Shear Wave Elastography for Distinguishing Cervical Lymph Node Malignancy: A Prospective, Observational Study

Background/Objectives: Differentiating between benign and malignant cervical lymph nodes (LNs) is a critical challenge in the clinical setting. We assessed the ability of shear wave elastography (SWE) to distinguish between lymphomas and solid tumor metastases presenting as cervical adenopathy. Methods: We performed a single-center, prospective, observational study in adults with clinically suspicious cervical lymph nodes. The ultrasound examination included conventional ultrasound and SWE with quantitative assessment (tissue stiffness in kPa). Pathology examination was the definitive confirmation method. Simple univariate binary logistic regression and multiple univariate binary logistic regression were used. Results: The maximum shear wave velocity (SWV) in patients with benign pathologies was 35 kPa, lower than the minimal values for lymphoma (40 kPa) and metastases (50 kPa). Furthermore, squamous cell carcinoma and distant metastases were more prevalent among men. Independent from other factors used in the statistical model, we found a positive association between sex and the presence of metastatic lymph nodes. Finally, each 1 kPa from SWE measurement was associated with a 3% increase in the risk for LNs to present metastatic adenopathy. Conclusions: This study highlights the potential of SWE for the preoperative assessment of nodal status in patients with various malignancies affecting the head and neck region, thyroid, and other areas.