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. 2014 Jan;3(1):58-62.
doi: 10.4103/2303-9027.121252.

Role of high resolution ultrasound/endosonography and elastography in predicting lymph node malignancy

Hussein Hassan Okasha  1 , Mona Mansour  1 , Khaled Ahmed Attia  1 , Hany Mahmoud Khattab  2 , Amr Yahia Sakr  3 , Mohamed Naguib  1 , Wael Aref  1 , Ahmed Abdel-Moaty Al-Naggar  1 , Reem Ezzat  4
Affiliations

Role of high resolution ultrasound/endosonography and elastography in predicting lymph node malignancy

Hussein Hassan Okasha et al. Endosc Ultrasound. 2014 Jan.

Abstract

Objective: The objective of this study is to evaluate the role of high resolution ultrasonography (US) and endoscopic ultrasound (EUS)-elastography in predicting malignant lymphadenopathy.

Patients and methods: This prospective study included 88 patients who underwent EUS or US examination of different groups of lymph nodes (LNs). The classification as benign or malignant based on the real time elastography pattern and the B-mode US/EUS images was compared with the final diagnosis obtained by EUS or US guided fine-needle aspiration cytology (FNAC), tru-cut biopsy or excisional biopsy and follow-up in benign lesions not indicated for biopsy for at least 12 months.

Results: Regarding the echogenicity, 98.3% of the benign LNs were hyperechoic, 1.7% was hypoechoic while 89.7% of the malignant LNs were hypoechoic, 3.4% were heterogenous and 6.9% were hyperechoic. With cut-off value of 1.93, the sensitivity of longitudinal to transverse ratio was 73% and the specificity was 100%. Score 1 elastography had specificity of 100% in diagnosis of benign LNs, sensitivity was 76.3%, positive predictive value (PPV) was 100%, negative predictive value (NPV) was 84.7% while score 2 had a sensitivity of 60%, specificity of 31.5%, PPV of 15.3%, NPV of 79.3%. Score 3 had a sensitivity of 70.2%, specificity of 100%, PPV of 13.8%, NPV of 100% in detecting malignancy while score 4 had a sensitivity of 85.5%, specificity of 100%, PPV of 100%, NPV of 65.5%.

Conclusion: Elastography is a promising diagnostic modality that may complement standard ultrasound and EUS and help guide FNAC during staging of LNs.

Keywords: Lymph node; elastography; endoscopic ultrasound; malignant; ultrasonography.

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Conflict of interest statement

Conflict of Interest: None declared.

Figures

Figure 1
Figure 1
Mentioned in the result section. (a) Prediction of longitudinal/transverse (L/T) ratio for probability of malignancy; (b) Sensitivity and specificity of L/T ratio in detection of malignancy
Figure 2
Figure 2
Ultrasound elastography images of a benign cervical lymph node (LN), malignant cervical LN and malignant peripancreatic LN. (a) A benign cervical LN showing elasticity score 1; (b) A malignant cervical LN showing elasticity score 3; (c) A malignant peripancreatic LN showing elasticity score 4
See this image and copyright information in PMC

References

    1. Huwart L, Peeters F, Sinkus R, et al. Liver fibrosis: Non-invasive assessment with MR elastography. NMR Biomed. 2006;19:173–9. - PubMed
    1. Ophir J, Céspedes I, Ponnekanti H, et al. Elastography: A quantitative method for imaging the elasticity of biological tissues. Ultrason Imaging. 1991;13:111–34. - PubMed
    1. Ophir J, Garra B, Kallel F, et al. Elastographic imaging. Ultrasound Med Biol. 2000;26(Suppl 1):S23–9. - PubMed
    1. Alam F, Naito K, Horiguchi J, et al. Accuracy of sonographic elastography in the differential diagnosis of enlarged cervical lymph nodes: Comparison with conventional B-mode sonography. AJR Am J Roentgenol. 2008;191:604–10. - PubMed
    1. Furukawa MK, Kubota A, Hanamura H, et al. Clinical application of real-time tissue elastography to head and neck cancer – Evaluation of cervical lymph node metastasis with real-time tissue elastography. Nihon Jibiinkoka Gakkai Kaiho. 2007;110:503–5. - PubMed