Real-Time Tissue Elastography for the Diagnosis of Lymph Node Metastasis in Oral Squamous Cell Carcinoma

Ishibashi, Naomi; Yamagata, Kenji; Sasaki, Hiroyoshi; Seto, Kahori; Shinya, Yoshiko; Ito, Hiroyuki; Shinozuka, Keiji; Yanagawa, Toru; Onizawa, Kojiro; Bukawa, Hiroki

doi:10.1016/j.ultrasmedbio.2011.12.004

Cited by 35 publications

(36 citation statements)

References 15 publications

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“…They also found significant differences in elastography scores and portions of blue areas between metastatic and nonmetastatic LNs, revealing a sensitivity of 83.87% and a specificity of 82.50%. In our investigation, however, real-time tissue elastography revealed an even higher sensitivity which might be caused by the different anatomical regions that had been investigated (cervical LNs in the study of Ishibashi et al [35] vs. mainly inguinal LNs in our study). The usefulness of real-time tissue elastography concerning the differential diagnoses of cervical lymphadenopathy has been explored by Bhatia et al [36].…”

Section: Discussioncontrasting

confidence: 56%

“…Ishibashi et al [35] investigated the value of real-time tissue elastography for the diagnosis of LN metastases in patients with oral squamous carcinoma. They also found significant differences in elastography scores and portions of blue areas between metastatic and nonmetastatic LNs, revealing a sensitivity of 83.87% and a specificity of 82.50%.…”

Section: Discussionmentioning

confidence: 99%

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Real-Time Tissue Elastography as Promising Diagnostic Tool for Diagnosis of Lymph Node Metastases in Patients with Malignant Melanoma: A Prospective Single-Center Experience

et al. 2013

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Background: Real-time tissue elastography is a new, noninvasive method inultrasonography, differentiating tissues according to their stiffness. Earlier studies have highlighted this technique as a useful diagnostic tool for the detection of noncutaneous malignancies like breast, prostate and thyroid cancer based on the principle that tumor cells present a higher stiffness compared to the adjacent normal tissue. Objective: The purpose of our study was to investigate the value of real-time tissue elastography for the differentiation of benign and metastatic peripheral lymph nodes (LN) in patients with cutaneous melanoma by comparing this technique with conventional B-mode sonography combined with power Doppler sonography (PDS). Methods: In this prospective study, 36 melanoma patients (23 females and 13 males, mean age 62.7 ± 11.1 years) undergoing LN excision at the Department of Dermatology and Allergy, University of Bonn, were included between July 2011 and July 2012. Real-time tissue elastography was planned prior to surgery and histopathological examination. Elasticity images had been qualitatively scored for the proportion of stiff areas from pattern 1-5 (soft to stiff) on the basis of a newly defined system for LNs. Results: A total of 42 LNs have been removed in 36 patients. Of these 42 LNs, 21 carried melanoma cells and 21 were benign LNs. Significant differences in elastographic patterns were found between metastatic and nonmetastatic LNs. In real-time tissue elastography, 19 (90.5%) of 21 metastatic LNs showed a pattern of 3, 4 or 5. Of all benign LNs, 76.2% had a pattern of 1 or 2 in their elastogram. Sensitivity and specificity of B-mode sonography combined with PDS were 80.9 and 76.2%, respectively, 90.5 and 76.2% for elastography and 95.2 and 76.2% for the combined evaluation. Conclusion: An elastography pattern ≥3 was identified as an independent significant factor, predicting a metastatic LN involvement. The combination of elastography with conventional B-mode sonography has the potential to further improve the differentiation between benign and metastatic peripheral LNs in melanoma patients.

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Section: Discussioncontrasting

confidence: 56%

Section: Discussionmentioning

confidence: 99%

Real-Time Tissue Elastography as Promising Diagnostic Tool for Diagnosis of Lymph Node Metastases in Patients with Malignant Melanoma: A Prospective Single-Center Experience

et al. 2013

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“…To remedy this deficit, Ishibashi et al, (2012) raised a modification of the previously reported scoring system by Alam et al, ( 2011). Score 1, no blue area; Score 2, small blue area; Score 3, half of LN colored blue; Score 4, more than half of the LN colored blue; and Score 5, a peripheral blue area and a central red, yellow or green area (indicating obvious central necrosis).…”

Section: 5487 Clinical Value Of Real Time Elastography In Patients Wmentioning

confidence: 99%

Clinical Value of Real Time Elastography in Patients with Unexplained Cervical Lymphadenopathy: Quantitative Evaluation

Fu¹,

Yun-fei²,

Yan³

et al. 2014

Asian Pacific Journal of Cancer Prevention

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Ultrasonography is non-invasive and can give useful clues in the diagnosis of cervical lymphadenopathy, However, differential diagnosis is difficult in some situations even combined with color Doppler imaging. The present study was conducted to evaluate the clinical value of real time elastography in patients with unexplained cervical lymphadenopathy using a quantitative method. From May 2011 to February 2012, 39 enlarged lymph nodes from 39 patients with unexplained cervical lymphadenopathy were assessed. All the patients were examined by both B-mode ultrasound, color Doppler flow imaging and elastography. The method of analyzing elasto-graphic data was the calculation of the 10 parametres ("mean", "sd", "area%", "com", "kur", "ske", "con", "ent", "idm", "asm") offered by the software integrated into the Hitachi system. The findings were then correlated with the definitive tissue diagnosis obtained by lymph node dissection or biopsy. Final histology revealed 10 cases of metastatic lymph nodes, 11 cases of lymphoma, 12 cases of tuberculosis and 6 cases of nonspecific lymphadenitis. The significant distinguishing features for conventional ultrasound were the maximum short diameter (p=0.007) and absent of echogenic hilum (p=0.0293). The diagnostic accuracy was 43.6% (17/39 cases) and there were 17 patients with equivocal diagnosis. For elastography, "mean" (p=0.003), "area%" (p=0.009), "kurt" (p=0.0291), "skew" (p=0.014) and "cont" (p=0.012) demonstrated significant differences between groups. With 9 of the 17 patients with previous equivocal diagnoses (52.9%) definite and correct diagnoses could be obtained. The diagnostic accuracy for conventional ultrasound combined elastography was 69.2% (27/39 cases). There were differences in the diagnostic sensitivity of the two methods (p=0.0224). Ultrasound combined with elastography demonstrated higher rates of conclusive and accurate diagnoses in patients with unexplained cervical lymphadenopathy than conventional ultrasound. The quantitative program showed good correlation with the pathology of different lymph node diseases.

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“…Appearance of lymph node types on sonoelastography: a. benign, soft node, type 1 in all scores; b. node with less than 50% hard surface, type 2 in most scores, type 1 by Furukawa [19]; c. Node with central stiff area, occupying more than 50% of the surface, type 3 according to Alam [7] and [19], type 4 according to Ishibashi [21] and type 5 by Lenghel [15]; d. node with central elastic core and hard peripheral rim, more than 50% blue, type 4 by [7] and [21], type 3 by [19], type 5 by [15]; e. the node surface is entirely blue, type 5 by [7], type 4 by [19] and [21], type 7 by [15]; f. Node with central necrosis displaying the blue-green-red pattern, type 5 by [21], type 8 by [15], unclassified by other authors.…”

Section: Figmentioning

confidence: 99%

Differentiating benign from malignant superficial lymph nodes with sonoelastography

et al. 2013

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The aim of the paper is to provide a comprehensive overview on the applications of real time sonoelastography (SE) in the diagnosis of superficial lymphadenopathy. Some technical aspects of performing SE are presented as a preamble. The typical appearance of benign and malignant nodes is illustrated. The paper discusses and depicts the various elastographic scores in use. It also provides a critical appraisal of the relative strain ratio (SR) or stiffness index. Shear wave elastography, as a novel technique, is mentioned. In conclusion, hardness on more than 50% of the node surface or SR > 1.5 is fair to good indicators of malignancy. Work is still needed both to fully understand the various appearance of disease and to standardize the application.Keywords: sonoelastography, lymph nodes, neoplasm Accurate assessment of the superficial lymph node status is of paramount importance in the treatment planning, follow-up and prognosis of malignancies originating in the head and neck, breast, superficial tissues or in lymphoma. Ultrasonography (US) is extensively used as a first line diagnostic means, due to its cost-effectiveness, ease of use and high resolution of provided information. However, grey-scale and Doppler information are limited either in sensitivity or specificity and no single US criterion has sufficient diagnostic accuracy [1][2][3][4][5].Sonoelastography (SE) depicts the relative stiffness of tissues. Beyond breast, prostate and thyroid applications, over the last five years, the method was also used as a complimentary imaging technique to conventional US for the assessment of superficial lymph nodes [6][7][8][9]. Assessment of nodal SE information is done either by grading the appearance on a score system (elasticity score -ES) or by calculating a relative stiffness or strain ration (SR) [10].The aim of this paper is to review the current status of the knowledge on the applications of SE in the diagnosis of the character of superficial lymphadenopathy. Technical aspectsReal-time sonoelastography is, essentially, an elaborate speckle tracking technique with autocorrelation for out-of-plane displacement of the target [11,12]. It provides information about the relative stiffness of the structures within the scan plane, inside a region of interest (ROI). It is, therefore, important to encompass in the scan area not only the target lesion but also surrounding "normal" reference soft tissues. There are no standard recommendations on how to achieve this. In our experience [13,14], the upper limit of the ROI should always be placed as close to the transducer as possible. When aiming to use ES, the ROI should exceed the target boundaries at least 5 mm on each side. When the purpose is to calculate SR, the ROI should be as wide as possible, to encompass both the target lesion and the surrounding, reference tissue, at the same depth with the lesion. Transducer stabilizer, although desirable, is difficult to use of curved surfaces such as neck or axilla. During compression the transducer should be perpen...

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Real-Time Tissue Elastography for the Diagnosis of Lymph Node Metastasis in Oral Squamous Cell Carcinoma

Cited by 35 publications

References 15 publications

Real-Time Tissue Elastography as Promising Diagnostic Tool for Diagnosis of Lymph Node Metastases in Patients with Malignant Melanoma: A Prospective Single-Center Experience

Real-Time Tissue Elastography as Promising Diagnostic Tool for Diagnosis of Lymph Node Metastases in Patients with Malignant Melanoma: A Prospective Single-Center Experience

Clinical Value of Real Time Elastography in Patients with Unexplained Cervical Lymphadenopathy: Quantitative Evaluation

Differentiating benign from malignant superficial lymph nodes with sonoelastography

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