Ĭervical lymph nodes (CLN) and adjacent normal structures are color-coded representing varying degree of tissue hardness.
PATHOLOGICAL LYMPH NODE MANUAL
Strain elastography measures the relative stiffness of the lymph node with respect to adjacent normal tissue in response to externally applied manual force. Elastography can help in characterizing lymph nodes based on the stiffness of tissues (malignant tissues are harder than benign). There is however a considerable overlap in diagnostic criteria on B-mode ultrasonography and CDI for differentiating benign and malignant cervical lymph nodes. Various criteria are defined on B-mode ultrasonography and color Doppler imaging (CDI) for lymph node evaluation. Hence, its evaluation will give a clue to the underlying cause and help in treatment planning and ultrasonography (USG) is usually the first preferred imaging modality. Elastography pattern and cut-off strain index of two can effectively differentiate benign from malignant cervical lymph nodes.Ĭervical lymphadenopathy can manifest secondary to benign or malignant etiology. ConclusionĮlastography can be a useful adjunct to ultrasonography for the accurate diagnosis of cervical lymphadenopathy. Together, ultrasonography and elastography achieved sensitivity of 96%, specificity of 94%, and diagnostic accuracy of 95%. In the current study, the use of strain index cut-off of two showed sensitivity of 93%, specificity of 96%, and diagnostic accuracy of 94%. Five-scale elastography pattern had 83% sensitivity, 97% specificity, and 89% diagnostic accuracy. Combined use of all ultrasonography parameters yielded better sensitivity (90%), specificity (88%), and diagnostic accuracy (89%) than individual parameters. ResultsĪmong all ultrasonography parameters, fatty hilum was found to have the highest diagnostic accuracy (73%), followed by vascularity pattern (70%). On elastography, lymph nodes were defined based on elastography pattern and strain index. Vascularity of lymph nodes on color Doppler imaging was divided into three patterns. Lymph node morphology on B-mode was assessed based on short axis diameter, short-to-long axis ratio, fatty hilum, echogenicity, and margin. Patients underwent ultrasonography (B-mode and color Doppler imaging) followed by elastography. This study aimed to correlate B-mode ultrasonography, color Doppler imaging, and elastography findings with pathological findings and to calculate sensitivity, specificity, and diagnostic accuracy of ultrasonography and elastography. Combined use of ultrasonography and elastography improves diagnostic efficacy in differentiating benign from malignant cervical lymph nodes, thereby helping in treatment planning and reducing unnecessary fine needle aspiration cytology/ biopsy.
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