Diagnostic Accuracy of Multiparametric Ultrasound Versus Cross-Sectional Imaging for Differentiating Benign and Malignant Cervical Lymph Nodes: A Histopathology-Referenced Retrospective Study

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, 6.0–24.9%), higher sensitivity by 12.5% (95% CI, 2.5–23.4%), 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.