Perfluorobutane CEUS for early-stage cervical lymphoma: diagnostic value of the postvascular phase starfield sign

Abstract Early differentiation of cervical lymphoma from benign lymphadenopathy remains challenging on conventional imaging. This study assesses the diagnostic efficacy of perfluorobutane contrast-enhanced ultrasound (CEUS) in differentiating early-stage cervical lymphoma from benign lymph nodes (LN...

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Main Authors: Xia Liang, Xian-Tao Zeng, Zhi-Liang Hong, Xiao-Ying Lin, Miao-jiao Su, Jian-Chuan Yang, Song-Song Wu
Format: Article
Language:English
Published: Nature Portfolio 2025-08-01
Series:Scientific Reports
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Online Access:https://doi.org/10.1038/s41598-025-13771-0
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author Xia Liang
Xian-Tao Zeng
Zhi-Liang Hong
Xiao-Ying Lin
Miao-jiao Su
Jian-Chuan Yang
Song-Song Wu
author_facet Xia Liang
Xian-Tao Zeng
Zhi-Liang Hong
Xiao-Ying Lin
Miao-jiao Su
Jian-Chuan Yang
Song-Song Wu
author_sort Xia Liang
collection DOAJ
description Abstract Early differentiation of cervical lymphoma from benign lymphadenopathy remains challenging on conventional imaging. This study assesses the diagnostic efficacy of perfluorobutane contrast-enhanced ultrasound (CEUS) in differentiating early-stage cervical lymphoma from benign lymph nodes (LNs). From November 2023 to January 2025 we prospectively enrolled patients suspected of having cervical lymphoma based on ultrasound (US) findings and scheduled for LN biopsy. All patients underwent CEUS to evaluate LN vascular (5–60 s post-injection) and postvascular (10–30 min post-injection) phases before biopsy. Histopathology served as the reference standard. Diagnostic performance metrics, including sensitivity, specificity, and accuracy, were calculated. Logistic regression analyzed the area under the receiver operating characteristic curve (AUC) for US, CEUS, and combined features. Forty-seven LNs (23 lymphomas, 24 benign) were analyzed. The sensitivity of the postvascular phase starfield sign was 91.30%, specificity was 83.33%, positive predictive value was 84.00%, negative predictive value was 90.91%, and the AUC was 0.87 (95% CI 0.76–0.98). The AUC for CEUS was 0.89 (95% CI 0.79–1.00), and the AUC for the combination of postvascular phase and US features was 0.92 (95% CI 0.82–1.00), significantly higher than that for US features alone (AUC, 0.68; 95% CI 0.53–0.84; P < 0.05). Perflubutane CEUS can effectively distinguish between cervical lymphoma and benign LNs. The postvascular phase starfield sign demonstrates significant diagnostic efficacy and could improve clinical management strategies.
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institution Kabale University
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language English
publishDate 2025-08-01
publisher Nature Portfolio
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spelling doaj-art-42a96ca8b707433fb9b2e0a74ef98b422025-08-20T03:46:00ZengNature PortfolioScientific Reports2045-23222025-08-0115111010.1038/s41598-025-13771-0Perfluorobutane CEUS for early-stage cervical lymphoma: diagnostic value of the postvascular phase starfield signXia Liang0Xian-Tao Zeng1Zhi-Liang Hong2Xiao-Ying Lin3Miao-jiao Su4Jian-Chuan Yang5Song-Song Wu6Shengli Clinical Medical College of Fujian Medical UniversityShengli Clinical Medical College of Fujian Medical UniversityShengli Clinical Medical College of Fujian Medical UniversityShengli Clinical Medical College of Fujian Medical UniversityShengli Clinical Medical College of Fujian Medical UniversityShengli Clinical Medical College of Fujian Medical UniversityShengli Clinical Medical College of Fujian Medical UniversityAbstract Early differentiation of cervical lymphoma from benign lymphadenopathy remains challenging on conventional imaging. This study assesses the diagnostic efficacy of perfluorobutane contrast-enhanced ultrasound (CEUS) in differentiating early-stage cervical lymphoma from benign lymph nodes (LNs). From November 2023 to January 2025 we prospectively enrolled patients suspected of having cervical lymphoma based on ultrasound (US) findings and scheduled for LN biopsy. All patients underwent CEUS to evaluate LN vascular (5–60 s post-injection) and postvascular (10–30 min post-injection) phases before biopsy. Histopathology served as the reference standard. Diagnostic performance metrics, including sensitivity, specificity, and accuracy, were calculated. Logistic regression analyzed the area under the receiver operating characteristic curve (AUC) for US, CEUS, and combined features. Forty-seven LNs (23 lymphomas, 24 benign) were analyzed. The sensitivity of the postvascular phase starfield sign was 91.30%, specificity was 83.33%, positive predictive value was 84.00%, negative predictive value was 90.91%, and the AUC was 0.87 (95% CI 0.76–0.98). The AUC for CEUS was 0.89 (95% CI 0.79–1.00), and the AUC for the combination of postvascular phase and US features was 0.92 (95% CI 0.82–1.00), significantly higher than that for US features alone (AUC, 0.68; 95% CI 0.53–0.84; P < 0.05). Perflubutane CEUS can effectively distinguish between cervical lymphoma and benign LNs. The postvascular phase starfield sign demonstrates significant diagnostic efficacy and could improve clinical management strategies.https://doi.org/10.1038/s41598-025-13771-0PerflubutaneCervical lymphomaContrast-enhanced ultrasoundPostvascular phaseLymph nodeStarfield sign
spellingShingle Xia Liang
Xian-Tao Zeng
Zhi-Liang Hong
Xiao-Ying Lin
Miao-jiao Su
Jian-Chuan Yang
Song-Song Wu
Perfluorobutane CEUS for early-stage cervical lymphoma: diagnostic value of the postvascular phase starfield sign
Scientific Reports
Perflubutane
Cervical lymphoma
Contrast-enhanced ultrasound
Postvascular phase
Lymph node
Starfield sign
title Perfluorobutane CEUS for early-stage cervical lymphoma: diagnostic value of the postvascular phase starfield sign
title_full Perfluorobutane CEUS for early-stage cervical lymphoma: diagnostic value of the postvascular phase starfield sign
title_fullStr Perfluorobutane CEUS for early-stage cervical lymphoma: diagnostic value of the postvascular phase starfield sign
title_full_unstemmed Perfluorobutane CEUS for early-stage cervical lymphoma: diagnostic value of the postvascular phase starfield sign
title_short Perfluorobutane CEUS for early-stage cervical lymphoma: diagnostic value of the postvascular phase starfield sign
title_sort perfluorobutane ceus for early stage cervical lymphoma diagnostic value of the postvascular phase starfield sign
topic Perflubutane
Cervical lymphoma
Contrast-enhanced ultrasound
Postvascular phase
Lymph node
Starfield sign
url https://doi.org/10.1038/s41598-025-13771-0
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