Abstract
Purpose: To prospectively estimate the reliability of B-mode ultrasonography and sonoelastography in differentiating benign and malignant cervical lymph nodes with cytological findings as to the reference standard.Materials and Methods: A total of 50 patients referred for sonography for enlarged cervical lymph nodes were included in the study. They were subjected initially to B-mode ultrasonography and sonoelastography and later underwent fine-needle aspiration cytology (FNAC) in the same sitting. Sensitivity, specificity, and accuracy were compared.Results: Out of 50 cases, 33 were males, and 17 were females. On B-mode ultrasonography, 15 enlarged cervical lymph nodes were benign-looking and 35 were malignant-looking. When studied on elastography, 12 were benign-looking and 38 showed features of malignancy. However, when studied histopathologically, 18 were benign and 32 were malignant. The sensitivity, specificity, and diagnostic accuracy were compared, and the results were better in sonoelastography than B-mode ultrasonography. When both B-mode and sonoelastography were combined, an increase in the sensitivity for differentiation was achieved. However, a decrease in specificity was noted when both modalities were combined in our study, probably due to a significant number of patients with tuberculous cervical lymphadenopathy.Conclusion: In countries like India, where granulomatous infection like tuberculosis is prevalent, the combination of sonoelastography with B-mode ultrasonography has decreased specificity in the differentiation of benign and malignant cervical lymph nodes, and histopathology is always needed for the final confirmation of diagnosis. The decreased specificity on elastography is attributed to simultaneous coexisting inflammation and fibrosis in chronic granulomatous lymphadenopathy.
Highlights
Metastatic cervical lymph nodes are common in patients with head and neck, as well as non-head and neck cancers [1,2,3]
The sensitivity, specificity, and diagnostic accuracy were compared, and the results were better in sonoelastography than B-mode ultrasonography
A decrease in specificity was noted when both modalities were combined in our study, probably due to a significant number of patients with tuberculous cervical lymphadenopathy
Summary
Metastatic cervical lymph nodes are common in patients with head and neck, as well as non-head and neck cancers [1,2,3]. Appraisal of the nodal condition is requisite in patients with head and neck carcinomas as it forecasts the prognosis and helps in selecting treatment alternatives [6,7,8]. Both medical and dental professionals worldwide face problems in the early perception and diagnosis of such cancers [9]. At times metastatic cervical lymphadenopathy is the first symptom in patients with malignancies of the head and neck, lung, breast, and other sites. Differentiation between benign and malignant lymphadenopathy is essential, and one of the differentiating indicators is lymph node hardness or elasticity [11]
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