Utility of ultrasound elastography to differentiate benign from malignant cervical lymph nodes

Abstract

Background: The purpose of this study was to evaluate the usefulness of strain elastography and acoustic radiation force impulse (ARFI) imaging in the differentiation of benign and malignant cervical lymph nodes (LNs). Materials and Methods: In this prospective study, 50 enlarged cervical LNs (33 benign and 17 malignant) were examined by B-mode ultrasound (US), color Doppler, and strain elastography. Elastographic patterns (1–5) were categorized based on distribution of hard area within LN. The shear wave velocity (SWV) of LNs was evaluated by ARFI imaging. Diagnostic performance of sonoelastographic parameters was compared taking histopathology of LN as a reference standard. Optimal cutoff value of the mean SWV values for predicting malignancy was determined using receiver operating characteristic curve analysis. Results: Among US parameters, borders of LN had the highest diagnostic accuracy (80%), while echogenicity had the least (48%). Majority of benign LNs ( n = 31) had elastography patterns 1 and 2, while majority of malignant LNs ( n = 16) had patterns 3–5 ( P = 0.000). The sensitivity, specificity, and accuracy of elastography were 94.1%, 93.9%, and 94%, respectively. The mean SWV of benign LNs (1.670 ± 0.367 m/s) differed significantly from malignant LNs (2.965 ± 0.826 m/s; P = 0.000). A cutoff value of 2.05 m/s predicted malignancy with 88.2% sensitivity and 84.8% specificity and gave an area under the curve of 0.949 (95% confidence interval: 0.70–1.20). Conclusion: Elastography has high diagnostic accuracy in differentiating benign and malignant cervical LNs and can be potentially useful in selecting the LN with high probability of malignancy, on which fine-needle aspiration cytology/biopsy can be performed.

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

“…Interestingly, false-positive results in our study represented 50% of pattern 3 in elastogram, and the same percentage was also documented by Ishibashi et al 24 Moreover, other studies reported that false-positive diagnoses constituted 3.5 to 33% of pattern 3. 17,19,25 These notable findings can classify pattern 3 as border line or suspicious for malignancy, therefore false-positive results could be expected in this pattern with infectious mononucleosis and granulomatous lymphadenitis. 18 Conversely, the present study did not report any falsenegative results.…”

Ultrasonography and Sonoelastography Characteristics of Benign vs. Malignant Mesenteric Lymph Nodes in Cats: An Update

“…As for the sonographic evaluation, borders, echogenicity, the presence of hilum, patterns of vascularization, and S/L ratio were recorded for each lymph node, thus providing a scoring rubric as previously described in the text. This choice was based on reports in the current literature that describe the single feature as not being accurate enough to distinguish benign from malignant lymph nodes, and the scores based on the combined findings provided more accurate diagnoses, as described in the recent literature available for canine species and people [ 7 , 43 ].…”

Tuberculosis conundrum - current and future scenarios: A proposed comprehensive approach combining laboratory, imaging, and computing advances

“…Cervical, axillary, and inguinal lymph nodes are easily evaluated by standard USE; and USE has the potential to non-invasively differentiate tuberculous from metastatic lymph nodes because of the latter’s greater stiffness[ 40 , 41 ]. On strain USE a cut-off value of 3.0 (strain ratio) has been suggested for determining if a mass/tissue is benign or malignant[ 42 - 44 ].…”