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Utility of Sonoelastography Beyond Sonography for Differentiation Between Benign and Malignant Lymphadenopathy

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Abstract

Cervical lymphadenopathy is a common clinical entity with varied causes. The current study aims to evaluate the diagnostic performance of sonography, sonoelastography, and their combination for differentiation between benign and malignant causes of cervical lymphadenopathy. After approval of study protocol by the hospital review board and written informed consent, 70 neck nodes in 70 patients were evaluated with grayscale ultrasound and color Doppler followed by ultrasound strain elastography (USE). The final diagnosis was based on ultrasound-guided fine-needle aspiration cytology (FNAC)/histopathological examination (HPE). Various ultrasound features observed were nodal size, shape, presence of echogenic hilum, intranodal necrosis, and pattern of vascularity. Score was given for each feature and the sum was used for calculation of diagnostic accuracy of sonography. Ultrasound elastography was interpreted by obtaining color-coded elastogram and strain ratio. Cut-offs for all the parameters were determined from receiver operating characteristic (ROC) curve. The diagnostic performance of conventional ultrasound and sonoelastography was evaluated individually as well as in combination against cytological or histopathological diagnosis. Out of 70 nodes examined, 36 were malignant and 34 were benign on histopathology. Among all ultrasound features, pattern of vascularity on color Doppler showed maximum sensitivity, i.e., 94%, while intranodal necrosis had maximum specificity, i.e., 70%, for differentiation between benign and malignant cervical lymphadenopathy. Sensitivity, specificity, and accuracy were 68.6%, 60%, and 64.3%, respectively, for ultrasound with Doppler; 77.15, 92.3%, and 85.7% for sonoelastography; and 60%, 97.1%, and 77.1% for combined evaluation. Strain ratio had highest specificity (94.3%) and diagnostic accuracy (85.7%) among all ultrasound and elastographic parameters. Combined ultrasound and ultrasound elastographic evaluation shows better diagnostic accuracy compared to conventional ultrasound evaluation. Ultrasound evaluation should be followed by elastography in all cases of cervical lymphadenopathy wherever possible.

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Data Availability

Analyzed data is included in the article. Dataset used for the current study is available with the corresponding author and available on request.

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Authors and Affiliations

  1. Department of Radiodiagnosis, VMMC and Safdarjung Hospital, New Delhi, India

    Renu Yadav & Amita Malik

  2. C I O Lab, VMMC and Safdarjung Hospital, New Delhi, India

    Rajni Prasad

Authors
  1. Renu Yadav
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  2. Amita Malik
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  3. Rajni Prasad
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Contributions

Each author contributed substantially to the design of work. RY and AM collected, analyzed, and interpreted the patient data generated from sonographic and sonoelastographic examination in cervical lymphadenopathy. RP performed the histopathological examination of FNAC/biopsy slides. RY and AM were major contributors in manuscript writing. All authors have read and approved the final manuscript and take full accountability of the work and data given.

Corresponding author

Correspondence to Renu Yadav.

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Ethics Approval and Consent to Participate

The study was approved by the ethical committee of Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India, 110029, with approval number IEC/VMMC/SJH/Thesis/November - 2014/411. Written informed consent was obtained from all study subjects before enrolling into study

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Not applicable.

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The authors declare no competing interests.

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Yadav, R., Malik, A. & Prasad, R. Utility of Sonoelastography Beyond Sonography for Differentiation Between Benign and Malignant Lymphadenopathy. SN Compr. Clin. Med. 3, 2116–2126 (2021). https://doi.org/10.1007/s42399-021-00980-7

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  • DOI: https://doi.org/10.1007/s42399-021-00980-7

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