The Role of Strain Elastography in Evaluating Borderline Axillary Lymph nodes

mjlh klyh Tb lkndy Pub Date : 2022-05-05 DOI:10.47723/kcmj.v18i1.692

A. Muhi, A. Kamal, S. Dawood, T. F. Kareem, Rasha Thameen Thameen Fakhri, Zaid Al-Attar

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Abstract

Background: Axillary lymph node (ALN) enlargement with diffuse cortical thickening and conserved echogenic hilum may represent a diagnostic and therapeutic challenge. Sonographic strain elastography may help the characterization of borderline ALN. Aim: To evaluate the strain elastography of borderline ALN and to calculate a cutoff value of strain ratio (SR) that can identify suspicious ALN with the highest sensitivity and specificity to reduce unnecessary invasive procedures. Subjects and Methods: A prospective study included 45 patients who attended the Breast clinic in Oncology Teaching Hospital with borderline axillary lymphadenopathy (intact hilum and diffusely thickened cortex more than 3mm) who had normal ipsilateral breast, suspicious ipsilateral breast lesion, or who had ipsilateral mastectomy. B-mode sonography and elastography were performed for all participants. Four-point elasticity score (ES), and SR were obtained for the targeted lymph node followed by ultrasound-guided fine need aspirate (FNA) biopsy.. Results: Malignant ALN constituted 20% of the cohort. B mode measurements were not able to differentiate between cytologically confirmed benign and malignant ALN in terms of axis ratio (mean ± standard deviation, 0.46 ± 0.08 vs 0.50 ± 0.12) and cortical thickness (4.88 ± 1.93 vs 6.27 ± 2.46). The mean SR of all samples was 2.66 ± 2.25. Metastatic ALN depicted significantly higher SR (P<0.0001), with 88.9% exhibiting ES score 3 and 4. None of the metastatic ALN had ES score 1. ROC curve was used to investigate the utility of SR as a diagnostic tool. The area under the curve (AUC) was 0.906 with a 95% CI of 0.814-0.997, P<0.001. SR cutoff of 2.1 was chosen with 100% sensitivity and 66.7% specificity. Conclusion: High proportion of borderline ALNs are not malignant. Strain elasticity can improve the risk stratification of such cases and prevent unnecessary invasive procedures. We suggested an algorithm that could better tackle borderline ALN which will need further evaluation

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应变弹性成像在评估腋窝交界淋巴结中的作用

背景：腋窝淋巴结（ALN）肿大伴弥漫性皮质增厚和保守的回声门可能是诊断和治疗的挑战。超声应变弹性成像可能有助于边界ALN的表征。目的：评估边界ALN的应变弹性成像，并计算应变比（SR）的临界值，该值可以以最高的灵敏度和特异性识别可疑ALN，以减少不必要的侵入性手术。受试者和方法：一项前瞻性研究纳入了45名在肿瘤教学医院乳腺诊所就诊的边缘腋窝淋巴结病患者（门完整，皮质弥漫性增厚超过3mm），他们的同侧乳腺正常，同侧乳腺病变可疑，或进行了同侧乳房切除术。对所有参与者进行了B型超声和弹性成像。获得目标淋巴结的四点弹性评分（ES）和SR，然后进行超声引导的细针穿刺（FNA）活检。。结果：恶性ALN占队列的20%。B型测量无法在轴比（平均值±标准差，0.46±0.08 vs 0.50±0.12）和皮质厚度（4.88±1.93 vs 6.27±2.46）方面区分细胞学证实的良性和恶性ALN。所有样本的平均SR为2.66±2.25。转移性ALN的SR明显更高（P＜0.0001），88.9%的患者ES评分为3和4。转移性ALN的ES评分均为1。ROC曲线用于研究SR作为诊断工具的效用。曲线下面积（AUC）为0.906，95%CI为0.814-0.997，P<0.001。选择2.1的SR临界值具有100%的敏感性和66.7%的特异性。结论：高比例的交界性ALN不是恶性的。应变弹性可以改善此类病例的风险分层，并防止不必要的侵入性手术。我们提出了一种算法，可以更好地处理需要进一步评估的边界ALN

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