B-mode ultrasound, color Doppler, and sonoelastography in differentiation between benign and malignant cervical lymph nodes with special emphasis on sonoelastography

Abstract

BackgroundEnlarged cervical lymph nodes are the most commonly encountered neck lumps. Ultrasonography is the most extensively used tool for classification of superficial lymph nodes due to its availability and low cost. Ultrasound (US) elastography refers to a non-invasive imaging technique that can describe tissue displacement (i.e., strain) or stiffness in response to a given force.The aim of this study is to compare between B-mode sonography, color Doppler, and sonoelastography in assessment of enlarged deep cervical lymph nodes.ResultsThe prevalence of benign lymph nodes was 26 out of 84 (31%). Lymphomatous lymph nodes were 22/84 (26.2%), while metastatic lymph nodes were 36/84 (42.8%). Color Doppler evaluation of nodal vascular pattern was of high sensitivity (91.7%), specificity (80.8%), and accuracy (88.6%) for differentiating metastatic and benign nodes (P value was < 0.001). There was a significant difference between elasticity scores of benign and malignant lymph nodes (P < 0.001). The most frequent score in the malignant group was 3 (21/27) (77.8%) while the most frequent score in the benign group was 2 (5/11) (45.5%). The mean strain ratio (strain index) for malignant lymph nodes (mean 3.2 ± 0.8) was significantly greater than that for benign lymph nodes (mean 1.1 ± 0.8).ConclusionUltrasound elastography with its high sensitivity and specificity is a helpful improvement in US for the assessment of cervical lymph nodes, in which biopsies should be performed.