Evaluation of the role of sono-elastography in diagnosis of enlarged cervical lymph nodes

Utility of perioperative ultrasonography and fine-needle aspiration cytology in differentiation between benign and malignant cervical lymphadenopathy: a retrospective cohort study

Background

The preoperative differentiation of benign form malignant cervical lymphadenopathy (CLA) is crucial in determining the need for surgical intervention. This study aims to assess the diagnostic performance of ultrasonography (US), fine-needle aspiration cytology (FNAC), and their combination with the postoperative histopathological diagnoses of CLA.

Method

In a retrospective study between April 2021 and May 2023, 214 patients with CLA were assessed with preoperative US and FNAC. The morphological parameters, including tissue margins, vascularity, and fatty hilum echogenicity, were collected and analyzed retrospectively. The diagnostic efficacies of US, FNAC, and their combined use were compared to the postoperative histopathological findings.

Result

In the final histopathological examination, 185 cases (86.4%) were found to be benign, while 29 cases (13.6%) were determined to be malignant. The US features of fatty hilum, echogenicity, and vascularity pattern had the highest diagnostic accuracy in characterizing CLA patterns, with values of 88.3%, 85.5%, and 85.0%, respectively. The receiver operating characteristic (ROC) curve showed a significantly higher area under the curve (AUC) value of 0.883 (95% CI: 0.832-0.923; P<0.0001) for the combined use of all US parameters with better sensitivity (93.10%) and specificity (68.65%) than individual parameters. The overall sensitivity, specificity, and accuracy of FNAC were 97.3%, 82.8%, and 95.3%, respectively. Additionally, US parameters and FNAC together showed a significantly higher AUC value of 0.924 (95% CI: 0.880-0.956; P<0.0001) and achieved a sensitivity of 86.21% and specificity of 88.65%.

Conclusions

The combined use of US and FNAC provides high sensitivity, specificity, and diagnostic accuracy in characterizing CLA patterns. In limited-resources settings, this approach is feasible, less invasive, and cost-effective, thereby enabling clear management strategies and avoiding additional surgical interventions.

Shear wave elastography versus strain elastography to identify benign superficial lymph nodes: sonographic assessment with histopathological confirmation

Background

Differentiation between benign and malignant superficial lymph nodes (LNs) presents clinical dilemma. No specific criteria are established with conventional ultrasound to make a distinction. We aimed to study the added value of shear wave velocity (SWV) measurement with acoustic radiation force impulse (ARFI) and strain elastography (SE) to identify benign superficial LNs. The study included 115 superficial LNs subjected to conventional ultrasonography, 4-scale strain elastography and shear wave velocity measurement using ARFI. Histopathological analysis was obtained for all examined nodes.

Results

SE correctly diagnosed 89.3% of the reactive and 92.2% of the metastatic LNs and erroneously diagnosed 72.7% of the lymphoma LNs as being benign. Overall sensitivity, specificity, PPV, NPV and accuracy were 74.4%, 73%, 85.3%, 57.4% and 73.9%, respectively. The receiver operating curve analysis of SWV measurement using ARFI revealed a cut-off value of ≥ 2.70 m/sec to recognize malignant LNs and to obtain best sensitivity (88.5%) and specificity (89.2%) (Area under the curve: 0.819, 95% confidence interval (CI): 0.744 and 0.894). The PPV, NPV and accuracy were 94.5%, 78.6% and 88.7%, respectively. As compared to SE, ARFI boosted the diagnostic accuracy of lymphoma LNs from 27.3 to 68.2% and showed better specificity and NPV to identify benign LN as contrasted to SE.

Conclusions

SE could be adequate to differentiate reactive from metastatic LN but not from Lymphomas. Shear wave elastography is a reasonable imaging modality to identify benign lymph nodes. ARFI at a cut-off value of < 2.7 m/sec was superior to SE and the best B-mode features.

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

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.

Role of Sonoelastography in Differentiating Benign From Malignant Cervical Lymph Nodes and Correlating With Pathology

Background and aim

Combined use of ultrasonography and elastography improves diagnostic efficacy in differentiating benign from malignant cervical lymph nodes, thereby helping in treatment planning and reducing unnecessary fine needle aspiration cytology/ biopsy. This study aimed to correlate B-mode ultrasonography, color Doppler imaging, and elastography findings with pathological findings and to calculate sensitivity, specificity, and diagnostic accuracy of ultrasonography and elastography.

Material and methods

Patients underwent ultrasonography (B-mode and color Doppler imaging) followed by elastography. Lymph node morphology on B-mode was assessed based on short axis diameter, short-to-long axis ratio, fatty hilum, echogenicity, and margin. Vascularity of lymph nodes on color Doppler imaging was divided into three patterns. On elastography, lymph nodes were defined based on elastography pattern and strain index.

Results

Among all ultrasonography parameters, fatty hilum was found to have the highest diagnostic accuracy (73%), followed by vascularity pattern (70%). Combined use of all ultrasonography parameters yielded better sensitivity (90%), specificity (88%), and diagnostic accuracy (89%) than individual parameters. Five-scale elastography pattern had 83% sensitivity, 97% specificity, and 89% diagnostic accuracy. In the current study, the use of strain index cut-off of two showed sensitivity of 93%, specificity of 96%, and diagnostic accuracy of 94%. Together, ultrasonography and elastography achieved sensitivity of 96%, specificity of 94%, and diagnostic accuracy of 95%.

Conclusion

Elastography can be a useful adjunct to ultrasonography for the accurate diagnosis of cervical lymphadenopathy. Elastography pattern and cut-off strain index of two can effectively differentiate benign from malignant cervical lymph nodes.