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

Abstract

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.

Utility of perioperative ultrasonography and fine-needle aspiration cytology in differentiation between benign and malignant cervical lymphadenopathy: a retrospective cohort study

“…In our analysis, margin irregularity was more commonly observed in malignant CLA cases; however, this difference was not statistically significant, aligning with previous observations 19 , 20 . We did not observe a statistically significant correlation of the Short/long-axis ratio, diverging from previously reported studies 13 , 21 . Nevertheless, a statistically significant association was noted in the short-axis diameter, echoing the findings of van den Brekel et al 22 In our study, a short-axis dimension greater than 11 mm was associated with malignant CLA, yielding a sensitivity, specificity, PPV, NPV, and accuracy of 71.9%, 100.0%, 100.0%, 35.8%, and 75.7%, respectively.…”

“…In addition, morphological analysis was performed, which included measuring the short-axis dimension (threshold of 11 mm), short-to-long axis (S/L) ratio (cut-off value of 0.6), fatty hilum presence, echogenicity (homogenous or heterogeneous), calcification, and lymph node margins regularity. The vascularity of the lymph nodes was also evaluated using colour Doppler imaging (CDI), and categorized into three distinct patterns: pattern 1, indicative of hilar vascularity or no flow, suggesting benign characteristics; pattern 2, representing peripheral vascularity; and pattern 3, denoting mixed vascularity, both of which were considered indicative of malignant characteristics 10 , 13 . Features suggestive of malignancy included an L/S ratio greater than 0.6, short-axis dimension greater than 11, indistinct boundaries, hypoechoic nature, heterogeneous echogenicity, absence of lymphatic hilum, and abnormal blood flow patterns.…”

“…Furthermore, a receiver operating characteristic (ROC) curve was created to assess the diagnostic efficacy of US features alone, and in combination with FNAC, for predicting malignancy. A ROC curve was constructed to determine the most optimal measurable cut-off for diagnosis 10 , 13 , 14 .…”

Effectiveness of Two-Dimensional Shear-Wave Sonoelastography in the Diagnosis and Follow-up of Infantile Hypertrophic Pyloric Stenosis

“…Another eld in which USE is used is the differential diagnosis of pathologies that cause lymphadenopathy. Most such studies have been conducted in adults [30]. Bhatia et al, stated that USE is useful in the differential diagnosis of cervical benign and malignant lymphadenopathies [31].…”

Diagnostic Accuracy of Elastography to Differentiate Between Malignant and Benign Lymph Nodes of Neck and Head Region Taking Histopathology as Gold Standard

“…The lymph node (LN) is an oval-shaped lymphatic system organ that is linked through lymphatic vessels and is extensively distributed in the stomach, armpit, and all across the body [1][2][3] . Immune cells like T and B, are primarily located at lymph nodes.…”