Can Strain Elastography Improve the Diagnosis of Unilateral Axillary Lymphadenopathy?

Document Type : Original Article


The Department of Diagnostic and Interventional Radiology, Faculty of Medicine, Cairo University


Abstract Background: Prompt evaluation of unilateral axillary lymphadenopathy may be challenging. Though it is most commonly caused by benign disorders, it may be the first sign of breast cancer. Aim of Study: To assess the diagnostic performance of strain elastography in the evaluation of unilateral axillary lymphadenopathy and whether it can improve the reliability of conventional ultrasound and avoid unnecessary interven-tional procedures. Patients and Methods: This study included 77 female patients who were referred from the surgical outpatient clinic for the evaluation of unilateral, clinically palpable axillary lymphadenopathy. Gray scale ultrasound and strain elastog-raphy were performed, and final categorization of lymph nodes was done individually. The results were then compared to the histopathology results, sparing those who were catego-rized by imaging as non-specific lymph nodes, for whom follow-up was performed. Results: In this prospective study, 51/77 (66.2%) lymph nodes were non-specific or reactive, and 26/77 (33.8%) lesions were malignant or metastatic. In comparison to strain elastog-raphy, which had a sensitivity of 86.36% and a specificity of 65.45%, and overall accuracy of 71.43%, ultrasound results analysis had a greater sensitivity of 92.7% and a comparable specificity of 64.3%, and a greater overall accuracy of 74.03%. Conclusions: Strain elastography can be used as a com-plementary imaging tool to ultrasound examination in the evaluation of unilateral axillary lymphadenopathy. Guided by the patient's clinical data, it can increase our confidence in the diagnosis, allowing for short-interval follow-up with a subsequent reduction in the rate of interventional procedures.