Comparative study of sonography including Doppler and sonoelastography in cervical lymphadenopathy

Background: Cervical lymphadenopathy, or abnormal enlargement of the lymph nodes in the neck, requires accurate differentiation between benign and malignant causes for effective management. Aims and Objectives: This study aimed to assess the diagnostic accuracy of B-mode sonography, color Doppler, and sonoelastography in distinguishing benign from malignant cervical lymph nodes. Materials and Methods: This prospective study included 72 patients who underwent cervical lymph node evaluation using B-mode ultrasound, color Doppler, and strain elastography, followed by pathological confirmation. The parameters assessed were nodal size, shape, vascularity, strain index, and elastographic pattern to differentiate benign from malignant nodes, thereby aiding in the non-invasive diagnostic accuracy of fine needle aspiration biopsy. Results: Histopathology revealed 31 benign (43.1%) and 41 malignant (56.9%) lymph nodes. B-mode features, including short-axis diameter, long-to-short-axis ratio, hilum presence, shape, margins, and echogenicity, showed significant differences between benign and malignant nodes (P<0.05). The absence of a visible hilum demonstrated high diagnostic performance, with an overall accuracy of 90.3%, sensitivity of 87.8%, and specificity of 93.5%. Color Doppler also demonstrated excellent performance (accuracy 91.7%). Strain elastography showed high specificity (90.3%) using a strain index cutoff of 1.5, and elastographic patterns revealed an accuracy of 83.3% in differentiating benign and malignant nodes. Conclusion: B-mode sonography and color Doppler are essential modalities for evaluating cervical lymphadenopathy. Strain elastography provides complementary information, particularly in terms of specificity, and can help avoid unnecessary invasive procedures such as biopsy. The combination of these imaging modalities improves the overall diagnostic accuracy in distinguishing benign cervical lymph nodes from malignant ones.