Dataset Information

Incorporation of shear wave elastography into a prediction model in the assessment of cervical lymph nodes.

ABSTRACT:

Rationale and objectives

To assess the performance of shear wave elastography (SWE) and an extended model in predicting malignant cervical lymph nodes (LNs).

Materials and methods

109 patients who underwent ultrasound (US) and SWE before needle biopsy were enrolled. The optimal cutoff value of elasticity indices (EIs) was determined by receiver operating characteristic (ROC) curves. The c-statistic, net reclassification improvement (NRI) and integrated discrimination improvement (IDI) were used to compare extended model and traditional one.

Results

Malignant LNs had higher EIs than benign nodes (p < 0.001). The optimal cutoff point was 42 kilopascal, corresponding to 83.3% sensitivity, 64.7% specificity, and 68.8% overall accuracy. A multivariable logistic regression analysis confirmed that EI was an independent predictor for malignancy. The new extended prediction model had a positive NRI (0.96) and IDI (0.10) for predicting malignant neck LNs. Nevertheless, the c-statistic was not significantly different between the two models.

Conclusion

The parameter of SWE theoretically improve the model performance. However, its real clinical impact is minor, as the parameters of US-based model is already very robust. SWE can be considered as an adjunctive quantitative tool beyond conventional US examination.

SUBMITTER: Lo WC

PROVIDER: S-EPMC6695226 | biostudies-literature | 2019

REPOSITORIES: biostudies-literature

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Publications

Incorporation of shear wave elastography into a prediction model in the assessment of cervical lymph nodes.

Lo Wu-Chia WC Hsu Wan-Lun WL Wang Chi-Te CT Cheng Po-Wen PW Liao Li-Jen LJ

PloS one 20190815 8

<h4>Rationale and objectives</h4>To assess the performance of shear wave elastography (SWE) and an extended model in predicting malignant cervical lymph nodes (LNs).<h4>Materials and methods</h4>109 patients who underwent ultrasound (US) and SWE before needle biopsy were enrolled. The optimal cutoff value of elasticity indices (EIs) was determined by receiver operating characteristic (ROC) curves. The c-statistic, net reclassification improvement (NRI) and integrated discrimination improvement ( ...[more]

PMID: 31415610

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Project description:Purpose: To investigate N-staging Assessment of pretreatment Shear wave elastrography (SWE) in small cervical lymph nodes (0. 5 cm ? maximum diameter < 1 cm, intact capsule, no central necrosis, sCLNs) in nasopharyngeal carcinoma (NPC) patients. Methods: Pathological biopsy proven 28 NPC patients with sCLNs shown in pretreatment magnetic resonance (MR) images and 40 target lymph nodes were enrolled. All target lymph nodes were divided into metastasis and benign lymph node groups according to pathology. SWE was used to exam the real time SWE imaging of each target lymph nodes before conducting ultrasonography guided fine needle biopsy. The minimum (Emin), maximum (Emax), and mean (Emean) elasticity indices (kPa) of target lymph nodes were recorded. The SWE examination was repeated three times for the same target lymph node and each elasticity indices for statistic was determined by average of three measurements. SPSS 21.0 statistics software is used for statistical analysis. The receiver operating characteristic (ROC) curve was performed to obtain the cutoff value of elasticity indices of metastatic sCLNs. Statistical significance was assumed when the P < 0.05. Results: Nine lymph nodes were metastatic and 31 were benign. The Emin, Emax, and Emean of benign group were 8.15 ± 6.12, 25.05 ± 12.37, and 16.05 ± 8.29 kPa, respectively; Emin, Emax, and Emean of metastasis group were 11.5 ± 6.17, 41.38 ± 17.87, and 23.48 ± 6.50 kPa, respectively. The difference of the Emax and Emean between metastasis and benign group were statistically significant (P = 0.003 and 0.018). The area under the ROC curve of Emin, Emax, and Emean of metastasis lymph node were 0.685 (P = 0.095), 0.785 (P = 0.010), and 0.765 (P = 0.017), respectively. Emax of 27 kPa and Emean of 17 kPa were taken as the cutoff value of diagnosis for metastasis sCLNs: the sensitivity, specificity, and accuracy were 77.8 and 100%, 71.0 and 61.3%, 75.0 and 70.0%, respectively. Conclusions: Pretreatment SWE has high accuracy in evaluating the sCLNs in NPC patients and is helpful for accurate N-staging and survival prognosis. It can be used as a clinical supplementary examination.

Project description:IntroductionBishop score, the traditional method to assess cervical condition, is not a promising predictive tool of the outcome of labor induction. As an objective assessment tool, many cervical ultrasound measurements have been proposed to represent the individual components of the Bishop score, but none of them can measure the cervical stiffness. Cervical shear wave elastography is a novel tool to assess the cervical stiffness quantitatively.Material and methodsA total of 475 women who required labor induction were studied prospectively. Prior to routine digital assessment of the Bishop score, transvaginal sonographic measurement of cervical length, posterior cervical angle, angle of progression and shear wave elastography was performed. Shear wave elastography measurement was made at the inner, middle and outer regions of the cervix to assess homogeneity. Association of labor induction outcomes including the overall cesarean section and subgroups of cesarean section for failure to enter active phase, with cervical sonographic parameters and the Bishop score, were assessed using multivariate regression analyses. The predictive accuracy of the outcomes using models based on ultrasound measurement and the Bishop score was compared using the area under the receiver-operating characteristics curves.ResultsAmong 475 women, 82 (17.3%) required cesarean section. Shear wave elasticity was significantly higher in the inner cervical region than in other regions, indicating a greater stiffness (P < 0.001). Both inner cervical shear wave elasticity and cervical length were independent predictors of overall cesarean section (respective adjusted odds ratio [95% CI] 1.338 [1.001-1.598] and 1.717 [1.077-1.663]) and cesarean section for failure to enter active phase (respective adjusted odds ratio [95% CI] 1.689 [1.234-2.311] and 2.556 [1.462-4.467]), after adjusting for other covariates. Outcome prediction models using inner cervical shear wave elasticity and cervical length, had increased area under curve compared with models using the Bishop score (0.888 vs 0.819, P = 0.009).ConclusionsThe cervix is not a homogenous structure, with the inner cervix having the highest stiffness, which is an independent predictor of overall cesarean section, and specifically for those indicated because of failure to enter active phase. Models based on shear wave elastography and cervical length had higher predictive accuracy than models based on the Bishop score.

Project description:Objectives:The aim of the study was to compare elastographic means in parathyroid adenomas, using shear wave elastography and strain elastography. Methods:This prospective study examined 20 consecutive patients diagnosed with primary hyperparathyroidism and parathyroid adenoma, confirmed by biochemical assay, technetium-99 sestamibi scintigraphy, and pathology report, after parathyroid surgery. All patients were examined on conventional 2B ultrasound, 2D shear wave elastography, and strain elastography. We determined using 2D shear wave elastography (SWE) the elasticity index (EI) in parathyroid adenoma, thyroid parenchyma, and surrounding muscle and examined using strain elastography the parathyroid adenoma, and determined the strain ratio with the thyroid tissue and muscle tissue. Results:All patients had positive sestamibi scintigraphy and underwent surgery, with confirmation of parathyroid adenoma in all cases. The mean parathormone (PTH) value before surgery was 153.29?pg/ml (36.5, 464.8) and serum calcium concentration was 10.5?mg/dl (9, 11.5). We compared using 2D-SWE and strain elastography parathyroid adenoma with thyroid tissue and with surrounding muscle. The mean EI measured by SWE in parathyroid adenoma was 4.74?±?2.74?kPa and in thyroid parenchyma was 11.718?±?4.206?kPa (mean difference?=?6.978?kPa, p < 0.001), and the mean EI value in muscle tissue was 16.362?±?3.829?kPa (mean difference?=?11.622, p < 0.001). Using ROC analysis, we found that an EI below 7?kPa correctly identifies parathyroid tissue. We evaluated parathyroid adenomas using strain elastography by color mapping and strain ratio as a semiquantitative measurement; however, we could not find any statistical correlation comparing the strain ratio obtained from the parathyroid adenoma with the thyroid tissue (p=0.485). Conclusion:Ultrasound elastography is a helpful tool in identifying parathyroid adenomas. A cutoff value below 7?kPa can be used in 2D-SWE. Color maps in strain elastography without adding strain ratio can be used, parathyroid adenoma being identified as score 1 in the Rago criteria.

Dataset Information

Incorporation of shear wave elastography into a prediction model in the assessment of cervical lymph nodes.

Rationale and objectives

Materials and methods

Results

Conclusion

Publications

Incorporation of shear wave elastography into a prediction model in the assessment of cervical lymph nodes.

Similar Datasets

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