Accuracy of sonographic elastography in the differential diagnosis of enlarged cervical lymph nodes: Comparison with conventional B-mode sonography

OBJECTIVE. The purpose of our study was to evaluate the diagnostic performance of sonographic elastography and Bmode sonography individually and combined in the differentiation of reactively and metastatically enlarged cervical lymph nodes. SUBJECTS AND METHODS. Eighty-five lymph nodes (metastatic, n = 53; reactive, n = 32) from 37 patients were examined by both elastography and Bmode sonography in this prospective study. Elastographic patterns were determined on the distribution and percentage of the lymph node area with high elasticity (hard), with pattern 1 being an absent or very small hard area to pattern 5, a hard area occupying the entire lymph node. The cutoff line for reactive versus metastatic was set between patterns 2 and 3; patterns 3-5 were considered metastatic. Bmode sonographic diagnosis was based on the sum of scores for five criteria: short-axis diameter, shape, border (regular or irregular), echogenicity (homogeneous or inhomogeneous), and hilum (present or absent). The cutoff line for reactive versus metastatic was set between scores 6 and 7; scores 5 and 6 were considered reactive, and scores 7-10, metastatic. RESULTS. Sensitivity, specificity, and accuracy of Bmode sonography were 98%, 59%, and 84%, respectively; 83%, 100%, and 89% for elastography; and 92%, 94%, and 93% for the combined evaluation. CONCLUSION. The combination of highly specific elastography with highly sensitive conventional Bmode sonography has the potential to further improve the diagnosis of metastatic enlarged cervical lymph nodes.