Rahul Rajendra Arkar MBBS, DMRD, DNB, Presenter: Nothing to Disclose

Venkatesh Kasi Arunachalam MBBS, DMRD, Abstract Co-Author: Nothing to Disclose

R Rupa MBBS, DMRD, Abstract Co-Author: Nothing to Disclose

Tejas Mohan Kalyanpur DMRD, Abstract Co-Author: Nothing to Disclose

Mathew Cherian MD, Abstract Co-Author: Nothing to Disclose

Pankaj Mehta MD, Abstract Co-Author: Nothing to Disclose

Rajesh Kumar Vartharajaperumal MBBS, DMRD, Abstract Co-Author: Nothing to Disclose

To differentiate benign and metastatic cervical lymph nodes with B-mode and sonoelastography separately and combined with histopathologic findings as reference standard.

Two hundread  patients were assessed with B-mode sonography and sonoelastography. B-mode characteristics include - short axis dimension, short axis to long axis ratio, fatty hilum, calcification & vascularity. Elastographic pattern of lymph node after adequate compression was evaluated and categorized to one of the five groups as categorized by Ahuja A. T. et.al. (Ultrasound of malignant cervical lymph nodes, 2008 International Cancer Imaging Society). All patients underwent FNAC of the enlarged lymph node.The results of B-mode ultrasonography and sonoelastography were compared with histopathology and analysed statistically.  

Histopathology: Prevalence of malignant & benign lymph nodes was 64% and 36% respectively. B- mode sonography showed 32 false positive cases which include 8 of acute suppurative inflammation, 16 of tuberculosis & 8 of reactive hyperplasia. Elastography: 40 out of 72 benign cases showed patterns I & II (reactive). Remaining 32 cases were falsely reported as metastatic & include 20 of tuberculosis, 4 of necrotizing histiocytic lymphadenopathy (Kikuchi lymphadenopathy), 5 of chronic non-specific lymphadenitis & 3 of reactive hyperplasia. Among 128 histopathologically proven metastasis cases, 120 cases were metastatic on elastogram.  Diagnostic performance:The diagnostic performance of B-mode USG showed sensitivity, specificity & diagnostic accuracy of 84.4%, 55.6% & 74.0% respectively and Elastography showed sensitivity, specificity & diagnostic accuracy of 93.8%, 55.6% & 80 % respectively. The diagnostic performance of combined B-mode USG and Elastography showed sensitivity, specificity and diagnostic accuracy of 96.9%, 33.3% and 74% respectively.  

1.Ultrasound elastography increases the sensitivity in detecting metastatic cervical lymph nodes. 2.The specificity however is significantly lower than the western literature; probably due to significant number of patients having tuberculous cervical lymphadenopathy.  

In view of high false positve results with ultrasound elastography evaluation of cervical lymph nodes in countries where infections like tuberculosis are more prevalent, ultrasound elastography should be used very cautiously in characterising cervical lymphadenoapthy.

Arkar, R, Kasi Arunachalam, V, Rupa, R, Kalyanpur, T, Cherian, M, Mehta, P, Vartharajaperumal, R, "All That Blue Is Not Malignant " — Role of Ultrasound Elastography in the Evaluation of Cervical Lymph Nodes.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14003283.html