Real-time qualitative ultrasound elastography of cervical lymph nodes in routine clinical practice: interobserver agreement and correlation with malignancy.
To evaluate real-time qualitative ultrasound (US) elastography for cervical lymphadenopathy in routine clinical practice, 74 nodes (37 malignant, 37 benign) in 74 patients undergoing sonography underwent US elastography prior to fine needle aspiration for cytology. Dynamic cine loops of elasticity imaging displayed using a chromatic-scale were qualitatively scored by three independent observers for the proportion of stiff areas from ES1-4 (soft to stiff). There was fair to good interobserver agreement as indicated by weighted kappa (κ) statistic from 0.374 to 0.738. Median ES for benign and malignant nodes were 2 and 3 respectively. ES was higher in malignant nodes (p = 0.0003-0.0049, Mann Whitney U tests) although areas under receiver operating characteristic curves (0.68-0.74) indicated suboptimal discrimination. The optimal discriminatory cut-off, ES > 2, achieved only 62.2% sensitivity, 83.8% specificity and 73% accuracy for malignancy. Improvements in reliability and accuracy of real-time qualitative ultrasound elastography are required for it to be adopted into routine clinical practice.
Department of Diagnostic Radiology and Organ Imaging, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin N.T., Hong Kong.
Kunwar S S
KS
Bhatia
Carmen C M
CC
Cho
Yuen-Hok
YH
Yuen
Darshana D
DD
Rasalkar
Ann D
AD
King
Anil T
AT
Ahuja
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D044963:Biopsy, Fine-Needle; D003937:Diagnosis, Differential; D054459:Elasticity Imaging Techniques; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000000981:diagnostic imaging* / Q000473:pathology; D008206:Lymphatic Diseases / Q000000981:diagnostic imaging*; D008207:Lymphatic Metastasis / Q000000981:diagnostic imaging* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009333:Neck; D015588:Observer Variation; D012372:ROC Curve; D012680:Sensitivity and Specificity; D055815:Young Adult