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Reliability of sonoelastography in predicting pediatric cervical lymph node malignancy

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A Letter to the Editor to this article was published on 26 September 2018

Abstract

Purpose

Controversy exists as regards the best non-invasive diagnostic tool for pediatric cervical lymphadenopathy. The current work aimed to evaluate the reliability, sensitivity, specificity, and accuracy of sonoelastography in diagnosing benign and/or malignant pediatric cervical lymphadenopathy.

Methods

Prospective study took place over a period of 4 years from January 2013 to December 2016. A total of 177 lymph nodes (LNs) in 128 children with an age ranging from 11 months to 12 years were recruited in this study. Patients were 77 males and 51 females with a ratio of 3:2. All patients underwent a thorough history taking and clinical examination of the neck focusing on the cervical lymph nodes. After that, a B-mode sonography, Color Doppler ultrasound, and Sonoelastography were performed. Elastographic patterns of 1–5 were evaluated, whereas patterns of 3–5 (firm to hard) were suspected to have a malignant nature. Sonographic-guided aspiration cytology took place in 107 lymph nodes and excisional biopsy in 102 lymph nodes, whereas 13 lymph nodes responded adequately to conservative treatment. They proved to be benign reactive hyperplasia.

Results

The majority of LNs (87%) were of the malignant type that showed an elastographic pattern of 3–5. The same patterns were observed in only 6 (3.4%) of the benign LNs. Sonoelastography showed a sensitivity of 85.9%, specificity of 100%, PPV of 100%, NPV of 75.96%, and overall accuracy of 90.23% in distinguishing benign from malignant lymph nodes. Using the B-Mode ultrasound, an abnormal hilum was seen in 75%. The accuracy of color Doppler US reached 82.7%.

Conclusions

Sonoelastography may be superior to other US modalities in elucidating different cervical lymph node biopsy helping to distinguish benign from malignant lesions. This may replace the lymph node biopsies in the future. Moreover, its use in the follow-up of patients with cervical malignancies may reduce the number of future biopsies. Further studies with more patients may be needed for a better assessment of results.

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Authors and Affiliations

  1. Departments of Pediatric Surgery, Surgery, Radiology, Pathology, College of Medicine, King Faisal University, Al-Ahsa, Saudi Arabia

    Ossama M. Zakaria, Ahmed Mousa, Reema AlSadhan, Mohamed Y. Daoud, Asmaa Al-Taher, Krishna Swaroop, Haytham Al-Arfaj & Essam M. Abdelbary

  2. Division of Pediatric Surgery, Department of Surgery, Faculty of Medicine, Suez Canal University, Ismailia, Egypt

    Ossama M. Zakaria

  3. Department of Vascular Surgery, Faculty of Medicine for Males, Al-Azhar University, Cairo, Egypt

    Ahmed Mousa

  4. Division of Pediatric Surgery, Faculty of Medicine, Menoufia University, Menoufia, Egypt

    Tamer A. Sultan

  5. Medical Imaging Department, King Abdul-Aziz Hospital, Health Affairs of the Ministry of National Guard, Al-Ahsa, Saudi Arabia

    Ahmed F. Eid

  6. Department of Surgery, Imam Abdulrahman Bin Faisal University, College of Medicine, Dammam, Saudi Arabia

    Hazem M. Zakaria

  7. Department of General, Visceral, Thoracic and Vascular Surgery, Hanse Klinikum Stralsund, University Medicine of Greifswald, Greifswald, Germany

    Amr M. El-Gibaly

Authors
  1. Ossama M. Zakaria
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  2. Ahmed Mousa
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  3. Reema AlSadhan
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  4. Tamer A. Sultan
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  5. Ahmed F. Eid
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  6. Mohamed Y. Daoud
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  7. Asmaa Al-Taher
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  8. Hazem M. Zakaria
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  9. Krishna Swaroop
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  11. Haytham Al-Arfaj
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  12. Essam M. Abdelbary
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Corresponding author

Correspondence to Ossama M. Zakaria.

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Zakaria, O.M., Mousa, A., AlSadhan, R. et al. Reliability of sonoelastography in predicting pediatric cervical lymph node malignancy. Pediatr Surg Int 34, 885–890 (2018). https://doi.org/10.1007/s00383-018-4301-x

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  • DOI: https://doi.org/10.1007/s00383-018-4301-x

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