# Comparison of conventional ultrasonography and elastography ultrasound in detecting malignant cervical lymph nodes

## TL;DR

This study compares conventional ultrasound and two types of ultrasound elastography for detecting cancerous cervical lymph nodes, finding that one method (VTIQ) performs better than the other (SE).

## Contribution

The study provides a large-scale comparison of elastography techniques for cervical lymph node malignancy detection in clinical practice.

## Key findings

- VTIQ showed higher diagnostic accuracy (AUC 0.84) compared to SE (AUC 0.74) for malignant lymph nodes.
- VTIQ had better specificity and lower false-negative and false-positive rates than SE.
- Combining conventional ultrasound with elastography improves diagnostic precision for cervical lymph node diseases.

## Abstract

In the contemporary landscape, conventional ultrasonography (US) stands as the primary modality for diagnosing cervical lymphadenopathy. While ultrasound elastography introduces an avenue for discerning the tissue hardness of lymph nodes (LNs) and contributes additional evidence for a conclusive diagnosis, skepticism persists among clinicians regarding its routine diagnostic utility, primarily attributed to the restricted case inclusion prevalent in most published reports. This study aimed to compare the performance of strain elastography (SE) and Virtual Touch Tissue Imaging Quantification (VTIQ) with that of conventional US for the measurement of cervical LNs.

We performed a retrospective chart review of patients with cervical lymphadenopathy who underwent both conventional ultrasound (US) and elastography ultrasound at Shandong Provincial Hospital affiliated to Shandong First Medical University from January 2021 to December 2022.The stiffness of 123 abnormal cervical lymph nodes (LNs) in 106 patients, substantiated by pathologic diagnoses, was quantified through elastography. Conventional US, strain elastography (SE), and Virtual Touch Tissue Imaging Quantification (VTIQ) were employed for the comprehensive evaluation of all identified LNs. The diagnostic efficacy of elastography’s quantitative analysis was meticulously assessed utilizing receiver operating characteristic (ROC) curves.

Pathological analysis affirmed malignancy in 89 out of 123 abnormal cervical lymph nodes (LNs) within the cohort of 106 patients. The area under the ROC curve (AUC) revealed a significantly greater discriminatory capacity for malignant LNs with Virtual Touch Tissue Imaging Quantification (VTIQ) compared to Strain Elastography (SE) (AUC, 0.84 vs. 0.74; z=2.83, p=0.005). VTIQ exhibited superior specificity, false-negative ratio, and false-positive ratio in contrast to SE. However, SE demonstrated heightened sensitivity in the detection of malignant LNs.

Both Strain Elastography (SE) and Virtual Touch Tissue Imaging Quantification (VTIQ) demonstrated commendable diagnostic performance for malignant nodes, with VTIQ exhibiting superior conspicuity over SE. The amalgamation of conventional ultrasonography with elastography enhances the precision of ultrasound diagnosis in cervical lymph node diseases.