Role of strain elastosonography, B mode and color duplex ultrasonography in differentiation between benign and malignant axillary lymph nodes

Aim and objectives: to evaluate diagnostic accuracy of combined gray scale, color Doppler and strain elastosonography in differentiation between benign and malignant axillary lymph nodes. Methodology: 50 patients with 60 enlarged axillary lymph nodes (20 male and 30 female), their ages ranged from 25 to 66 years with a mean of 37.4 years. Grey scale, color-power Doppler US and strain elastography were performed for all patient. Results: absent echogenic hilum, LS/TS ratio less than 2, transverse diameter more than 7, cortical thickness more than 3 mm, high RI were the most US patterns predictive of malignancy. Suspicious lymph nodes by elastography (Scores 3 and 4) were found in 45 (75%) lymph nodes with sensitivity 88.89%, specificity 66.67%; accuracy 83.33%. The best strain ratio cutoff of 2.3 with sensitivity 87.89% and specificity 65.67%; accuracy 82.3%. Rounded shaped, loss or compressed nodal hilum and suspicious elastography score (3 & 4) were the most predictive for malignancy with sensitivity 86.67% and specificity 93.33%; accuracy 88.33%. Conclusion: combined gray scale, color Doppler US and elastography improve diagnostic accuracy of conventional ultrasound alone in differentiation between benign and malignant axillary lymph nodes with sensitivity 86.67%, and specificity 93.33%; accuracy 88.33%.