Ultrasonography.  2022 Apr;41(2):279-290. 10.14366/usg.21107.

Diagnostic value of supersonic shear impulse elastography for malignant cervical lymph nodes: a Bayesian analysis

• Qiu Y
• Xing Z
• Yang Q
• Luo Y

• KMID: 2527429
• DOI: http://doi.org/10.14366/usg.21107

Abstract

Purpose
This study aimed to assess the diagnostic performance of supersonic impulse (SSI) elastography in differentiating malignant and benign cervical lymph nodes.
Methods
The Medline, Embase, and Cochrane Central databases were searched until December 1, 2020. Two different reviewers checked the studies and extracted the data. The diagnostic yields were quantitatively synthesized using a Bayesian bivariate model with an integrated nested Laplace approximation in R.
Results
In total, 590 patients with 892 cervical lymph nodes who underwent SSI elastography were included. The total prevalence of malignancy was 33.7% (301/892), and the four elastic modulus values (mean, maximum, minimum, and standard deviation) were significantly different between malignant and benign lymph nodes. For the mean elastic modulus, the summary estimates for sensitivity and specificity were 0.720 (95% credible interval [CrI], 0.592 to 0.824) and 0.877 (95% CrI, 0.727 to 0.969), respectively. The estimated area under the curve (AUC) was 0.845 (95% CrI, 0.672 to 0.914). For the maximum elastic modulus, the sensitivity and specificity were estimated to be 0.809 (95% CrI, 0.698 to 0.899) and 0.816 (95% CrI, 0.643 to 0.924), respectively. The estimated AUC was 0.834 (95% CrI, 0.579 to 0.938). The minimum and standard deviation of the elastic modulus and the outcomes of the positive and negative likelihood ratio, diagnostic odds ratio, and risk difference were also calculated.
Conclusion
SSI elastography is an acceptable imaging technique for diagnosing malignant cervical lymph nodes, and it can play a complementary role today. Both maximum and mean elastic modulus values should be taken into consideration to make a clinical judgment.

Keyword

Elasticity imaging techniques; Neck; Lymph nodes; Thyroid

Reference

References

1. Ying L, Hou Y, Zheng HM, Lin X, Xie ZL, Hu YP. Real-time elastography for the differentiation of benign and malignant superficial lymph nodes: a meta-analysis. Eur J Radiol. 2012; 81:2576–2584.

2. Esen G. Ultrasound of superficial lymph nodes. Eur J Radiol. 2006; 58:345–359.

3. Suh CH, Choi YJ, Baek JH, Lee JH. The diagnostic performance of shear wave elastography for malignant cervical lymph nodes: a systematic review and meta-analysis. Eur Radiol. 2017; 27:222–230.

4. Leboulleux S, Girard E, Rose M, Travagli JP, Sabbah N, Caillou B, et al. Ultrasound criteria of malignancy for cervical lymph nodes in patients followed up for differentiated thyroid cancer. J Clin Endocrinol Metab. 2007; 92:3590–3594.

5. Saadi R, LaRusso S, Vijay K, Goldenberg D. Elastography as a potential modality for screening cervical lymph nodes in patients with papillary thyroid cancer: a review of literature. Ear Nose Throat J. 2018; 97:31–39.

6. Choi YJ, Lee JH, Baek JH. Ultrasound elastography for evaluation of cervical lymph nodes. Ultrasonography. 2015; 34:157–164.

7. McInnes MD, Moher D, Thombs BD, McGrath TA, Bossuyt PM; PRISMA-DTA Group, et al. Preferred reporting items for a systematic review and meta-analysis of diagnostic test accuracy studies: the PRISMA-DTA statement. JAMA. 2018; 319:388–396.

8. Whiting PF, Rutjes AW, Westwood ME, Mallett S, Deeks JJ, Reitsma JB, et al. QUADAS-2: a revised tool for the quality assessment of diagnostic accuracy studies. Ann Intern Med. 2011; 155:529–536.

9. Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ. 2003; 327:557–560.

10. Rue H, Martino S, Chopin N. Approximate Bayesian inference for latent Gaussian models by using integrated nested Laplace approximations. J R Stat Soc Series B Stat Methodol. 2009; 71:319–392.

11. Guo J, Riebler A, Rue H. Bayesian bivariate meta-analysis of diagnostic test studies with interpretable priors. Stat Med. 2017; 36:3039–3058.

12. Simpson D, Rue H, Riebler A, Martins TG, Sorbye S. Penalising model component complexity: a principled, practical approach to constructing priors. Stat Sci. 2017; 32:1–28.

13. Lo WC, Hsu WL, Wang CT, Cheng PW, Liao LJ. Incorporation of shear wave elastography into a prediction model in the assessment of cervical lymph nodes. PLoS One. 2019; 14:e0221062.

14. Kang HJ, Seo M, Sohn YM, Yun SJ, Min SY, You MW, et al. Comparison of diagnostic performance of B-mode ultrasonography and shear wave elastography in cervical lymph nodes. Ultrasound Q. 2019; 35:290–296.

15. You J, Chen J, Xiang F, Song Y, Khamis S, Lu C, et al. The value of quantitative shear wave elastography in differentiating the cervical lymph nodes in patients with thyroid nodules. J Med Ultrason (2001). 2018; 45:251–259.

16. Kim HJ, Choi IH, Jin SY, Park HK, Byun DW, Suh K, et al. Efficacy of shear-wave elastography for detecting postoperative cervical lymph node metastasis in papillary thyroid carcinoma. Int J Endocrinol. 2018; 2018:9382649.

17. Chang W, Tang L, Lu C, Wu M, Chen M. Shear wave elastography in the evaluation of level VI lymph nodes in papillary thyroid carcinoma: combined with gray-scale ultrasound ex vivo. BMC Cancer. 2018; 18:1001.

18. Chen BB, Li J, Guan Y, Xiao WW, Zhao C, Lu TX, et al. The value of shear wave elastography in predicting for undiagnosed small cervical lymph node metastasis in nasopharyngeal carcinoma: a preliminary study. Eur J Radiol. 2018; 103:19–24.

19. Desmots F, Fakhry N, Mancini J, Reyre A, Vidal V, Jacquier A, et al. Shear wave elastography in head and neck lymph node assessment: image quality and diagnostic impact compared with B-mode and Doppler ultrasonography. Ultrasound Med Biol. 2016; 42:387–398.

20. Jung WS, Kim JA, Son EJ, Youk JH, Park CS. Shear wave elastography in evaluation of cervical lymph node metastasis of papillary thyroid carcinoma: elasticity index as a prognostic implication. Ann Surg Oncol. 2015; 22:111–116.

21. Choi YJ, Lee JH, Lim HK, Kim SY, Han MW, Cho KJ, et al. Quantitative shear wave elastography in the evaluation of metastatic cervical lymph nodes. Ultrasound Med Biol. 2013; 39:935–940.

22. Bhatia KS, Cho CC, Tong CS, Yuen EH, Ahuja AT. Shear wave elasticity imaging of cervical lymph nodes. Ultrasound Med Biol. 2012; 38:195–201.

23. Suh CH, Kim SY, Kim KW, Lim YS, Lee SJ, Lee MG, et al. Determination of normal hepatic elasticity by using real-time shear-wave elastography. Radiology. 2014; 271:895–900.

24. Saftoiu A, Gilja OH, Sidhu PS, Dietrich CF, Cantisani V, Amy D, et al. The EFSUMB guidelines and recommendations for the clinical practice of elastography in non-hepatic applications: update 2018. Ultraschall Med. 2019; 40:425–453.

25. Janssen J, Dietrich CF, Will U, Greiner L. Endosonographic elastography in the diagnosis of mediastinal lymph nodes. Endoscopy. 2007; 39:952–957.

26. Dong W, Horiuchi K, Tokumitsu H, Sakamoto A, Noguchi E, Ueda Y, et al. Time-varying pattern of mortality and recurrence from papillary thyroid cancer: lessons from a long-term follow-up. Thyroid. 2019; 29:802–808.

27. Sengul D, Sengul I, Van Slycke S. Risk stratification of the thyroid nodule with Bethesda indeterminate cytology, category III, IV, V on the one surgeon-performed US-guided fine-needle aspiration with 27-gauge needle, verified by histopathology of thyroidectomy: the additional value of one surgeon-performed elastography. Acta Chir Belg. 2019; 119:38–46.