title: Role of high resolution ultrasound/endosonography and elastography in predicting lymph node malignancy.
abstract: OBJECTIVE
  The objective of this study is to evaluate the role of high resolution ultrasonography (US) and endoscopic ultrasound (EUS)-elastography in predicting malignant lymphadenopathy.
  
  
  METHODS
  This prospective study included 88 patients who underwent EUS or US examination of different groups of lymph nodes (LNs). The classification as benign or malignant based on the real time elastography pattern and the B-mode US/EUS images was compared with the final diagnosis obtained by EUS or US guided fine-needle aspiration cytology (FNAC), tru-cut biopsy or excisional biopsy and follow-up in benign lesions not indicated for biopsy for at least 12 months.
  
  
  RESULTS
  Regarding the echogenicity, 98.3% of the benign LNs were hyperechoic, 1.7% was hypoechoic while 89.7% of the malignant LNs were hypoechoic, 3.4% were heterogenous and 6.9% were hyperechoic. With cut-off value of 1.93, the sensitivity of longitudinal to transverse ratio was 73% and the specificity was 100%. Score 1 elastography had specificity of 100% in diagnosis of benign LNs, sensitivity was 76.3%, positive predictive value (PPV) was 100%, negative predictive value (NPV) was 84.7% while score 2 had a sensitivity of 60%, specificity of 31.5%, PPV of 15.3%, NPV of 79.3%. Score 3 had a sensitivity of 70.2%, specificity of 100%, PPV of 13.8%, NPV of 100% in detecting malignancy while score 4 had a sensitivity of 85.5%, specificity of 100%, PPV of 100%, NPV of 65.5%.
  
  
  CONCLUSIONS
  Elastography is a promising diagnostic modality that may complement standard ultrasound and EUS and help guide FNAC during staging of LNs.
authors.affiliation: Department of Internal Medicine and Gastroenterology, Cairo University, Cairo, Egypt.
authors.forename: Hussein Hassan
authors.initials: HH
authors.lastname: Okasha
authors.affiliation: Department of Internal Medicine and Gastroenterology, Cairo University, Cairo, Egypt.
authors.forename: Mona
authors.initials: M
authors.lastname: Mansour
authors.affiliation: Department of Internal Medicine and Gastroenterology, Cairo University, Cairo, Egypt.
authors.forename: Khaled Ahmed
authors.initials: KA
authors.lastname: Attia
authors.affiliation: Department of Pathology, Cairo University, Cairo, Egypt.
authors.forename: Hany Mahmoud
authors.initials: HM
authors.lastname: Khattab
authors.affiliation: Department of Oncology, Cairo University, Cairo, Egypt.
authors.forename: Amr Yahia
authors.initials: AY
authors.lastname: Sakr
authors.affiliation: Department of Internal Medicine and Gastroenterology, Cairo University, Cairo, Egypt.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Naguib
authors.affiliation: Department of Internal Medicine and Gastroenterology, Cairo University, Cairo, Egypt.
authors.forename: Wael
authors.initials: W
authors.lastname: Aref
authors.affiliation: Department of Internal Medicine and Gastroenterology, Cairo University, Cairo, Egypt.
authors.forename: Ahmed Abdel-Moaty
authors.initials: AA
authors.lastname: Al-Naggar
authors.affiliation: Department Internal Medicine and Gastroenterology, Assiut University, Assiut, Egypt.
authors.forename: Reem
authors.initials: R
authors.lastname: Ezzat
keywords: Lymph node; elastography; endoscopic ultrasound; malignant; ultrasonography