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Eur J Pediatr Surg 2022; 32(04): 321-326
DOI: 10.1055/s-0041-1729900
Original Article

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

Ahmed Elgendy 
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
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Abstract

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.

Keywords

ultrasound elastography - children - cervical lymphadenopathy - lymphoma - reactive hyperplasia

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.




Publikationsverlauf

Eingereicht: 15. Dezember 2020

Angenommen: 06. April 2021

Artikel online veröffentlicht:
06. Juni 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Niedzielska G, Kotowski M, Niedzielski A, Dybiec E, Wieczorek P. Cervical lymphadenopathy in children--incidence and diagnostic management. Int J Pediatr Otorhinolaryngol 2007; 71 (01) 51-56
    CrossrefPubMedGoogle Scholar
  • 2 Rajasekaran K, Krakovitz P. Enlarged neck lymph nodes in children. Pediatr Clin North Am 2013; 60 (04) 923-936
    CrossrefPubMedGoogle Scholar
  • 3 Grant CN, Aldrink J, Lautz TB. et al. lymphadenopathy in children: a streamline approach for the surgeon – a report from the APSA cancer committee. J Pediatr Surg 2020
    PubMedGoogle Scholar
  • 4 Lee DH, Baek HJ, Kook H, Yoon TM, Lee JK, Lim SC. Clinical value of fine needle aspiration cytology in pediatric cervical lymphadenopathy patients under 12-years-of-age. Int J Pediatr Otorhinolaryngol 2014; 78 (01) 79-81
    CrossrefPubMedGoogle Scholar
  • 5 Nolder AR. Paediatric cervical lymphadenopathy: when to biopsy?. Curr Opin Otolaryngol Head Neck Surg 2013; 21 (06) 567-570
    PubMedGoogle Scholar
  • 6 Ludwig BJ, Wang J, Nadgir RN, Saito N, Castro-Aragon I, Sakai O. Imaging of cervical lymphadenopathy in children and young adults. AJR Am J Roentgenol 2012; 199 (05) 1105-1113
    CrossrefPubMedGoogle Scholar
  • 7 Ebeed AE, Romeih MAE, Refat MM, Salah MN. Role of ultrasound, color doppler, elastography and micropure imaging in differentiation between benign and malignant thyroid nodules. Egypt J Radiol Nucl Med 2018; 49: 553-563
    PubMedGoogle Scholar
  • 8 Tan R, Xiao Y, He Q. Ultrasound elastography: Its potential role in assessment of cervical lymphadenopathy. Acad Radiol 2010; 17 (07) 849-855
    CrossrefPubMedGoogle Scholar
  • 9 Barr RG, Zhang Z. Shear-wave elastography of the breast: value of a quality measure and comparison with strain elastography. Radiology 2015; 275 (01) 45-53
    CrossrefPubMedGoogle Scholar
  • 10 Thumar V, Squires JH, Spicer PJ, Robinson AL, Chan SS. Ultrasound elastography applications in pediatrics. Ultrasound Q 2018; 34 (04) 199-205
    CrossrefPubMedGoogle Scholar
  • 11 Lo WC, Cheng PW, Wang CT, Liao LJ. Real-time ultrasound elastography: an assessment of enlarged cervical lymph nodes. Eur Radiol 2013; 23 (09) 2351-2357
    CrossrefPubMedGoogle Scholar
  • 12 Alam F, Naito K, Horiguchi J, Fukuda H, Tachikake T, Ito K. Accuracy of sonographic elastography in the differential diagnosis of enlarged cervical lymph nodes: comparison with conventional B-mode sonography. AJR Am J Roentgenol 2008; 191 (02) 604-610
    CrossrefPubMedGoogle Scholar
  • 13 Larsson LO, Bentzon MW, Berg Kelly K. et al. Palpable lymph nodes of the neck in Swedish schoolchildren. Acta Paediatr 1994; 83 (10) 1091-1094
    CrossrefPubMedGoogle Scholar
  • 14 Zakaria OM, Mousa A, AlSadhan R. et al. Reliability of sonoelastography in predicting pediatric cervical lymph node malignancy. Pediatr Surg Int 2018; 34 (08) 885-890
    CrossrefPubMedGoogle Scholar
  • 15 Strassen U, Geisweid C, Hofauer B, Knopf A. Sonographic differentiation between lymphatic and metastatic diseases in cervical lymphadenopathy. Laryngoscope 2018; 128 (04) 859-863
    CrossrefPubMedGoogle Scholar
  • 16 Teng DK, Wang H, Lin YQ, Sui GQ, Guo F, Sun LN. Value of ultrasound elastography in assessment of enlarged cervical lymph nodes. Asian Pac J Cancer Prev 2012; 13 (05) 2081-2085
    CrossrefPubMedGoogle Scholar
  • 17 Abdelgawad EA, Abu-samra MF, Abdelhay NM, Abdel-Azeem HM. B-mode ultrasound, color Doppler, and sonoelastography in differentiation between benign and malignant cervical lymph nodes with special emphasis on sonoelastography. Egypt J Radiol Nucl Med 2020; 51: 157
    CrossrefPubMedGoogle Scholar
  • 18 Acu L, Oktar SÖ, Acu R, Yücel C, Cebeci S. value of ultrasound elastography in the differential diagnosis of cervical lymph nodes: a comparative study with B-mode and color Doppler sonography. J Ultrasound Med 2016; 35 (11) 2491-2499
    CrossrefPubMedGoogle Scholar
  • 19 Hefeda MM, Badawy ME. Can ultrasound elastography distinguish metastatic from reactive lymph nodes in patients with primary head and neck cancers?. Egypt J Radiol Nucl Med 2014; 45 (03) 715-722
    CrossrefPubMedGoogle Scholar
  • 20 Moharram MA, Abd-ElMaboud NM, Ahmed HA. Evaluation of the role of sono-elastography in diagnosis of enlarged cervical lymph nodes. Egypt J Radiol Nucl Med 2017; 48: 381-391
    CrossrefPubMedGoogle Scholar
  • 21 Hasan DI, Ahmed AF, Haggag R, Mohamed A. Ultrasound elastography in pathological enlarged cervical lymph nodes compared to histopathology. Egypt J Radiol Nucl Med 2016; 47: 1349-1359
    CrossrefPubMedGoogle Scholar
  • 22 Chiorean L, Barr RG, Braden B. et al; Current Clinical Applications and Literature Review. Transcutaneous ultrasound: elastographic lymph node evaluation. Ultrasound Med Biol 2016; 42 (01) 16-30
    CrossrefPubMedGoogle Scholar
  • 23 Zhen X, Sun L, Qiu J, Wang H. Comparison of virtual touch tissue quantification with strain ratio in differentiating malignant from benign cervical lymph nodes. J Hard Tissue Biol 2015; 24 (01) 49-53
    CrossrefPubMedGoogle Scholar
  • 24 Ishibashi N, Yamagata K, Sasaki H. et al. Real-time tissue elastography for the diagnosis of lymph node metastasis in oral squamous cell carcinoma. Ultrasound Med Biol 2012; 38 (03) 389-395
    CrossrefPubMedGoogle Scholar
  • 25 Kanagaraju V, Rakshith AVB, Devanand B, Rajakumar R. Utility of ultrasound elastography to differentiate benign from malignant cervical lymph nodes. J Med Ultrasound 2019; 28 (02) 92-98
    PubMedGoogle Scholar
  • 26 Locke R, MacGregor F, Kubba H. The validation of an algorithm for the management of paediatric cervical lymphadenopathy. Int J Pediatr Otorhinolaryngol 2016; 81: 5-9
    CrossrefPubMedGoogle Scholar
  • 27 Celenk F, Baysal E, Aytac I. et al. Incidence and predictors of malignancy in children with persistent cervical lymphadenopathy. Int J Pediatr Otorhinolaryngol 2013; 77 (12) 2004-2007
    CrossrefPubMedGoogle Scholar
  • 28 Anne S, Teot LA, Mandell DL. Fine needle aspiration biopsy: role in diagnosis of pediatric head and neck masses. Int J Pediatr Otorhinolaryngol 2008; 72 (10) 1547-1553
    CrossrefPubMedGoogle Scholar
  • 29 Huyett P, Monaco SE, Choi SS, Simons JP. Utility of fine-needle aspiration biopsy in the evaluation of pediatric head and neck masses. Otolaryngol Head Neck Surg 2016; 154 (05) 928-935
    CrossrefPubMedGoogle Scholar
  • 30 Locke R, Comfort R, Kubba H. When does an enlarged cervical lymph node in a child need excision? A systematic review. Int J Pediatr Otorhinolaryngol 2014; 78 (03) 393-401
    CrossrefPubMedGoogle Scholar
  • 31 De Corti F, Cecchetto G, Vendraminelli R, Mognato G. Fine-needle aspiration cytology in children with superficial lymphadenopathy. Pediatr Med Chir 2014; 36 (02) 80-82
    CrossrefPubMedGoogle Scholar