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Updated: Mar 29, 2026
High-frequency Ultrasound Imaging of Mouse Cervical Lymph Nodes
Published on: July 25, 2015
Shear Wave Elastography in Head and Neck Lymph Node Assessment: Image Quality and Diagnostic Impact Compared with
Florian Desmots1, Nicolas Fakhry2, Julien Mancini3
1Department of Radiology, Hôpital d'Instruction des Armées Laveran, Marseille, France.
Insights
Shear wave elastography (SWE) accurately differentiates benign from malignant head and neck lymph nodes (HNLNs), especially small ones. This reproducible technique shows malignant HNLNs are stiffer, improving diagnostic accuracy.
Area of Science:
- Medical Imaging
- Diagnostic Ultrasound
- Oncology
Background:
- Differentiating benign from malignant head and neck lymph nodes (HNLNs) is crucial for patient management.
- Conventional B-mode and Doppler ultrasonography have limitations in accurately characterizing HNLNs.
- Novel imaging techniques are needed to improve diagnostic performance for HNLNs.
Purpose of the Study:
- To evaluate the diagnostic performance of shear wave elastography (SWE) compared to B-mode and Doppler ultrasonography.
- To assess SWE's ability to differentiate benign from malignant HNLNs.
- To analyze SWE's effectiveness, particularly in the subgroup of sub-centimeter HNLNs.
Main Methods:
- Prospective examination of 62 HNLNs from 56 patients using B-mode, Doppler, and SWE.
- Histopathology or cytology and follow-up served as the reference standard.
- Quantitative parameters, including maximum shear elasticity modulus (μmax), were measured; qualitative criteria were also assessed.
Main Results:
- Malignant HNLNs exhibited significantly higher stiffness (μmax) compared to benign nodes (p < 0.001).
- μmax demonstrated the highest diagnostic accuracy (AUC = 0.903), outperforming other quantitative criteria, especially in sub-centimeter HNLNs (AUC = 0.929).
- SWE showed good intra-observer reproducibility (0.899), even in the sub-centimeter subgroup (0.728).
Conclusions:
- Shear wave elastography is a promising, reproducible quantitative tool for predicting malignancy in HNLNs.
- SWE is particularly effective in differentiating sub-centimeter malignant HNLNs, offering improved diagnostic accuracy.
- Combining SWE with B-mode ultrasonography may further enhance diagnostic performance for HNLNs.
Abstract:
The aim of this study was to assess the diagnostic performance of shear wave elastography (SWE) in comparison to B-mode and Doppler ultrasonography in differentiating benign from malignant head and neck lymph nodes (HNLNs). Sixty-two HNLNs from 56 patients were prospectively examined using B-mode, Doppler and SWE. The standard of reference was histopathology or cytology and follow-up. Qualitative malignant criteria (hilum infiltration, cortical hypo-echogenicity, irregular margins, abnormal vessels) were assessed on a five-point scale. Four quantitative parameters were obtained: long axis length, short axis length, short axis/long axis ratio, resistive index and maximum shear elasticity modulus (μmax). Diagnostic performance was analyzed with special emphasis on the sub-centimeter HNLN subgroup. Thirty HNLNs were malignant (48%). μmax intra-observer reproducibility was 0.899 (0.728 in sub-centimeter subgroup). Malignant HNLNs were stiffer (μmax = 72.4 ± 59.0 kPa) compared with benign nodes (μmax = 23.3 ± 25.3 kPa) (p < 0.001). Among the quantitative criteria, μmax had the highest diagnostic accuracy (area under the curve = 0.903 ± 0.042), especially in the sub-centimeter subgroup (area under the curve = 0.929 ± 0.045; p < 0.001) in which the area under the curve was significantly higher compared with the other quantitative criteria (p < 0.05). The additional use of SWE combined with B-mode tended to improve diagnostic accuracy (p > 0.05). SWE is a promising reproducible quantitative tool with which to predict malignant HNLNs, especially sub-centimeter nodes.
