Texture analysis of ultrasonography to differentiate metastatic from nonmetastatic cervical lymph nodes in mandibular gingival squamous cell carcinoma

Aim This study aimed to distinguish between metastatic and nonmetastatic cervical lymph nodes (CLNs) in patients with mandibular gingival squamous cell carcinoma using texture analysis of lymph nodes on ultrasonography images. Methods A total of 29 metastatic and 34 nonmetastatic CLNs were selected for this study. Fifty‐six texture characteristics were retrieved from the ultrasonography images using the LIFEx software. The Mann–Whitney U test was used to evaluate measurable differences in texture characteristics between metastatic and nonmetastatic CLNs. The ability of the surface features to distinguish between metastatic and nonmetastatic CLNs was illustrated using receiver operating characteristic curves. Youden's J statistic was used to determine the receiver operating characteristic curve cutoff values with maximal sensitivity and specificity. Results Gray‐level nonuniformity, run length nonuniformity, coarseness, strength, and zone size nonuniformity showed the most notable contrast between the metastatic and nonmetastatic CLNs ( p < 0.001). Zone size nonuniformity showed an area under the curve value of 0.827, sensitivity of 0.645, and specificity of 0.972 at the cutoff value of 1010.538. Conclusion Qualitative characteristics may be the optimal surface features to distinguish between metastatic and nonmetastatic CLNs and predict CLN metastasis in patients with mandibular gingival squamous cell carcinoma.