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Is Acoustic Radiation Force Impulse (ARFI) Ultrasound Elastography Valuable in the Assessment of Cervical Lymphadenopathy?

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Indian Journal of Otolaryngology and Head & Neck Surgery Aims and scope Submit manuscript

Abstract

Cervical lymphadenopathy frequently poses a diagnostic challenge as neither clinical nor imaging assessment can reliably differentiate between benign and malignant lymphadenopathy. Non-invasive differentiation between the two may help to reduce the number of FNAC or biopsy. The purpose of this study was to evaluate whether the new ARFI technique (Virtual Touch Quantification), in conjunction with gray scale sonography and Doppler, can help in the characterization and differentiation of benign from malignant cervical lymphadenopathy. Fifty adult patients with cervical lymphadenopathy were included in the study and sonoelastography was done. Sonoelastographic findings were compared to the gold standard histopathology or cytopathology. ARFI measurements in benign and malignant enlarged lymph nodes were compared using the Student t test and ROC curve was used to arrive at the Youden index, sensitivity, specificity, PPV, NPV and diagnostic accuracy. Sonographic patterns indicative of malignancy includes heterogenous echopattern, short axis/long axis ratio > 0.5, absent echogenic fatty hilum and mixed vascular pattern. Sensitivity, specificity, PPV, NPV and accuracy in differentiation between the benign and malignant lymph nodes using ARFI elastography was 79.17, 100, 100, 83.9 and 89.9% respectively. ROC curve analysis of SWVs for differentiation between the malignant and benign lymph nodes gave a cut-off value of 2.8 m/s with an area under curve of 0.892. ARFI imaging technique quantifies the tissue stiffness of the cervical lymph nodes non-invasively and aids in characterisation and differentiation of benign from malignant cervical lymphadenopathy in conjunction with conventional sonography.

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Authors and Affiliations

  1. Department of Imaging Sciences and Interventional Radiology, Sree Chitra Institute of Medical Sciences and Technology (SCTIMST), Trivandrum, 695011, India

    S Vinayagamani

  2. Department of Radiodiagnosis, Maulana Azad Medical College and Associated Lok Nayak Hospital, New Delhi, 110002, India

    Anjali Prakash, Veena Chowdhury & Anju Garg

  3. Department of Pathology, Maulana Azad Medical College and Associated Lok Nayak Hospital, New Delhi, 110002, India

    Shyam L. Jain

  4. Department of ENT, Maulana Azad Medical College and Associated Lok Nayak Hospital, New Delhi, 110002, India

    Achal Gulati

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  1. S Vinayagamani
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  2. Anjali Prakash
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  3. Veena Chowdhury
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  4. Shyam L. Jain
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  5. Achal Gulati
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  6. Anju Garg
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Correspondence to S Vinayagamani.

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Vinayagamani, S., Prakash, A., Chowdhury, V. et al. Is Acoustic Radiation Force Impulse (ARFI) Ultrasound Elastography Valuable in the Assessment of Cervical Lymphadenopathy?. Indian J Otolaryngol Head Neck Surg 70, 597–603 (2018). https://doi.org/10.1007/s12070-018-1306-7

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  • DOI: https://doi.org/10.1007/s12070-018-1306-7

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