Eur J Pediatr Surg
DOI: 10.1055/s-0041-1729900
Original Article

Ultrasound Elastography in the Diagnosis of Malignant Cervical Lymphadenopathy in Children: Can It Replace Surgical Biopsy?

1  Surgical Oncology Unit, Department of Surgery, Tanta University, Tanta, Egypt
Eslam Elhawary
2  Pediatric Hematology/Oncology and Bone Marrow Transplantation Unit, Department of Pediatrics, Tanta University, Tanta, Egypt
Mohamed M. Shareef
3  Department of Pathology, Tanta University, Tanta, Egypt
Marwa Romeih
4  Department of Radiology, Helwan University, Cairo, Egypt
Ahmed Ebeed
5  Department of Radiology, Kafrelsheikh University, Kafrelsheikh, Egypt
› Author Affiliations


Introduction We aimed to assess the accuracy of ultrasound elastography in detecting pediatric malignant cervical lymph nodes, and if this modality can obviate the need for surgical biopsies.

Material and Methods A prospective study from September 2017 to September 2020 included 64 children with persistent cervical lymphadenopathy. Patients were evaluated by meticulous history and physical assessment. B-mode ultrasound, color Doppler, and sonoelastography were conducted thereafter. Elastography scans were classified into five patterns, and patterns from 3 to 5 were considered as malignancies. All children underwent open biopsies followed by pathological examination. Results of tissue diagnosis were compared with patterns of elastography to determine its accuracy.

Results Twenty-eight patients (43.8%) had malignant nodes and the remaining 36 (56.2%) were due to benign causes. Elastography patterns of 1 and 2 were documented in 30 patients, and all of them were diagnosed as benign lesions. Patterns of 3 to 5 were demonstrated in 34 patients. Out of them, 28 were confirmed as malignancies, while 6 children were of benign nature (false positive). Ultrasound elastography achieved sensitivity and specificity of 100 and 85.7%, respectively, and an overall accuracy of 90.6% in the differentiation between malignant and benign entities. The overall accuracy of B-mode and color Doppler were 75 and 82.2%, respectively.

Conclusion Elastography is a useful tool that should be added to ultrasound modalities during the diagnosis of pediatric cervical lymphadenopathy. Surgical biopsy in eligible patients is imperative to commence proper therapy or to discharge the child. Despite favorable results of elastography, it cannot replace surgical biopsy or change its indications.

Authors' Contributions

Study design: A.E. Patients' management: all authors.

Data collection: all authors. Data analysis: A.E. and E.E. Manuscript writing: A.E. Manuscript critical revision: A.E., E.E., and M.R. All authors read and approved the final version of the manuscript.

Publication History

Received: 15 December 2020

Accepted: 06 April 2021

Publication Date:
06 June 2021 (online)

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