Objective: To evaluate diagnostic performance of sono-elastography, B-mode, and Doppler ultrasonography in the differentiation of reactive and malignant enlarged cervical lymph nodes (LNs).

Materials and Methods: The present research was prospectively conducted in all consecutive patients that requested ultrasonography for their enlarged cervical LNs at the Department of Radiology, Phramongkutklao Hospital between January 2018 and November 2018. Informed consents were obtained in all patients. Shear wave sono-elastography, B-mode ultrasonography, and Doppler ultrasonography were performed in all patients.

Results: One hundred nine LNs from 34 patients were studied. One patient with six LNs was lost to follow-up, then only 103 LNs from 33 patients were included in analyses. Fifty-seven LNs (55.4%) were found to be benign and 46 LNs (44.6%) were malignant. B-mode ultrasonography revealed the size criterion was slightly more accurate than the shape criterion. The Doppler ultrasonography assessment provides the highest accuracy compared to the other methods. Sono-elastography assessment at a cut-off point of 45 pKa has high specificity of 98.2% but low sensitivity at 17.4% with an accuracy of 62.1%.

Conclusion: Shear wave sono-elastography is useful for evaluating the cervical LNs. It helped distinguishing malignant from benign LNs. A high specificity may help choose the LNs for biopsy, which avoid the invasiveness of biopsy and save money. However, further study in larger group of patients and use of a combined evaluation (Doppler ultrasonography with shear wave sono-elastography) will help increasing the accuracy.

Keywords: Shear wave elastography, Cervical lymph nodes, Sonoelastography

Received 26 Apr 2019 | Revised 28 May 2019 | Accepted 5 Jun 2019