Role of Sonoelastography in Characterizing Cervical Lymph Nodes with Histopathological Correlation

Abstract

INTRODUCTION: Cervical lymphadenopathy is common in clinical practice, arising from various causes like infections, vasculitis, and malignancies. In head and neck oncology, metastatic cervical lymphadenopathy is especially prevalent, often signaling a more aggressive disease. Accurate diagnosis and differentiation of these conditions are crucial for effective patient management and treatment planning.

OBJECTIVES

Primary objective

• To evaluate the accuracy and efficacy of sonoelastography in differentiating benign and malignant cervical lymph nodes using histopathological diagnosis as reference.

Secondary objective

• To determine the individual as well as combined role of ultrasonogram, Doppler and elastography in characterizing the benign and malignant nature of lymph nodes.
• To evaluate for replacing invasive methods like FNAC/ biopsy with non-invasive elastography for diagnosing malignant nodes.

MATERIALS AND METHODS: Eighty patients meeting the inclusion criteria were studied. Cervical lymph nodes were assessed using B-mode ultrasonography and Doppler to evaluate size, shape, margin, hilum, echogenicity, and intranodal vascular patterns. Real-time elastography classified the nodes as benign or malignant, with findings correlated to histopathology between September 2022 and February 2024 at Sri Manakula Vinayagar Medical College, Puducherry. Data was analyzed using MS Excel and SPSS version 24.

RESULTS: B-mode ultrasonography alone had a sensitivity of 80.7%, specificity of 77.7%, positive predictive value of 63.6%, and negative predictive value of 89.3%. Elastography alone showed a sensitivity of 69.2%, specificity of 85.1%, positive predictive value of 69.2%, and negative predictive value of 85.1%. When combined, sensitivity increased to 92.3%, specificity to 88.8%, positive predictive value to 80.0%, and negative predictive value to 96.0%. Thus, combining elastography with ultrasonography enhances diagnostic accuracy.

CONCLUSION: In conclusion, combining B-mode ultrasonography, Doppler, and elastography offers a comprehensive and highly accurate tool for diagnosing and characterizing cervical lymphadenopathy as benign or malignant. This integrated approach enhances diagnostic accuracy, crucial for effective patient management and treatment, reducing the need for invasive procedures in benign cases.