Ultrasound elastography: Its potential role in assessment of cervical lymphadenopathy

The aims of this study were to investigate the value of ultrasound elastography (UE) in the diagnosis of lymphadenopathy and to explore whether UE could improve the differentiation between benign and malignant cervical lymph nodes (LNs).

B-mode ultrasound, power Doppler imaging, and UE were performed in 107 consecutive patients with 128 cervical LNs. Only LNs that unequivocally matched between sonography and pathology were analyzed. The results of B-mode ultrasound, power Doppler imaging, and UE were interpreted separately to assess cervical LNs, using histopathologic analysis as the reference standard.

A marked difference (P = .000) was found in the strain ratio between 70 malignant LNs (median, 2.71; range, 1.36-36.09) and 58 benign LNs (median, 1.44; range, 0.62-3.90). Receiver-operating characteristic curves showed that a strain ratio > 1.5 had high utility in enlarged cervical LN classification, with 92.5% sensitivity, 53.4% specificity, and a Youden's index of 0.463. These results were significantly better than those obtained using the best grayscale criterion, a ratio of long-axis to short-axis diameter > 2, which yielded 58.6% sensitivity, 70% specificity, and a Youden's index of 0.286. The kappa values for interobserver agreement were highest using UE, at 0.881 (observer 1 vs observer 2), 0.828 (observer 1 vs observer 3), and 0.946 (observer 2 vs observer 3).

UE as an adjunct ultrasound modality holds some promise in screening and monitoring lymphadenopathy.