Evaluation and optimization of benign and malignant differentiation of cervical lymph nodes based on ultrasound and strain elastography
ZHAO Longxu
DU Xiaoying
HOU Yingying
SUI Yang
TAN Peijin
Abstract：Objective To investigate the correlation between ultrasound sonographic indexes and malignant lymph nodes in the neck and the value of combined strain elastography for distinguishing benign and malignant lymph nodes in the neck in clinical practice.Methods A total of 252 patients(252 lymph nodes)who underwent ultrasonography of cervical lymph nodes and lymph node puncture biopsy in the First Affiliated Hospital of Bengbu Medical University from September 2023 to June 2024 were selected for routine ultrasonography and strain elastography,and they were divided into benign and malignant groups according to pathological results.Ultrasound indicators such as L/S,morphology,border,internal echo,gate structure and blood flow type in the guidelines for ultrasound examination of lymph nodes were included in single-factor and logistic multifactorial regression analyses to analyse ultrasound sonogram indicators with higher correlation with benign and malignant cervical lymph nodes,using the results of puncture pathology as the gold standard;using the results of puncture pathology as the gold standard,the ROC curve of the strain ratio(SR value)was plotted and the optimal cut-off value was selected to analyse the efficacy of using elastography to diagnose malignant lymph nodes in the neck;and the efficacy of ultrasound,elastography and the combination of the two for the differential diagnosis of the nature of cervical lymph nodes was comparatively analyzed.Results Among the 252 cervical lymph nodes,104(41.3%)were benign lesions and 148(58.7%)were malignant lesions.The ultrasound indexes in which the differences between benign and malignant lymph nodes were all statistically significant were:L/S,morphology,internal echoes,gate structure,and blood flow type(P<0.05),and multifactorial logistic regression analysis showed that the ultrasound sonographic indexes associated with malignant lymph nodes in the neck according to the size of the OR value were:blood flow type,gate structure,internal echoes(P<0.05).The SR value of 252 cases of cervical lymph nodes,with an optimal cut-off value of 1.34,had a sensitivity of 77.0%,specificity of 84.6%,accuracy of 80.2%,and AUC of 0.808(95%CI:0.752-0.865)for diagnosing cervical malignant lymph nodes,while ultrasonic diagnosis of cervical malignant lymph nodes had a sensitivity of 66.2%,a specificity of 78.8%,and an accuracy of 71.4%,with an AUC of 0.725(95%CI:0.661-0.789);the combined diagnosis of the two had a sensitivity of 90.5%,a specificity of 74.0%,an accuracy of 83.7%,and an AUC of 0.853(95%CI:0.801-0.905).Conclusion The ultrasound sonographic indicators that are more relevant to the benign and malignant nature of cervical lymph nodes are,in order,blood flow type,gate structure,and internal echo;combined ultrasound and strain elastography can improve the early diagnostic efficacy of benign and malignant nature of cervical lymph nodes to a certain extent.
Keywords：cervical lymph nodesultrasoundultrasound elastographystrain elastograpy
Publication Date：2025-05-20
Online Publishing Date：2025-08-15(First online date of this platform, not the publication date of the document)
Pages：7( 582-588 )