A Preliminary Study On Differential Diagnosis Of Cervical Lymph Nodes With Different Pathological Types By Two Dimensional Shear Wave Elastography (2D-SWE)

Objective: To investigate the diagnostic value of 2D-SWE(Two-dimensional shear wave elastography)in different pathological types of cervical lymph nodes.Methods: The conventional US(ultrasonography)and 2D-SWE were performed on 145 enlarged cervical lymph nodes in 101 patients,the observation and measurement included :the internal echo,hilum medulla,aspect ratio,blood flow pattern,maximum stiffness value(Qbox Emax),mean stiffness value(Qbox Emean)and standard deviation of stiffness value(Qbox SD).Finally all nodes were divided into reactive hyperplasia group,lymphatic tuberculosis group,lymphoma group,and metastatic lymph nodes group according to the pathological results of surgery or fine needle aspiration and follow-up.The parameters with high diagnostic value were screened out by multinomial logistic regression analysis and the cutoff value was determined by ROC curve.Result: The internal echo,blood flow pattern and Qbox Emax showed high differential diagnostic value among different pathological types of lymph nodes.The stiffness of lymphomas,lymphatic tuberculosis and metastatic lymph nodes was higher than that of reactive hyperplasia lymph nodes(P all<0.001)and increased step by step,according to the comparisons between any two groups,The Qbox Emax cutoff value between lymphoma and reactive hyperplasia lymph nodes was30kpa(P<0.001),AUC,sensitivity and specificity was 0.783,78.57% and 67.92%,the Qbox Emax cutoff value between lymphatic tuberculosis and lymphoma was 47.53kpa(P<0.001),AUC,sensitivity and specificity was 0.856,71.43% and 91.30%,the metastatic lymph nodes was stiffer than lymphatic tuberculosis but the difference had no statistic significance(P > 0.05).Based on these thresholds and analysis of related reasons,the following inference was made:when Qbox Emax ≤ 30 kpa,there is a high possibility ofreactive hyperplasia lymph nodes,30kpa<Qbox Emax≤47.53 kpa is highly likely to be lymphoma or chronic lymphadenitis,when Qbox Emax > 47.53 kpa,the lymph node tuberculosis or metastatic lymph node were more likely.Conclusion: The 2D-SWE parameter Qbox Emax can properly reflect the stiffness variance of different pathological types of lymph nodes,and the stiffness values of most lymph nodes are distributed in certain ranges,therefore,Qbox Emax can be used as an important supplementary indicator for ultrasonic differential diagnosis of cervical lymph nodes.