Utility of addition of elastography to ultrasonography and Doppler in assessment of cervical lymphadenopathy with cyto-histopathological correlation

Abstract

Cervical lymphadenopathy is a common clinical condition with a wide spectrum of etiologies ranging from benign reactive processes to malignancy. Conventional ultrasonography (USG) with Doppler provides valuable morphological and vascular information but has limitations in accurately differentiating benign from malignant lymph nodes. Elastography, by assessing tissue stiffness, has emerged as a promising adjunct. The objective of the study was to correlate conventional ultrasonographic and elastographic findings with histopathology and compare their diagnostic performance in differentiating benign from malignant cervical lymph nodes. A cross-sectional study was conducted on 75 patients with cervical lymphadenopathy at a tertiary care center for a duration of 2 years. All patients who fulfilled the inclusion criteria and gave informed consent were enrolled. All subjects underwent imaging, including B-mode USG, color Doppler, and real-time elastography using USG machine GE Voluson S10, with linear transducer of frequency 7–13 MHz. Ultrasound-guided fine-needle aspiration cytology or biopsy of the cervical lymph node was subsequently performed. Diagnostic performance of conventional USG, elastography, and combined sonoelastography was calculated. Malignant nodes showed significantly higher short-axis diameter, round shape, irregular borders, loss of hilum, and peripheral/mixed vascularity ( P < 0.05). Mean strain ratio was significantly higher in malignant nodes ( P < 0.0001), consistent with increased tissue stiffness. Combined sono-elastography demonstrated higher sensitivity (95%) compared to conventional USG (85%). Sonoelastography significantly improves diagnostic performance and serves as a valuable adjunct to conventional USG in differentiating benign from malignant cervical lymphadenopathy.