{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T11:13:27Z","timestamp":1788347607072,"version":"build-2803163510"},"reference-count":46,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T00:00:00Z","timestamp":1788307200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"VICTOR BABES UNIVERSITY OF MEDICINE AND PHARMACY TIMISOARA"},{"id":[{"id":"https:\/\/ror.org\/00afdp487","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Cervical lymph node status is the single most important prognostic determinant in head and neck squamous cell carcinoma (HNSCC), yet conventional gray-scale ultrasound relies on morphological criteria that only indirectly reflect the underlying biological process driving nodal progression: tumor angiogenesis. This narrative review focuses specifically on cervical lymph nodes and examines whether multiparametric ultrasound (B-mode, Doppler, elastography, and contrast-enhanced ultrasound [CEUS]) can serve as a non-invasive, repeatable surrogate for nodal angiogenic activity in HNSCC and outlines a practical framework for its use in the head and neck clinic; evidence on the primary tumor itself was outside this review\u2019s scope. A narrative synthesis of the literature on angiogenesis biology in HNSCC and on multiparametric ultrasound of cervical lymph nodes was performed, drawing on systematic reviews, meta-analyses, and clinical pilot studies identified through PubMed-indexed sources. Vascular endothelial growth factor (VEGF)-driven neoangiogenesis is a recognized diagnostic, prognostic, and predictive biological axis in HNSCC. Ultrasound modalities that visualize or quantify microvascular architecture and perfusion\u2014Doppler vascularity patterns, shear-wave elastography, and CEUS\u2014track features that are biologically continuous with angiogenesis (disorganized, high-permeability neovessels; altered tissue stiffness from stromal remodeling). Combining CEUS with B-mode ultrasound improves diagnostic accuracy for inconclusive cervical lymph nodes compared with either modality alone, and pilot multiparametric protocols in HNSCC show reproducible irregular contrast enhancement and elastographic heterogeneity in metastatic nodes. Multiparametric ultrasound does not replace histology, but it offers a repeatable, radiation-free, low-cost window onto the vascular phenotype of HNSCC that complements morphological staging. Given the heterogeneity and methodological limitations of the available evidence, multiparametric ultrasound should currently be regarded as a promising imaging biomarker rather than an established non-invasive surrogate for angiogenesis. Larger prospective, HNSCC-specific cohorts using standardized acquisition protocols, with direct histological correlation, are needed before this approach can be adopted into routine diagnostic pathways.<\/jats:p>","DOI":"10.3390\/medicina62091684","type":"journal-article","created":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T10:02:52Z","timestamp":1788343372000},"page":"1684","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Seeing Angiogenesis: Multiparametric Ultrasound as a Non-Invasive Window into the Vascularization Status of Cervical Lymph Nodes in Head and Neck Squamous Cell Carcinoma"],"prefix":"10.3390","volume":"62","author":[{"given":"Marius Liviu","family":"Moise","sequence":"first","affiliation":[{"name":"Radiology Department, Emerald Medical Center, Corneliu Coposu Boulevard 14, 300552 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8933-3060","authenticated-orcid":false,"given":"Cristina Stefania","family":"Dumitru","sequence":"additional","affiliation":[{"name":"Department II of Microscopic Morphology, Discipline of Histology, \u201cVictor Babes\u201d University of Medicine and Pharmacy Timisoara, E. Murgu Square, No. 2, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2520-7636","authenticated-orcid":false,"given":"Dorin","family":"Novacescu","sequence":"additional","affiliation":[{"name":"Department II of Microscopic Morphology, Discipline of Histology, \u201cVictor Babes\u201d University of Medicine and Pharmacy Timisoara, E. Murgu Square, No. 2, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alina Cristina","family":"Barb","sequence":"additional","affiliation":[{"name":"Department II of Microscopic Morphology, Discipline of Histology, \u201cVictor Babes\u201d University of Medicine and Pharmacy Timisoara, E. Murgu Square, No. 2, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diana","family":"Szekely","sequence":"additional","affiliation":[{"name":"Doctoral School, \u201cVictor Babes\u201d University of Medicine and Pharmacy Timisoara, E. Murgu Square, No. 2, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-3410-3870","authenticated-orcid":false,"given":"Alexia","family":"Manole","sequence":"additional","affiliation":[{"name":"Faculty of Medicine and Pharmacy, University of Oradea, 410087 Oradea, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cristian Silviu","family":"Suciu","sequence":"additional","affiliation":[{"name":"Department II of Microscopic Morphology, Discipline of Histology, \u201cVictor Babes\u201d University of Medicine and Pharmacy Timisoara, E. Murgu Square, No. 2, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5755-179X","authenticated-orcid":false,"given":"Flavia","family":"Zara","sequence":"additional","affiliation":[{"name":"Department II of Microscopic Morphology, Discipline of Histology, \u201cVictor Babes\u201d University of Medicine and Pharmacy Timisoara, E. Murgu Square, No. 2, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raul","family":"Patrascu","sequence":"additional","affiliation":[{"name":"Department of Functional Sciences, \u201cVictor Babes\u201d University of Medicine and Pharmacy, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,2]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Barsouk, A., Aluru, J.S., Rawla, P., Saginala, K., and Barsouk, A. (2023). 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