Modified sonoelastographic scale score for lymph node assessment in lymphoma – a preliminary report

Abstract

Elastography is a new method of assessment of lymph node consistency. The majority of papers focus on metastases detection of head and neck or breast tumors. The typical desmoplastic reaction in connective tissue stroma in cancer, which is responsible for tissue's hardening, is seen in lymphoma less frequently.Material and methodsStudy of 15 patients with active Hodgkin and non-Hodgkin lymphomas and 16 previously treated patients with no evidence of recurrence. A total of 60 patients suffering from reactive lymphadenopathy was the control group. The size, appearance, vascularity and elastogram of lymph node was analyzed.ResultsType C elastogram correlated strongly with lymph nodes which presented at least three pathologic features in 2D image. Large lymph nodes with long axis diameter over 3 cm may have ‘cheese with holes’ appearance rather than common type C elastogram.ConclusionAccording to our simplified sonoelastography scoring system, type C elastogram was present mainly in patients with active lymphoma affecting lymph nodes, which showed all four features that we analyzed using conventional ultrasonography. This elastogram was also present in reactive lymphadenopathies. Distinctive for large lymph nodes in patients with active forms of lymphoma “cheese with holes” appearance, can be considered as equal with type C image, although it is corresponding to type B sonoelastographic map.

Differentiating cervical metastatic lymphadenopathy and lymphoma by shear wave elastography

“…We considered these pathologic differences may differ the result of tissue elasticity of metastatic and lymphomatous LN, resultant of different SWE value of two diseases. The advanced subtypes of nodular sclerosis and mixed-cell of Hodgkin’s lymphoma are exceptional, because they usually have desmoplastic reaction, and this feature may be the cause of difficulty to differentiate them from metastatic LN 28 . However, in our study, two mixed cell type Hodgkin’s lymphoma had SWE pattern 1 (absent or very small red area) so all three radiologists could diagnose them correctly.…”

The EFSUMB Guidelines and Recommendations for the Clinical Practice of Elastography in Non-Hepatic Applications: Update 2018

“…Only a limited number of studies with small sample sizes are available and invariably have a selection bias [308,309]. Some malignant lymph nodes cannot be discriminated by tissue stiffness alone, as is the case with the lymph nodes of lymphoma [310]. There is no standardization of the technique particularly in SE, making study comparisons difficult [311].…”

Dentists can provide reliable shear wave elastography measurements of the stiffness of masseter muscles: A possible scenario for a faster diagnostic process

“…In contrast, in other specialties of medicine, SWE of internal organs can be conducted by physicians who treat the disease themselves and, at the same time, can use this examination as a fast, cheap and non-invasive modality to evaluate disease progression or to check the effectiveness of the treatment being used. 22,23 Furthermore, SWE can be performed by a trained radiology technician. 24 Such approaches may help in designing faster pathways for diagnosis and treatment evaluation as well as reducing treatment costs.…”