IJSR - International Journal of Scientific Research

DR. BHUSHAN A. SHRIKHANDE; DR. SHYAM A. CHHADI

Volume : VIII, Issue : VIII, August - 2019

B–MODE ULTRASOUND AND ELASTOGRAPHY TO DISTINGUISH BETWEEN BENIGN AND MALIGNANT CERVICAL LYMPH NODES.

Dr. Bhushan A. Shrikhande, Dr. Shyam A. Chhadi

Abstract :

Differentiating benign and malignant cervical lymph nodes is important to institute proper treatment. The status of lymph nodes is also important in staging of malignancy and evaluating the prognosis of the underlying disease. Hence, accurate differentiation of benign and malignant lymph nodes (LNs) is a crucial issue. The present study was carried out on 100 patients with enlarged cervical lymph nodes, examined with B–mode US, Doppler US and Sonoelastography in the Ultrasound unit of Galaxy Diagnostic Centre, Nagpur (M.S.), India. The aim was to prospectively estimate the diagnostic accuracy of sonoelastography in the differentiation between benign and malignant cervical lymph nodes. Sono–elastography is a new technique of sonography that is noninvasive, available and easy to apply. It evaluates the stiffness of the lesions based on response to the compression and decompression. By applying a mechanical force to the target lesion, an elastogram is obtained. The results appear as red or green indicating softness or blue, indicating hardness of the tissue.[FIG:2] Factors affecting stiffness include types of cell in the lesion, the quantity of cells and micro and macro pathological structures in the vicinity. So, ultrasound–elastography can visualize the hardness of the lesion by reflecting its biological characteristics. With prior verbal and written consent, patients were examined on gray–scale ultrasound on transverse images and then using elastographic ultrasonography technique. Strain ratio was calculated as the ratio of stiffness between cervical lymph node and surrounding normal muscle tissue. Patients were followed up by fine needle aspiration cytology (FNAC) findings & postoperative histopathology report in cases of inconclusive FNAC . Regarding sonoelastography, relation between elastograph scores and malignant cervical lymph nodes showing sensitivity, specificity and p value was calculated. RESULTS: Categorical variables were presented in number and percentage (%) and continuous variables were presented as mean ± SD and median. Inter–rater kappa agreement was used to find out the strength of agreement between various parameters and FNA result. Ultrasound had a sensitivity of 75.00%, a specificity of 87.50%, a positive predictive value of 70.00%, a negative predictive value of 90.00% and diagnostic accuracy of 84.00% in the prediction of malignancy. Ultrasound elastoscore had a sensitivity of 79.00%, a specificity of 94.44%, a positive predictive value of 84.62%, a negative predictive value of 91.89% and diagnostic accuracy of 90.00 % in the prediction of malignancy