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Real-time qualitative ultrasound elastography of cervical lymph nodes in routine clinical practice: interobserver
Kunwar S S Bhatia1, Carmen C M Cho, Yuen-Hok Yuen
1Department of Diagnostic Radiology and Organ Imaging, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin N.T., Hong Kong.
Insights
Real-time ultrasound (US) elastography for cervical lymphadenopathy showed fair interobserver agreement but suboptimal discrimination for malignancy. Improvements are needed for routine clinical use.
Area of Science:
- Medical Imaging
- Oncology
- Diagnostic Ultrasound
Background:
- Cervical lymphadenopathy diagnosis often requires fine needle aspiration.
- Ultrasound elastography offers a non-invasive method to assess tissue stiffness.
- Qualitative assessment of elasticity imaging is being explored for clinical application.
Purpose of the Study:
- To evaluate the clinical utility of real-time qualitative ultrasound elastography for differentiating benign from malignant cervical lymphadenopathy.
- To assess interobserver agreement in the qualitative scoring of ultrasound elastography.
- To determine the diagnostic accuracy of ultrasound elastography in routine practice.
Main Methods:
- Seventy-four cervical lymph nodes (37 malignant, 37 benign) in 74 patients were assessed using qualitative ultrasound elastography prior to fine needle aspiration.
- Elasticity imaging was displayed using a chromatic scale and scored by three observers (ES1-4, soft to stiff).
- Interobserver agreement was analyzed using the weighted kappa statistic; diagnostic performance was evaluated using receiver operating characteristic curves.
Main Results:
- Fair to good interobserver agreement was observed (κ = 0.374–0.738).
- Median elasticity scores (ES) were higher for malignant nodes (3) than benign nodes (2) (p = 0.0003–0.0049).
- The optimal cut-off (ES > 2) yielded 62.2% sensitivity, 83.8% specificity, and 73% accuracy for malignancy, with suboptimal discrimination (AUC 0.68–0.74).
Conclusions:
- Real-time qualitative ultrasound elastography demonstrated fair interobserver agreement but limited diagnostic accuracy for cervical lymphadenopathy.
- Current reliability and accuracy require enhancement before widespread adoption in routine clinical practice.
- Further technical improvements are necessary to optimize ultrasound elastography for cervical lymph node assessment.
Abstract:
To evaluate real-time qualitative ultrasound (US) elastography for cervical lymphadenopathy in routine clinical practice, 74 nodes (37 malignant, 37 benign) in 74 patients undergoing sonography underwent US elastography prior to fine needle aspiration for cytology. Dynamic cine loops of elasticity imaging displayed using a chromatic-scale were qualitatively scored by three independent observers for the proportion of stiff areas from ES1-4 (soft to stiff). There was fair to good interobserver agreement as indicated by weighted kappa (κ) statistic from 0.374 to 0.738. Median ES for benign and malignant nodes were 2 and 3 respectively. ES was higher in malignant nodes (p = 0.0003-0.0049, Mann Whitney U tests) although areas under receiver operating characteristic curves (0.68-0.74) indicated suboptimal discrimination. The optimal discriminatory cut-off, ES > 2, achieved only 62.2% sensitivity, 83.8% specificity and 73% accuracy for malignancy. Improvements in reliability and accuracy of real-time qualitative ultrasound elastography are required for it to be adopted into routine clinical practice.
