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Accuracy of Sonographic Elastography in the Differential Diagnosis of Enlarged Cervical Lymph Nodes: Comparison with Conventional B-Mode Sonography

¹ Department of Radiology, Division of Medical Intelligence and Informatics, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan.
² Department of Clinical Radiology, Hiroshima University Hospital, 1-2-3, Kasumi-cho, Minami-ku, Hiroshima, 734-8551, Japan.
³ Present address: Hiroshima Atomic Bomb Casualty Council, Hiroshima, Japan.

OBJECTIVE. The purpose of our study was to evaluate the diagnostic performance of sonographic elastography and B-mode 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 B-mode 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. B-mode 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 B-mode 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 B-mode sonography has the potential to further improve the diagnosis of metastatic enlarged cervical lymph nodes.

Keywords: elastography • lymph nodes • metastasis • sonography

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