Skip to main content
SpringerLink
Log in

The value of ultrasound elastography in differential diagnosis of superficial lymph nodes

  • Research Article
  • Published:
Frontiers of Medicine in China Aims and scope Submit manuscript

Abstract

The study evaluated the value of ultrasound elastography in differentiating the benign and malignant superficial lymph nodes. A total of 112 subjects, including 82 patients with enlarged lymph nodes and 30 healthy volunteers, were recruited. All the subjects were examined by B-mode ultrasonography, power Doppler ultrasonography and elastography. Most of the patients were histopathologically confirmed by needle aspiration cytology and some patients were diagnosed by clinical data combined with follow-up findings. The sensitivity, specificity and accuracy of B-mode ultrasonography were 59.8%, 76.5% and 67.1%, those of the blood flow classification by power Doppler ultrasonography 77.0%, 82.3% and 79.4% and those of elastographic classification 74.7%, 97.1% and 84.5%, respectively. The elasticity of the lymph nodes was quantitatively measured and defined as stiffness value. When the stiffness value of 2.395 was taken as the cutoff point, the sensitivity and specificity of elastography were 78.41% and 98.51%, and the Youden index reached the highest, with the value being 0.7692. The stiffness values of two indeterminate benign lymph nodes, the elastrographic findings of which were rated as patterns 2 and 3, were below the cutoff point. The elastographic findings of 10 malignant lymph nodes were also classified as pattern 2 or 3. Only one of them had the stiffness values below the cutoff point. It was concluded that ultrasound elastography is a novel, noninvasive and convenient tool for the differentiation of the nature of the superficial lymph nodes in clinical practice.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Ferrari F S, Cozza S, Guazzi G, Della Sala L, Leoncini L, Lazzi S, Stefani P. Role of Doppler color in the differential diagnosis of benign and malignant adenopathies. Radiol Med (Torino), 1997, 93(3): 242–245

    CAS  Google Scholar 

  2. Yang W T, Chang J, Metreweli C. Patients with breast cancer: differences in color Doppler flow and gray-scale US features of benign and malignant axillary lymph nodes. Radiology, 2000, 215(2): 568–573

    PubMed  CAS  Google Scholar 

  3. Ho S S, Metrewefi C, Ahuja A T. Does anybody know how we should measure Doppler parameters in lymph nodes? Clin Radiol, 2001, 56(2): 124–126

    Article  PubMed  CAS  Google Scholar 

  4. Ophir J, Céspedes I, Ponnekanti H, Yazdi Y, Li X. Elastography: a quantitative method for imaging the elasticity of biological tissues. Ultrason Imaging, 1991, 13(2): 111–134

    Article  PubMed  CAS  Google Scholar 

  5. Sohn Y M, Kim M J, Kim E K, Kwak J Y, Moon H J, Kim S J. Sonographic elastography combined with conventional sonography: how much is it helpful for diagnostic performance? J Ultrasound Med, 2009, 28(4): 413–420

    PubMed  Google Scholar 

  6. Thitaikumar A, Mobbs L M, Kraemer-Chant C M, Garra B S, Ophir J. Breast tumor classification using axial shear strain elastography: a feasibility study. Phys Med Biol, 2008, 53(17): 4809–4823

    Article  PubMed  Google Scholar 

  7. Saleem S. Elastography and its role in breast cancer screening. J Coll Physicians Surg Pak, 2009, 19(3): 203–204

    PubMed  Google Scholar 

  8. Thomas A, Kümmel S, Fritzsche F, Warm M, Ebert B, Hamm B, Fischer T. Real-time sonoelastography performed in addition to B-mode ultrasound and mammography: improved differentiation of breast lesions? Acad Radiol, 2006, 13(12): 1496–1504

    Article  PubMed  Google Scholar 

  9. Tardivon A, El Khoury C, Thibault F, Wyler A, Barreau B, Neuenschwander S. Elastography of the breast: a prospective study of 122 lesions. J Radiol, 2007, 88(5 Pt 1): 657–662

    Article  PubMed  CAS  Google Scholar 

  10. Itoh A, Ueno E, Tohno E, Kamma H, Takahashi H, Shiina T, Yamakawa M, Matsumura T. Breast disease: clinical application of US elastography for diagnosis. Radiology, 2006, 239(2): 341–350

    Article  PubMed  Google Scholar 

  11. Ou B, Luo B M, Feng X, Yang H Y, Zhi H, Wen Y L. The value of ultrasonic elastography in differential diagnosing breast small masses. Zhonghua Chaosheng Yingxiangxue Zazhi, 2007, 16(6): 506–508 (in Chinese)

    Google Scholar 

  12. Zhi H, Xiao X Y, Yang H Y, Wen Y L, Ou B, Luo B M, Liang B L. Semi-quantitating stiffness of breast solid lesions in ultrasonic elastography. Acad Radiol, 2008, 15(11): 1347–1353

    Article  PubMed  Google Scholar 

  13. Adler D D, Carson P L, Rubin J M, Quinn-Reid D. Doppler ultrasound color flow imaging in the study of breast cancer: preliminary findings. Ultrasound Med Biol, 1990, 16(6): 553–559

    Article  PubMed  CAS  Google Scholar 

  14. Zhi H, Ou B, Luo BM, Feng X, Wen Y L, Yang H Y. Comparison of ultrasound elastography, mammography, and sonography in the diagnosis of solid breast lesions. J Ultrasound Med, 2007, 26(6): 807–815

    PubMed  Google Scholar 

  15. Luo B M, Ou B, Zhi H. Factors affecting the performance of ultrasonic elastography in breast tumors and its solutions. Zhongguo Yixue Kexueyuan Xuebao, 2008, 30(1): 112–115 (in Chinese)

    PubMed  Google Scholar 

  16. Luo B M, Zeng J, Ou B, Zhi H. Effects of pressure and compression frequency on diagnosis of breast masses by ultrasonic elastography. Zhongguo Yixue Yingxiang Jishu, 2007, 23(8): 1152–1154 (in Chinese)

    Google Scholar 

  17. Luo B M, Zeng J, Ou B, Zhi H. Effects of region of interesting on diagnostic results of ultrasonic elastography. Zhongguo Yixue Yingxiang Jishu, 2007, 23(9): 1330–1332 (in Chinese)

    Google Scholar 

  18. Jank S, Robatscher P, Emshoff R, Strobl H, Gojer G, Norer B. The diagnostic value of ultrasonography to detect occult lymph node involvement at different levels in patients with squamous cell carcinoma in the maxillofacial region. Int J Oral Maxillofac Surg, 2003, 32(1): 39–42

    Article  PubMed  CAS  Google Scholar 

  19. Dangore S B, Degwekar S S, Bhowate R R. Evaluation of the efficacy of colour Doppler ultrasound in diagnosis of cervical lymphadenopathy. Dentomaxillofac Radiol, 2008, 37(4): 205–212

    Article  PubMed  CAS  Google Scholar 

  20. Chan JM, Shin L K, Jeffrey R B. Ultrasonography of abnormal neck lymph nodes. Ultrasound Q, 2007, 23(1): 47–54

    Article  PubMed  Google Scholar 

  21. Li P, Cai S, Jiang Y X. Ultrasonography differential diagnosis and development of superficial lymph node diseases. Zhongguo Yixue Yingxiang Jishu, 2007, 23(9): 1409–1413 (in Chinese)

    CAS  Google Scholar 

  22. Ghirardelli M L, Jemos V, Gobbi P G. Diagnostic approach to lymph node enlargement. Haematologica, 1999, 84(3): 242–247

    PubMed  CAS  Google Scholar 

  23. Miyagawa T, Tsutsumi M, Matsumura T, Kawazoe N, Ishikawa S, Shimokama T, Miyanaga N, Akaza H. Real-time elastography for the diagnosis of prostate cancer: evaluation of elastographic moving images. Jpn J Clin Oncol, 2009, 39(6): 394–398

    Article  PubMed  Google Scholar 

  24. Kamoi K, Okihara K, Ochiai A, Ukimura O, Mizutani Y, Kawauchi A, Miki T. The utility of transrectal real-time elastography in the diagnosis of prostate cancer. Ultrasound Med Biol, 2008, 34(7): 1025–1032

    Article  PubMed  Google Scholar 

  25. Alam F, Naito K, Horiguchi J, Fukuda H, Tachikake T, Ito K. Accuracy of sonographic elastography in the differential diagnosis of enlarged cervical lymph nodes: comparison with conventional B-mode sonography. Am J Roentgenol, 2008, 191(2): 604–610

    Article  Google Scholar 

  26. Dighe M, Bae U, Richardson M L, Dubinsky T J, Minoshima S, Kim Y. Differential diagnosis of thyroid nodules with US elastography using carotid artery pulsation. Radiology, 2008, 248(2): 662–669

    Article  PubMed  Google Scholar 

  27. Uchida H, Hirooka Y, Itoh A, Kawashima H, Hara K, Nonogaki K, Kasugai T, Ohno E, Ohmiya N, Niwa Y, Katano Y, Ishigami M, Goto H. Feasibility of tissue elastography using transcutaneous ultrasonography for the diagnosis of pancreatic diseases. Pancreas, 2009, 38(1): 17–22

    Article  PubMed  Google Scholar 

  28. Kolokythas O, Gauthier T, Fernandez A T, Xie H, Timm B A, Cuevas C, Dighe M K, Mitsumori L M, Bruce M F, Herzka D A, Goswami G K, Andrews R T, Oas K M, Dubinsky T J, Warren B H. Ultrasound-based elastography: a novel approach to assess radio frequency ablation of liver masses performed with expandable ablation probes: a feasibility study. J Ultrasound Med, 2008, 27(6): 935–946

    PubMed  Google Scholar 

  29. Salomon G, Köllerman J, Thederan I, Chun F K, Budäus L, Schlomm T, Isbarn H, Heinzer H, Huland H, Graefen M. Evaluation of prostate cancer detection with ultrasound real-time elastography: a comparison with step section pathological analysis after radical prostatectomy. Eur Urol, 2008, 54(6): 1354–1362

    Article  PubMed  Google Scholar 

  30. Furukawa M K, Kubota A, Hanamura H, Furukawa M. Clinical application of real-time tissue elastography to head and neck cancer-evaluation of cervical lymph node metastasis with realtime tissue elastography. Nippon Jibiinkoka Gakkai Kaiho, 2007, 110(7): 503–505

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Medical Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China

    Yanrong Zhang, Qing Lv, Mingxing Xie, Feixiang Xiang, Chengfa Lu, Tianwei Yan, Wei Li, Hui Xu & Yan Huang

  2. Department of Medical Ultrasound, The First Hospital, Jianli, 434000, China

    Yehua Yin

Authors
  1. Yanrong Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Qing Lv
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yehua Yin
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Mingxing Xie
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Feixiang Xiang
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Chengfa Lu
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Tianwei Yan
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Wei Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Hui Xu
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Yan Huang
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Qing Lv.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Zhang, Y., Lv, Q., Yin, Y. et al. The value of ultrasound elastography in differential diagnosis of superficial lymph nodes. Front. Med. China 3, 368–374 (2009). https://doi.org/10.1007/s11684-009-0063-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11684-009-0063-0

Keywords

Search

Navigation