A Comparative Evaluation of Strain and Shear Wave Ultrasound Elastography for Characterizing Cervical Lymphadenopathy

Area of Science:

• Medical Imaging
• Diagnostic Ultrasound
• Oncology

Background:

• Cervical lymphadenopathy diagnosis relies on invasive methods like fine needle aspiration cytology and histopathology.
• Conventional ultrasound has limitations in specificity for differentiating benign from malignant lymph nodes.
• Elastography techniques, including strain and shear wave elastography (SWE), assess tissue stiffness, a known indicator of malignancy.

Purpose of the Study:

• To evaluate the effectiveness of strain elastography and SWE in distinguishing between benign and malignant cervical lymph nodes.
• To compare the diagnostic performance of elastography techniques with conventional ultrasound methods.

Main Methods:

• A cross-sectional study involving 97 cervical lymph nodes in patients aged 5-60 years.
• Evaluation using B-mode ultrasound, color Doppler, strain ratio, and SWE, with histopathology/cytology as the reference standard.
• Receiver operating characteristic (ROC) analysis was employed to determine diagnostic accuracy.

Main Results:

• Malignant nodes exhibited higher mean elasticity (72.06 kPa) and strain ratio (2.30) compared to benign nodes (9.23 kPa and 1.18, respectively).
• SWE demonstrated 100% sensitivity and 85% specificity with a cutoff velocity of 2.195 m/s (AUC = 0.940).
• Strain ratio achieved 91.5% sensitivity and 99% specificity with a cutoff of 1.465 (AUC = 0.956).

Conclusions:

• Strain elastography and SWE, when used with conventional ultrasound, offer high accuracy in diagnosing cervical lymph node pathology.
• These non-invasive elastography methods can potentially decrease the necessity for invasive diagnostic procedures.
• Elastography provides valuable quantitative stiffness information for improved lymph node characterization.