Comparison of Diagnostic Performance of B-Mode Ultrasonography and Shear Wave Elastography in Cervical Lymph Nodes

Abstract

The purpose of this study was to compare the diagnostic performance of B-mode ultrasonography (US) and shear wave elastography (SWE) for differentiating benign from malignant cervical lymph nodes (LNs). This study evaluated 130 cervical LNs in 127 patients. On conventional B-mode US, short-axis and long-axis diameters, long-to-short-axis ratio, cortical morphology, border, and presence of necrosis or calcification were evaluated. Maximum elasticity value (Emax) was collected for SWE. The area under the receiver operator characteristic curve (AUC), sensitivity, and specificity of B-mode US features and SWE were compared. Final histopathologic results showed 89 benign and 41 metastatic LNs. Among the B-mode US features, cortical morphology had the highest AUC (0.884). When 54 kPa of Emax was applied as a cutoff value, the SWE showed significantly lower AUC than cortical morphology (0.734, P = 0.02). Both sensitivity and specificity for cortical morphology on B-mode US were higher than for Emax (80.5% vs 65.9%, P = 0.212 and 89.9% vs 76.4%, P = 0.026, respectively). Conventional B-mode US resulted in higher diagnostic yield than SWE in evaluating cervical LNs in our study. However, further studies on potential factors that may affect the SWE velocity are needed to validate the diagnostic value of SWE.

Diagnostic value of supersonic shear impulse elastography for malignant cervical lymph nodes: a Bayesian analysis

“…The eligible 10 articles with 590 patients (333 female and 257 male) were included in our study [13][14][15][16][17][18][19][20][21][22]. Seven of them were designed prospectively and 3 were retrospectively.…”

“…The intrinsic curvature of the neck and the superficial location of cervical lymph nodes can cause inhomogeneous stress distribution in the field of observation, though the primary thyroid cancer would have advantages in SSI in terms of its hardness [14,22]. In addition, the older subgroups showed a trend of lower sensitivity but higher specificity for both A c c e p t e d A r t i c l e mean and max elastic moduli.…”

The effect of regions-of-interest and elasticity modulus selection on differentiating benign and malignant cervical lymph nodes with shear wave elastography

“…Desmots et al reported a similar finding in another study on 62 LNs ( 13 ). However, Kang et al reported the opposite finding in a study of 130 LNs ( 14 ). Biological heterogeneity in the samples from different studies could partially contribute to the observed differences, such as the cell type and histology of the studied LNs.…”

“…However, although most of these studies demonstrated the ability of SWE in differentiating malignant cervical LNs from benign ones as well as in even more challenging subgroups, a standard quantitative elasticity modulus metric and a recommended threshold have not been established, especially in terms of the quantitative metric used for measuring elasticity modulus and selected ROI. Furthermore, inconsistent performances of SWE were also reported ( 13 , 14 , 20 ). A few studies reported an improvement of diagnostic accuracy with SWE compared with conventional US ( 13 , 20 ), while another study failed to show that ( 14 ).…”

“…Furthermore, inconsistent performances of SWE were also reported ( 13 , 14 , 20 ). A few studies reported an improvement of diagnostic accuracy with SWE compared with conventional US ( 13 , 20 ), while another study failed to show that ( 14 ). Using 67 LNs, Choi et al reported the superior performance of SWE compared with B-mode US in terms of accuracy, sensitivity, and specificity for differentiating malignant vs. benign cervical LNs ( 20 , 25 ).…”