A Prospective Multimodal Imaging Assessment of Cervical Lymphadenopathy: Evaluating the Incremental Diagnostic Performance of B-mode Ultrasonography and Elastography with Histopathological Correlation in the Differentiation of Benign and Malignant Etiologies View PDF

^*Makarand Wadibhasme
Department Of Radiology, Consultant Radiologist, CIIMS Hospital, Nagpur, Maharashtra, India
Chaithanya Isamalla
Department Of Radiology, Senior Consultant Radiologist, AIG Hospitals, Hyderabad, Telangana, India
Madireddy Veena
Department Of Radio Diagnosis, Professor Of Radiodiagnosis, Government Medical College, Sangareddy, Telangana, India
Sarika Bolenwar
Department Of Radiology, Consultant Radiologist, Vijaya Diagnostic Centre, Hyderabad, Telangana, India
Shirisha Jakka
Department Of Radiology, Senior Consultant Radiologist, Head Of Women’s Imaging, Krishna Institute Of Medical Sciences (KIMS) Hospital, , Hyderabad, Telangana, India

^*Corresponding Author:

Makarand Wadibhasme
Department Of Radiology, Consultant Radiologist, CIIMS Hospital, Nagpur, Maharashtra, India

Published on: 2026-03-27

Abstract

The aim of the study is to evaluate the role and diagnostic utility of B-mode ultrasonogram and elastography prospectively to differentiate the benign and malignant causes of cervical lymphadenopathy and the primary objective is to compare the results of ultrasonogram and elastography with histopathological examination (HPE) in order to determine the accuracy and efficacy of sonoelastography in differentiating: benign nodes (including reactive and tuberculous lymphadenitis) from malignant nodes (metastatic carcinoma and lymphoma) and among benign nodes, distinguishing tuberculous from reactive lymphadenitis where possible. Whereas the secondary objectives are to: a) determine the individual as well as combined role of ultrasonogram, Doppler and elastography in categorizing the benign and malignant nature of lymph nodes; b) to determine the role of sonoelastography in staging of head and neck cancers with cervical lymphadenopathy; and c) to evaluate replacing invasive methods like fine needle aspiration cytology (FNAC)/biopsy with non-invasive elastography for diagnosing malignant nodes.

Keywords

Cervical lymphadenopathy, B-mode Ultrasonography, Elastography, Etiologies

Introduction

Cervical lymphadenopathy is a prevalent clinical condition in the human body, affecting around 300 lymph nodes in the head and neck region. The condition can be caused by infection, inflammation, or malignant conditions. In children, it is primarily due to infection, with viral, bacterial, or protozoal agents contributing to the development of reactive hyperplasia [1].

Tuberculosis (TB) is a significant contributor to infectious diseases, with India having the highest prevalence of this disease. Lymphadenitis, an extrapulmonary manifestation of TB, is more common in cervical lymph nodes, constituting approximately 63% of cases. The demographic most affected by this phenomenon is children and young adults aged 11 - 30, with a slight preference towards females. Human immunodeficiency virus is another etiological factor contributing to the development of lymphadenopathy, with extra-pulmonary nodal TB being a prevalent manifestation in affected individuals [2].

Malignancy incidence is higher in adults compared to children, with secondary metastases often arising from malignancies originating in the head and neck region. Primary lymphadenopathy is the most frequently encountered form of lymphoma. Cervical lymphadenopathy can sometimes manifest as the initial symptom or indication of disease in instances of metastasis [3].

While the present study aims to differentiate benign from malignant cervical lymphadenopathy, it is important to note that in regions with high TB prevalence such as India, tuberculous lymphadenitis-though benign in nature-may exhibit imaging and elastographic features that overlap with malignancy. Therefore, special attention is given to distinguishing tuberculous nodes from neoplastic nodes in the analytical framework [4].

In regions with a high prevalence of TB, such as India, tuberculous lymphadenitis often presents with central caseous necrosis, which can mimic the necrotic appearance of malignant nodes on both B-mode ultrasound and elastography. Consequently, elastographic patterns indicative of necrosis-such as pattern 4-may be observed in both malignant and tuberculous nodes, posing a significant diagnostic challenge and potentially reducing the specificity of elastography in such settings [5].

The presence of cervical lymphadenopathy plays a pivotal role in the staging, treatment, and prognosis of the condition. Patients with ipsilateral cervical lymphadenopathy experience a decrease in their 5-year survival rate to 50%, bilateral cervical lymphadenopathy is associated with a decreased 5-year survival rate of 25%, and extra capsular extension of nodal metastasis results in a further 50% reduction. Assessment of these nodes is crucial for patient prognosis evaluation and treatment planning [6].