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

Abstract

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.

Management of Pediatric Persistent Asymptomatic Cervical Lymphadenopathy

“…Our study supports that high‐resolution ultrasonography is a safe and minimally invasive approach for the surveillance of patients with PACL, as shown in Figure 4. Diagnostic ultrasound has the additional attractive characteristic for pediatric patients of not necessitating sedation or anesthesia and lacks radiation exposure risks 18‐20 …”

“…Diagnostic ultrasound has the additional attractive characteristic for pediatric patients of not necessitating sedation or anesthesia and lacks radiation exposure risks. [18][19][20]…”

Ultrasound Elastography in Children

“…UE was found to be a useful tool in assessing cervical lymph nodes in detecting pediatric malignancy, where UE achieved sensitivity of 100% and specificity of 85.7% with an overall accuracy of 90.6% in the differentiation between malignant and benign entities. Despite these favorable results, UE cannot replace surgical biopsy [ 84 ]. On the other hand, the strain index showed less promise in differentiation of benign and malignant cervical lymph nodes with the sensitivity, specificity and accuracy of 71.6%, 76.5% and 75.0%, respectively [ 85 ].…”