B-mode ultrasound, color Doppler, and sonoelastography in differentiation between benign and malignant cervical lymph nodes with special emphasis on sonoelastography

Abdelgawad, Ehab Ali; Samra, Manal F. Abu; Abdelhay, Nasr Mohammed; Abdel-Azeem, Hoda Mokhtar

doi:10.1186/s43055-020-00273-4

Cited by 12 publications

(17 citation statements)

References 22 publications

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“…In our study, lymph nodal echogenicity had a diagnostic accuracy of 67%. Similar results were obtained in a study by Abdelgawad et al [ 8 ]. Benign lymph nodes (tuberculous and reactive lymphadenitis) tend to have homogenously hypoechoic echo pattern.…”

Section: Discussionsupporting

confidence: 92%

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Role of Sonoelastography in Differentiating Benign From Malignant Cervical Lymph Nodes and Correlating With Pathology

Vineela¹,

Sakalecha²,

Suresh³

2022

Cureus

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Background and aimCombined use of ultrasonography and elastography improves diagnostic efficacy in differentiating benign from malignant cervical lymph nodes, thereby helping in treatment planning and reducing unnecessary fine needle aspiration cytology/ biopsy. This study aimed to correlate B-mode ultrasonography, color Doppler imaging, and elastography findings with pathological findings and to calculate sensitivity, specificity, and diagnostic accuracy of ultrasonography and elastography. Material and methodsPatients underwent ultrasonography (B-mode and color Doppler imaging) followed by elastography. Lymph node morphology on B-mode was assessed based on short axis diameter, short-to-long axis ratio, fatty hilum, echogenicity, and margin. Vascularity of lymph nodes on color Doppler imaging was divided into three patterns. On elastography, lymph nodes were defined based on elastography pattern and strain index. ResultsAmong all ultrasonography parameters, fatty hilum was found to have the highest diagnostic accuracy (73%), followed by vascularity pattern (70%). Combined use of all ultrasonography parameters yielded better sensitivity (90%), specificity (88%), and diagnostic accuracy (89%) than individual parameters. Five-scale elastography pattern had 83% sensitivity, 97% specificity, and 89% diagnostic accuracy. In the current study, the use of strain index cut-off of two showed sensitivity of 93%, specificity of 96%, and diagnostic accuracy of 94%. Together, ultrasonography and elastography achieved sensitivity of 96%, specificity of 94%, and diagnostic accuracy of 95%. ConclusionElastography can be a useful adjunct to ultrasonography for the accurate diagnosis of cervical lymphadenopathy. Elastography pattern and cut-off strain index of two can effectively differentiate benign from malignant cervical lymph nodes.

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Section: Discussionsupporting

confidence: 92%

“…Benign lymph nodes (tuberculous and reactive lymphadenitis) tend to have homogenously hypoechoic echo pattern. However, lymphomatous and metastatic cervical lymph nodes can also be hypoechoic [ 8 , 9 ].…”

Section: Discussionmentioning

confidence: 99%

Role of Sonoelastography in Differentiating Benign From Malignant Cervical Lymph Nodes and Correlating With Pathology

Vineela¹,

Sakalecha²,

Suresh³

2022

Cureus

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“…Similar accurate results of sensitivity were also declared by Tan et al, Teng et al, and Abdelgawad et al, and they are 98.1, 96.4, and 92.8%, respectively. 8 16 17 In contradictory, Lo et al reported low sensitivity of 66.7% regarding elastography, and Acu et al observed sensitivity of 82.1%. 11 18 Both studies finally concluded that elastography has no additional benefits over B-mode and color Doppler ultrasound to improve the differentiation between malignant and benign nodes.…”

Section: Discussionmentioning

confidence: 99%

“…16,23 Abdelgawad et al also documented that one out of two patients with TB lymphadenitis was misdiagnosed as a malignant lesion by sonoelastography. 17 The false diagnosis is mainly based on the presence of internal calcification due to long-term organization that causes increased elasticity and may mimic malignancies. 23 Six patients were encountered as false-positive results in our study, one of them was TB lymphadenitis and the other five had nonspecific lymphadenitis of long duration more than 8 weeks before diagnosis that also led to increased fibrous tissue in internal structures and consequently appeared hard in consistency.…”

Section: Discussionmentioning

confidence: 99%

Ultrasound Elastography in the Diagnosis of Malignant Cervical Lymphadenopathy in Children: Can It Replace Surgical Biopsy?

et al. 2021

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Introduction We aimed to assess the accuracy of ultrasound elastography in detecting pediatric malignant cervical lymph nodes, and if this modality can obviate the need for surgical biopsies. Material and Methods A prospective study from September 2017 to September 2020 included 64 children with persistent cervical lymphadenopathy. Patients were evaluated by meticulous history and physical assessment. B-mode ultrasound, color Doppler, and sonoelastography were conducted thereafter. Elastography scans were classified into five patterns, and patterns from 3 to 5 were considered as malignancies. All children underwent open biopsies followed by pathological examination. Results of tissue diagnosis were compared with patterns of elastography to determine its accuracy. Results Twenty-eight patients (43.8%) had malignant nodes and the remaining 36 (56.2%) were due to benign causes. Elastography patterns of 1 and 2 were documented in 30 patients, and all of them were diagnosed as benign lesions. Patterns of 3 to 5 were demonstrated in 34 patients. Out of them, 28 were confirmed as malignancies, while 6 children were of benign nature (false positive). Ultrasound elastography achieved sensitivity and specificity of 100 and 85.7%, respectively, and an overall accuracy of 90.6% in the differentiation between malignant and benign entities. The overall accuracy of B-mode and color Doppler were 75 and 82.2%, respectively. Conclusion Elastography is a useful tool that should be added to ultrasound modalities during the diagnosis of pediatric cervical lymphadenopathy. Surgical biopsy in eligible patients is imperative to commence proper therapy or to discharge the child. Despite favorable results of elastography, it cannot replace surgical biopsy or change its indications.

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“…2 It is versatile masquerader as it can resemble infection or neoplasm and poses a diagnostic challenge to the clinicians 9 and on ultrasound and elastography. 10 B-mode sonography-Tubercular lymph nodes are large, S/L ratio>0.5, shows absence of echogenic hilum, intranodal necrosis, calci cation. Similar observations were made by Park J H et al 11 Ying et al 12 in their study including 315 tuberculous nodes, reported that 79% had increased S/L ratio >0.5 however the percentage was less than that in metastatic nodes 95%.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of sonographic and strain elastographic findings in tubercular cervical lymphadenopathy.Evaluation of sonographic and strain elastographic findings in tubercular cervical lymphadenopathy.

Yadav

Malik

Prasad

2022

Preprint

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Purpose–Tuberculous cervical lymphdaenopathy is the most common manifestation of extrapulmonary tuberculosis and frequently present imaging diagnostic dilemma with metastatic lymphadenopathy. Ours is observational study done to evaluate the role of sonography including Doppler and strain elastography in tubercular cervical lymphadenopathy.Methods-100 fine needle aspiration cytology/histopathological examination(FNAC/HPE) proven tubercular lymph nodes were evaluated with sonography and strain elastography Features evaluated with sonography are location, size, short/long axis diameter(S/L) ratio, presence or absence of echogenic hilum ,intra-nodal necrosis, intra-nodal calcification associated soft tissue features like periadenitis or collection and pattern of vascularity. With strain elastography(USE) color coded elastograms and strain ratio were evaluated. Results-On evaluation tubercular nodes are large size, S/L ratio >0.5, show intra-nodal necrosis and peripheral vascular pattern. 91% tuberculous lymph nodes had color coded elastograms>2 pattern which is similar to malignant lymph nodes and 99% of tuberculous lymph nodes show strain ratio< 1.99.Conclusion - Grey scale and Doppler assessment of tubercular lymph nodes reveals findings similar to that encountered in metastatic nodes, hence differentiation difficult .While strain ratio being semi-quantitative is more objective criteria of assessment compared to color coded elastograms. Hence adding semi-quantitative elastographic evaluation with US will help in further characterization of tuberculous nodes.

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B-mode ultrasound, color Doppler, and sonoelastography in differentiation between benign and malignant cervical lymph nodes with special emphasis on sonoelastography

Cited by 12 publications

References 22 publications

Role of Sonoelastography in Differentiating Benign From Malignant Cervical Lymph Nodes and Correlating With Pathology

Role of Sonoelastography in Differentiating Benign From Malignant Cervical Lymph Nodes and Correlating With Pathology

Ultrasound Elastography in the Diagnosis of Malignant Cervical Lymphadenopathy in Children: Can It Replace Surgical Biopsy?

Evaluation of sonographic and strain elastographic findings in tubercular cervical lymphadenopathy.Evaluation of sonographic and strain elastographic findings in tubercular cervical lymphadenopathy.

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