Reliability of sonoelastography in predicting pediatric cervical lymph node malignancy

Zakaria, Ossama M; Mousa, Ahmed; AlSadhan, Reema; Sultan, Tamer A; Eid, Ahmed Fathi; Daoud, Mahmoud; Al-Taher, Asmaa; Zakaria, Hazem; Swaroop, Krishna; El-Gibaly, Amr M.; Al-Arfaj, Haytham; Abdelbary, Essam

doi:10.1007/s00383-018-4301-x

Cited by 17 publications

(17 citation statements)

References 19 publications

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“…The study by Alam et al was similar to the study done by Zakaria et al [28]. Our study had tuberculosis and chronic granulomatous inflammation cases, which had given false-positive results as metastasis, leading to lower specificity and diagnostic accuracy.…”

Section: Discussionsupporting

confidence: 78%

Estimation of Accuracy of B-Mode Sonography and Elastography in Differentiation of Benign and Malignant Lymph Nodes With Cytology as Reference Standard: A Prospective Study

Rajendra¹,

Varatharajaperumal²,

Renganathan³

et al. 2021

Cureus

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Purpose: To prospectively estimate the reliability of B-mode ultrasonography and sonoelastography in differentiating benign and malignant cervical lymph nodes with cytological findings as to the reference standard.Materials and Methods: A total of 50 patients referred for sonography for enlarged cervical lymph nodes were included in the study. They were subjected initially to B-mode ultrasonography and sonoelastography and later underwent fine-needle aspiration cytology (FNAC) in the same sitting. Sensitivity, specificity, and accuracy were compared.Results: Out of 50 cases, 33 were males, and 17 were females. On B-mode ultrasonography, 15 enlarged cervical lymph nodes were benign-looking and 35 were malignant-looking. When studied on elastography, 12 were benign-looking and 38 showed features of malignancy. However, when studied histopathologically, 18 were benign and 32 were malignant. The sensitivity, specificity, and diagnostic accuracy were compared, and the results were better in sonoelastography than B-mode ultrasonography. When both B-mode and sonoelastography were combined, an increase in the sensitivity for differentiation was achieved. However, a decrease in specificity was noted when both modalities were combined in our study, probably due to a significant number of patients with tuberculous cervical lymphadenopathy. Conclusion:In countries like India, where granulomatous infection like tuberculosis is prevalent, the combination of sonoelastography with B-mode ultrasonography has decreased specificity in the differentiation of benign and malignant cervical lymph nodes, and histopathology is always needed for the final confirmation of diagnosis. The decreased specificity on elastography is attributed to simultaneous coexisting inflammation and fibrosis in chronic granulomatous lymphadenopathy.

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Section: Discussionsupporting

confidence: 78%

Estimation of Accuracy of B-Mode Sonography and Elastography in Differentiation of Benign and Malignant Lymph Nodes With Cytology as Reference Standard: A Prospective Study

Rajendra¹,

Varatharajaperumal²,

Renganathan³

et al. 2021

Cureus

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“…In selected cases, computed tomography or magnetic resonance imaging can be used to gain further information. Ultrasound elastography can also be used as an adjunct tool for sonographic findings, which can improve the accuracy of predicting malignant lymph nodes [ 2 ]. Thick cortex with loss of fatty hilum, central necrosis and a heterogeneous echo pattern with hyperechoic foci are suspicious characteristics in imaging modalities.…”

Section: Preoperative: Evaluation Images Special Needs and Biopsy Needmentioning

confidence: 99%

International Society of Paediatric Surgical Oncology (IPSO) Surgical Practice Guidelines

Abib¹,

Chui²,

Cox³

et al. 2022

ecancer

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Most children with tumors will require one or more surgical interventions as part of the care and treatment, including making a diagnosis, obtaining adequate venous access, performing a surgical resection for solid tumors (with staging and reconstruction), performing procedures for cancer prevention and its late effects, and managing complications of treatment; all with the goal of improving survival and quality of life. It is important for surgeons to adhere to sound pediatric surgical oncology principles, as they are closely associated with improved local control and survival. Unfortunately, there is a significant disparity in survival rates in low and middle income countries, when compared to those from high income countries.The International Society of Paediatric Surgical Oncology (IPSO) is the leading organization that deals with pediatric surgical oncology worldwide. This organization allows experts in the field from around the globe to gather and address the surgical needs of children with cancer. IPSO has been invited to contribute surgical guidance as part of the World Health Organization Initiative for Childhood Cancer. One of our goals is to provide surgical guidance for different scenarios, including those experienced in High-(HICs) and Low-and Middle-Income Countries (LMICs). With this in mind, the following guidelines have been developed by authors from both HICs and LMICs. These have been further validated by experts with the aim of providing evidence-based information for surgeons who care for children with cancer.We hope that this initiative will benefit children worldwide in the best way possible.

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“…In 2018, a prospective study reported excellent results of elastography in predicting malignant cervical lymphadenopathy in children compared with tissue sampling. 14 Interestingly, they also declared that such tool may be an option in the future to replace surgical biopsies and to follow-up children with cervical malignancies. We agree with their findings regarding increased sensitivity and specificity of elastography when combined with other ultrasound modalities, whereas we do not agree with their conclusion about the future potential replacement of biopsies by elastography or by any radiological modalities.…”

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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Reliability of sonoelastography in predicting pediatric cervical lymph node malignancy

Cited by 17 publications

References 19 publications

Estimation of Accuracy of B-Mode Sonography and Elastography in Differentiation of Benign and Malignant Lymph Nodes With Cytology as Reference Standard: A Prospective Study

Estimation of Accuracy of B-Mode Sonography and Elastography in Differentiation of Benign and Malignant Lymph Nodes With Cytology as Reference Standard: A Prospective Study

International Society of Paediatric Surgical Oncology (IPSO) Surgical Practice Guidelines

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

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