ORIGINAL PAPER
Evaluation of diagnostic value of conventional and color Doppler ultrasound with elastography strain ratios in differentiation between benign and malignant lymph nodes
More details
Hide details
Publication date: 2018-02-04
Pol J Radiol, 2018; 83: 32-36
KEYWORDS
ABSTRACT
Introduction: The aim of this study was to evaluate the diagnostic value of conventional ultrasonography (USG) and color Doppler ultrasonography (CDU) with elastography strain ratios (ESR) in discrimination between benign and malignant lymphatic nodes.
Material and methods: Two hundred and forty-seven patients (252 lymph nodes) were included in this study. USG and CDU with ESR were performed. Materials were obtained by using fine-needle or vacuum-assisted aspiration methods depending on the site and condition of lymph nodes. The χ2 test and Student’s t-test were used for comparisons.
Results: Ninety-two of 252 (36.5%) lymph nodes were malignant, and 160 (63.5%) were benign. Short axis, S/L ratio, presence or absence of the fatty hilum and extra-hilar vascularity were valuable, statistically significant indicators of malignancy. In contrast, long axis and ESR were not significant indicators of malignancy. The short axis cut-off value was calculated to be 12 mm and the S/L ratio cut-off value was calculated to be 1.
Conclusions: Long axis of lymph nodes and strain ratios cannot be used as malignancy criteria, and their use is controversial despite the fact that some studies have found them valuable. On the other hand, our results support common knowledge that the short axis, S/L ratio, absence of the fatty hilum, and extrahilar vascularity are significant indicators.
REFERENCES (16)
1.
Ying M, Bhatia KSS, Lee YH et al. Review of ultrasonography of malignant neck nodes: Greyscale, Doppler, contrast enhancement and elastography. Cancer Imaging 2014; 13: 658-669.
2.
Lo WC, Cheng PW, Wang CT et al. Real-time ultrasound elastography: An assessment of enlarged cervical lymph nodes. Eur Radiol 2013; 23: 2351-2357.
3.
Ying L, Hou Y, Zheng HM et al. Real-time elastography for the differentiation of benign and malignant superficial lymph nodes: A meta-.
4.
analysis. Eur J Radiol 2012; 81: 2576-2584.
5.
Lyshchik A, Higashi T, Asato R et al. Cervical lymph node metastases: Diagnosis at sonoelastography: Initial experience. Radiology 2007; 243: 258-267.
6.
Ishibashi N, Yamagata K, Sasaki H et al. Real-time tissue elastography for the diagnosis of lymph node metastasis in oral squamous cell carcinoma. Ultrasound Med Biol 2012; 38: 389-395.
7.
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. Am J Roentgenol 2008; 191: 604-610.
8.
Ying M, Ahuja AT, Evans R et al. Cervical lymphadenopathy: Sonographic differentiation between tuberculous nodes and nodal metastases from non-head and neck carcinomas. J Clin Ultrasound 1998; 26: 383-389.
9.
Ying M, Ahuja A, Brook F et al. Vascularity and greyscale sonographic features of normal cervical lymph nodes: Variations with nodal size. Clin Radiol 2001; 56: 416-419.
10.
Gupta A, Rahman K, Shahid M et al. Sonographic assessment of cervical lymphadenopathy: Role of high resolution and color doppler imaging. Head Neck 2011; 33: 297-302.
11.
Imani Moghaddam M, Davachi B, Mostaan LV et al. Evaluation of the sonographic features of metastatic cervical lymph nodes in patients with head and neck malignancy. J Craniofac Surg 2011; 22: 2179-2184.
12.
Lyshchik A, Higashi T, Asato R et al. Cervical lymph node metastases: Diagnosis at sonoelastographyinitial experience. Radiology 2007; 243: 258-267.
13.
Wu CH, Chang YL, Hsu WC et al. Usefulness of Doppler spectral analysis and power Doppler sonography in the differentiation of cervical lymphadenopathies. Am J Roentgenol 1998; 171: 503-509.
14.
Gronkiewicz J, Vade A. Cervical lymph node fine needle aspiration in patients with no history of malignancy. Ultrasound Q 2013; 29: 323-326.
15.
Yeon HY, Kim AJ, Son EJ et al. Sonographic findings predictive of central lymph node metastasis in patients with papillary thyroid carcinoma. J Ultrasound Med 2013; 32: 2145-2151.
16.
Park YM, Fornage BD, Benveniste AP et al. Strain elastography of abnormal axillary nodes in breast cancer patients does not improve diagnostic accuracy compared with conventional ultrasound alone. Am J Roentgenol 2014; 203: 1371-1378.