Quantitative and Qualitative Approach for Shear Wave Elastography in Superficial Lymph Nodes

Chami, L.; Giron, Alain; Ezziane, Malek; Leblond, Véronique; Charlotte, Frédéric; Pellot‐Barakat, Claire; Lucidarme, Olivier

doi:10.1016/j.ultrasmedbio.2021.04.008

Cited by 8 publications

(13 citation statements)

References 36 publications

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“…This could explain why in our cohort SWE was superior to the Solbiati Index, especially in the group of CLN with a SAD less than 1 cm. Our results support previous findings stating that higher velocity (and therefore higher stiffness) is a sign of malignancy [ 17 , 18 ], with the mean SWE in our cohort in benign CLN reported as 1.72 m/2 (±0.69 m/s) and the mean SWE of malignant CLN with 2.63 m/s (±1.03 m/s).…”

Section: Discussionsupporting

confidence: 92%

Quantitative Multiparametric Ultrasound (mpUS) in the Assessment of Inconclusive Cervical Lymph Nodes

Lerchbaumer

Wakonig

Arens

et al. 2022

Cancers

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Background: Enlarged cervical lymph nodes (CLN) are preferably examined by ultrasound (US) by using criteria such as size and echogenicity to assess benign and suspicious CLN, which should be histologically evaluated. This study aims to assess the differentiation of malign and benign CLN by using multiparametric US applications (mpUS). Methods: 101 patients received a standardized US protocol prior to surgical intervention using B-mode–US, shear-wave elastography (SWE) and contrast-enhanced ultrasound (CEUS). SWE was assessed by 2D real-time SWE conducting a minimum of five measurements, CEUS parameters were assessed with post-processing perfusion software. Histopathological confirmation served as the gold standard. Results: B-mode–US and SWE analysis of 104 CLN (36 benign, 68 malignant) showed a significant difference between benign and malignant lesions, presenting a larger long axis and higher tissue stiffness (both p < 0.001). Moreover, tissue stiffness assessed by SWE was significantly higher in CLN with regular B-mode–US criteria (Solbiati Index > 2 and short-axis < 1 cm, p < 0.001). No perfusion parameter on CEUS showed a significant differentiation between benign and malignant CLN. Discussion: As the only multiparametric parameter, SWE showed higher tissue stiffness in malignant CLN, also in subgroups with regular B-mode criteria. This fast and easy application may be a promising noninvasive tool to US examination to ameliorate the sonographic differentiation of inconclusive CLN.

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Section: Discussionsupporting

confidence: 92%

Quantitative Multiparametric Ultrasound (mpUS) in the Assessment of Inconclusive Cervical Lymph Nodes

Lerchbaumer

Wakonig

Arens

et al. 2022

Cancers

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“…In our study, both the E Median and Vs Median of malignant LNs (metastatic LNs and lymphoma) were remarkably higher than that of benign ones, and those of metastatic LNs were among the highest, which share similarities with previous studies (23)(24)(25). Since the invasiveness of malignancy may lead to the deposited extracellular matrix and cross-linked collagen to finally affect the stiffness of tissue growth (21,26), besides, calcification and inflammation of lesions may also elevate tissue stiffness (27).…”

Section: Discussionsupporting

confidence: 90%

“…The reasons may be summarized as follows: firstly, the stiffness of target LNs varies according to their pathological period and different primary tumors ( 35 ); secondly, the stiffness is closely related to the anatomical features of the body where the target LNs are located. Hence, the uneven skin of the neck and the presence of the large blood vessels or trachea may result in a higher E Median value, while axillary with loose subcutaneous tissue may indicate a lower value, and the reason is still unclear ( 25 ). In this study, the diagnostic performance of both conventional US, 2-D SWE, and the two combined showed that although SWE indicated an elevated diagnostic efficiency, the two combined were still higher than that of the single performance.…”

Section: Discussionmentioning

confidence: 99%

Differential Diagnosis Value of Shear-Wave Elastography for Superficial Enlarged Lymph Nodes

Sun

Wang

et al. 2022

Front. Oncol.

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ObjectivesTo evaluate the diagnostic efficiency and diagnostic threshold of conventional US and shear-wave elastography (SWE) in superficial enlarged lymph nodes (LNs).MethodsA total of 204 patients with superficial enlarged LNs were enrolled in this retrospective study aged 46.0 ± 15.2 years from March 2020 to March 2021. LNs with a long axis larger than 0.7 cm were considered as superficial enlarged. Before the histological biopsy, LNs that were considered suspicious according to both conventional US and SWE were included, while LNs with no or unclear pathological results, or with no satisfactory SWE images, were excluded. The conventional and 2-D SWE examinations were performed with Aplio i800 and Acuson sequoia equipped with i18LX5 linear-array transducer (5-18 MHz) and 10L4 linear-array transducer (4-10 MHz), respectively. Both E Median and Vs Median parameters were investigated by two senior ultrasound physicians. The pathological results were performed as the gold standard.ResultsVariables including transverse axis size, lymphatic hilum, L/T ratio, echogenicity, and color Doppler pattern were considered significant. The mean E Median value in benign, metastatic LNs, and lymphoma were 28.26 ± 8.87 kPa, 77.46 ± 22.85 kPa, and 50.37 ± 5.41 kPa (p <0.001), while Vs Median values were 3.02 ± 0.50 m/s, 4.87 ± 0.90 m/s, and 4.09 ± 0.22 m/s, respectively (p < 0.001). The diagnostic performance indicated the high sensitivity, specificity, PPV, NPV, and overall accuracy of conventional US combined with SWE. The optimal cutoff values of E Median and Vs Median for predicting malignant LNs were 42.90 kPa and 3.73 m/s, respectively. As AUC value, sensitivity, specificity, accuracy, PPV, and NPV revealed, the indexes of E Median were 0.976, 0.927, 0.975, 0.946, 0.983, and 0.897, respectively, while Vs Median were 0.970, 0.927, 0.963, 0.941, 0.975, and 0.895, respectively (p <0.001). The ROC curves of both E Median (AUC=0.976) Vs Median (AUC=0.970) suggested the remarkable diagnostic efficiency in distinguishing benignity between suspected malignant LNs.ConclusionsAbove results indicated that conventional US together with 2-D SWE could elevate the diagnostic performance. Meanwhile, the parameters of 2-D SWE including E Median and Vs Median could effectively assess malignant LNs, which provide valuable differentiating information in superficial enlarged LNs.

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“…Except for size, these values are hardly comparable as they are not objective criteria. Based on the assumption that tissue with a malignant transformation shows increased rigidity, this provides a complementary diagnostic parameter that is largely independent of the examiner’s subjective assessment [ 3 ]. At the current time, the elastography of cervical LNs is to be regarded as a useful additional procedure, but needs further standardization in order to improve the reproducibility and validity [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

Multiparametric Ultrasound of Cervical Lymph Node Metastases in Head and Neck Cancer for Planning Non-Surgical Therapy

et al. 2022

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Background: We aimed to evaluate multiparametric ultrasound, to achieve a better understanding of the baseline characteristics of suspected cervical lymph node metastases in head and neck cancer before induction chemotherapy or chemoradiation. Methods: From February 2020 to April 2021, our complete ultrasound examination protocol was carried out on clinically evident malignant lymph nodes of histologically proven HNSCC in the pre-therapeutic setting. Results: A total of 13 patients were eligible for analysis. Using elastography, irregular clear hardening in areas in the center of the lymph node could be detected in all cases. Elastographic Q-analysis showed a significantly softer cortex compared to the center and surrounding tissue. The time–intensity curve analysis showed high values for the area under the curve and a short time-to-peak (fast wash-in) in all cases compared to the surrounding tissue. A parametric evaluation of contrast enhanced the ultrasound in the early arterial phase and showed an irregular enhancement from the margin in almost all investigated lymph nodes. These results show that the implementation of comprehensive, multiparametric ultrasound is suitable for classifying suspected lymph node metastasis more precisely than conventional ultrasound alone in the pre-therapeutic setting of HNSCC. Thus, these parameters may be used for improvements in the re-staging after chemoradiation or neoadjuvant therapy monitoring, respectively.

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Quantitative and Qualitative Approach for Shear Wave Elastography in Superficial Lymph Nodes

Cited by 8 publications

References 36 publications

Quantitative Multiparametric Ultrasound (mpUS) in the Assessment of Inconclusive Cervical Lymph Nodes

Quantitative Multiparametric Ultrasound (mpUS) in the Assessment of Inconclusive Cervical Lymph Nodes

Differential Diagnosis Value of Shear-Wave Elastography for Superficial Enlarged Lymph Nodes

Multiparametric Ultrasound of Cervical Lymph Node Metastases in Head and Neck Cancer for Planning Non-Surgical Therapy

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