title: Accuracy of real-time ultrasound elastography in the differential diagnosis of lymph nodes in cutaneous malignant melanoma (CMM): a pilot study.
abstract: BACKGROUND
  We investigated the diagnostic ability of real-time elastography to differentiate between reactive and metastatic lymph nodes in cutaneous malignant melanoma (CMM) patients and to determine the optimum cutoff value for elastography scores for diagnosis CMM.
  
  
  METHODS
  Twenty lymph nodes (metastatic, n = 13; reactive, n = 7) from 12 patients with CMM were examined by both elastography and B-mode ultrasound in this prospective study. Elastographic patterns were given scores of 1-5 according to the percentage of high elasticity (hard) areas in the lymph node. Elastographic patterns 1, 2, 3, 4, and 5 were assigned elastography scores (ES) of 1, 2, 3, 4, and 5, respectively. B-mode ultrasound diagnosis was performed on the basis of the morphological patterns (balloon-shaped lymph node and loss of central echoes). The sensitivity, specificity, and accuracy were calculated, and receiver operating characteristic analysis was performed, comparing with elastograms and B-mode images, with histological findings as the reference standard.
  
  
  RESULTS
  Sensitivity, specificity, and accuracy of elastography were 100, 71, and 90 %, respectively, with an ES cutoff value of 3; 92, 100, and 95 % for elastography with an ES cutoff value of 4; and 77, 57, and 70 % for B-mode ultrasound.
  
  
  CONCLUSIONS
  Elastography can enhance the diagnostic accuracy of ultrasound for differentiating between reactive and malignant lymph nodes in CMM and might eliminate the need for sentinel lymph node biopsy. The optimum ES cutoff value for reactive versus metastatic lymph nodes is 4.
authors.affiliation: Department of Dermatology, Saitama Medical University, 38 Morohongo Moroyama-machi, Iruma-gun, Saitama, 350-0495, Japan, dai.ogata@gmail.com.
authors.forename: Dai
authors.initials: D
authors.lastname: Ogata
authors.forename: Takayoshi
authors.initials: T
authors.lastname: Uematsu
authors.forename: Shusuke
authors.initials: S
authors.lastname: Yoshikawa
authors.forename: Yoshio
authors.initials: Y
authors.lastname: Kiyohara
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003937:Diagnosis, Differential; D054459:Elasticity Imaging Techniques; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000000981:diagnostic imaging / Q000473:pathology*; D008207:Lymphatic Metastasis / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000473:pathology; D008297:Male; D008545:Melanoma / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D008875:Middle Aged; D010865:Pilot Projects; D021701:Sentinel Lymph Node Biopsy; D012878:Skin Neoplasms; D000096142:Cutaneous Malignant Melanoma
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