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Diagnostic efficacy of ultrasonography, Doppler ultrasonography and elastography in the evaluation of suspected malignant lymph nodes

Hülya Çetin Tunçez
Hülya Çetin Tunçez
, 
Ali Murat Koç
Ali Murat Koç
, 
Zehra Hilal Adıbelli
Zehra Hilal Adıbelli
, 
Fatma Zeynep Arslan
Fatma Zeynep Arslan
, 
Asuman Argon
Asuman Argon
 e 
Gülşen Yücel Oğuzdoğan
Gülşen Yücel Oğuzdoğan
   | 28 feb 2023
Journal of Ultrasonography's Cover Image
INFORMAZIONI SU QUESTO ARTICOLO
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Article Category: Research paper
Pubblicato online: 28 feb 2023
Pagine: 1 - 9
Ricevuto: 26 giu 2022
Accettato: 10 ott 2022
DOI: https://doi.org/10.15557/JoU.2023.0001
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© 2023 Hülya Çetin Tunçez, Ali Murat Koç, Zehra Hilal Adıbelli, Fatma Zeynep Arslan, Asuman Argon, Gülşen Yücel Oğuzdoğan, published by Sciendo
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Fig. 1

Schematic display of elasticity patterns with USE
Schematic display of elasticity patterns with USE

Fig. 2

On Doppler US, A. color and B. spectral Doppler examination of the lymph node with hilar blood supply is shown. On Doppler US, A. color and B. spectral Doppler examination of obliterated hilus lymph node with peripheral blood supply and asymmetric cortical thickness is seen
On Doppler US, A. color and B. spectral Doppler examination of the lymph node with hilar blood supply is shown. On Doppler US, A. color and B. spectral Doppler examination of obliterated hilus lymph node with peripheral blood supply and asymmetric cortical thickness is seen

Fig. 3

Visual representation of the distribution of pathology results and interpretations for different imaging methods
Visual representation of the distribution of pathology results and interpretations for different imaging methods

Fig. 4

A 48-year-old female patient was diagnosed with a BI-RADS 5 mass in the breast, and biopsy was planned from the suspicious axillary lymph node. Hilar blood supply was observed in the ovoid lymph node with a fatty hilum and asymmetrically increased cortical thickness (A). The strain ratio was determined as 2.06 on USE, and the elasticity pattern was determined as 3 (B). The pathology result was reported as malignant cytology
A 48-year-old female patient was diagnosed with a BI-RADS 5 mass in the breast, and biopsy was planned from the suspicious axillary lymph node. Hilar blood supply was observed in the ovoid lymph node with a fatty hilum and asymmetrically increased cortical thickness (A). The strain ratio was determined as 2.06 on USE, and the elasticity pattern was determined as 3 (B). The pathology result was reported as malignant cytology

Kappa analysis results for the compatibility of pathology results with B-mode, Doppler US and US elastography results

Pathological diagnosis Total Kappa value p
Benign Malignant
n % n % n %
B-mode US Benign 27 75.0 30 55.6 57 63.3 0.177 0.061
Malignant 9 25.0 24 44.4 33 36.7
Total 36 40.0 54 60.0 90 100.0
Doppler US Benign 28 77.8 22 41.5 50 56.2 0.001
Malignant 8 22.2 32 58.5 40 43.8 0.341
Total 36 40.0 54 60.0 90 100.0
US elastography Benign 21 58.3 17 31.5 38 42.2 0.266 0.012
Malignant 15 41.7 37 68.5 52 57.8
Total 36 40.0 54 60.0 90 100.0
B-mode US + Doppler US Benign 26 72.2 19 35.8 45 50.0 0.001
Malignant 10 27.8 35 64.2 45 50.0 0.350
Total 36 40.0 54 60.0 90 100.0
Doppler US + US elastography Benign 18 50.0 6 11.3 24 27.0 0.000
Malignant 18 50.0 48 88.7 66 73.0 0.409
Total 36 40.0 54 60.0 90 100.0
B-mode US + Doppler US + US elastography Benign 18 50.0 5 9.6 23 26.1 0.428 0.000
Malignant 18 50.0 49 90.4 67 73.9
Total 36 40.0 54 60.0 90 100.0

Ultrasonographic features of the examined lymph nodes according to their pathological diagnosis

Pathological diagnosis X2 p
Benign Malignant
n % n %
Shape Round 2 5.6 13 24.1
Ovoid 34 94.4 41 75.9 5.333 0.021
Hilum Normal fatty hilum 17 47.2 13 24.1 5.213 0.022
Abnormal obliterated hilum 19 52.8 41 75.9
Cortical No 28 77.8 46 85.2
necrosis Yes 8 22.2 8 14.8 0.811 0.368
Margin Regular 36 100.0 50 92.6 2.791 0.147
Irregular 0 0.0 4 7.4
Edema within the adjacent tissues No 34 94.4 53 98.1 0.92 0.561
Yes 2 5.6 1 1.9
Echogenicity Hypoechoic 34 94.4 54 100.0 2.900 0.163
Isoechoic 2 5.6 0 0.0

ROC analysis results for the power of imaging methods in predicting the pathology result of axillar lymph nodes

Threshold value Sensitivity Specificity Positive predictive value Negative predictive value Area under the curve Confidence interval (95%) P-value
Long axis >24 40.0 88.0 87.0 42.3 0.642 0.523–0.749 0.023
Short axis >10 54.0 84.0 87.1 47.7 0.73 0.615–0.826 0.000
Long axisshort axis ratio ≤1.46 24.0 100.0 100.0 39.7 0.624 0.504–0.733 0.060
Resistive index >0.76 52.9 80.0 84.4 45.5 0.621 0.503–0.730 0.055
Pulsatility index >1.26 66.7 60.0 76.2 48.4 0.639 0.518–0.748 0.036
Acceleration rate >0.41 66.7 52.0 72.7 44.8 0.573 0.452–0.688 0.295
Acceleration time ≤136 39.6 84.0 82.6 42.0 0.531 0.410–0.649 0.656
Elastography (strain ratio) >1.75 47.1 88.0 88.9 44.9 0.688 0.571–0.789 0.003

Elasticity scoring

Pattern 1 No stiff area within the lesion
Pattern 2 The percentage of stiff area is less than 45%
Pattern 3 The percentage of stiff area is greater than 45%
Pattern 4 The lesion is mostly stiff
Pattern 5 The lesion is completely stiff

ROC analysis results for the power of imaging methods in predicting pathological diagnosis

Sensitivity Specificity Positive predictive value Negative predictive value Area under the curve Confidence interval (95%) P-value Accuracy
B-mode US 44.4 75.0 72.7 47.4 0.597 0.489–0.699 0.108 56.7
Doppler US 58.5 77.8 79.5 56.0 0.681 0.574–0.776 0.002 66.3
US elastography 68.5 58.3 71.2 55.3 0.634 0.526–0.733 0.027 64.4
B-mode US + Doppler US 64.2 72.2 77.3 57.8 0.682 0.575–0.777 0.002 67.4
Doppler + US elastography US 88.7 50.0 72.3 75.0 0.693 0.587–0.787 0.001 73.0
B-+ mode US elastography US + Doppler US 90.4 50.0 72.3 78.3 0.702 0.595–0.795 0.001 73.9

ROC analysis results for the power of imaging methods in predicting the pathology result of cervical lymph nodes

Threshold value Sensitivity Specificity predictive Positive value predictive Negative value Area under the curve Confidence interval (95%) P-value
Long axis >33 33.3 100.0 100.0 84.6 0.515 0.242–0.781 0.947
Short axis >14 66.7 90.9 66.7 90.9 0.742 0.447–0.932 0.232
Long axis/short axis ratio ≤2.21 100.0 54.6 37.5 100.0 0.788 0.494–0.954 0.040
Resistive index >0.76 100.0 54.6 37.5 100.0 0.742 0.447–0.932 0.102
Pulsatility index >1.34 100.0 54.6 37.5 100.0 0.697 0.402–0.906 0.180
Acceleration rate >0.41 100.0 54.6 37.5 100.0 0.727 0.432–0.923 0.106
Acceleration time >181 0.0 63.6 0.0 70.0 0.53 0.255–0.793 0.848
Elastography (strain ratio) >1.96 66.7 81.8 50.0 90.0 0.576 0.292–0.826 0.758
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