Ultrasound Elastography in the Diagnosis of Malignant Cervical Lymphadenopathy in Children: Can It Replace Surgical Biopsy?
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Published on: January 12, 2017
Ahmed Elgendy1, Eslam Elhawary2, Mohamed M Shareef3
1Surgical Oncology Unit, Department of Surgery, Tanta University, Tanta, Egypt.
Insights
Ultrasound elastography shows high accuracy in detecting malignant pediatric cervical lymph nodes. However, it cannot replace surgical biopsies for definitive diagnosis and treatment planning.
Area of Science:
- Pediatric Radiology
- Oncology Imaging
- Diagnostic Ultrasound
Background:
- Persistent cervical lymphadenopathy is common in children.
- Distinguishing malignant from benign lymph nodes is crucial for appropriate management.
- Current diagnostic methods may involve invasive procedures.
Purpose of the Study:
- To evaluate the accuracy of ultrasound elastography in identifying malignant pediatric cervical lymph nodes.
- To determine if elastography can reduce the need for surgical biopsies.
Main Methods:
- Prospective study of 64 children with persistent cervical lymphadenopathy.
- Assessment included B-mode ultrasound, color Doppler, and sonoelastography.
- Elastography patterns were correlated with pathological examination of biopsy specimens.
Main Results:
- Ultrasound elastography demonstrated 100% sensitivity and 85.7% specificity for malignancy.
- Overall accuracy of elastography was 90.6%, outperforming B-mode (75%) and color Doppler (82.2%).
- Malignant nodes were correctly identified, while benign nodes were mostly accurately classified.
Conclusions:
- Ultrasound elastography is a valuable addition to ultrasound for diagnosing pediatric cervical lymphadenopathy.
- Despite high accuracy, elastography does not replace the necessity of surgical biopsy for definitive diagnosis.
- Elastography can aid in the diagnostic workup but does not alter biopsy indications.
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.
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