2022,6]]}},"alternative-id":["jcm11113206"],"URL":"https:\/\/doi.org\/10.3390\/jcm11113206","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,6,4]]}}}