Ultrasound shear wave elastography to enhance diagnostic accuracy of N3 cervical lymphadenopathy among patients with lung cancer.

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Purpose: Precise staging of metastatic cervical lymph nodes (LNs) in lung cancer patients predicts the outcome and helps optimize the treatment strategies. This study aimed to compare the diagnostic performance between ultrasound shear wave elastography (US-SWE) and conventional modalities on cervical LNs workup in patients with lung cancer. Materials and methods: This prospective study enrolled lung cancer suspects referred for US exam. Protocolized neck US was performed to identify the presence of LNs, using conventional US and SWE. Other staging modalities, including computed tomography (CT) and positron emission tomography (PET) were reviewed among enrollees. All suspicious LNs were confirmed by fine-needle aspiration with/without needle biopsies for definite diagnosis. Results: From Dec. 2017 to Apr. 2024, 508 lung cancer subjects, with 156 benign and 352 malignant cervical LNs, were included. For CT, the sensitivity, specificity, area under receiver operating characteristic curve (AUROC) were 65.1%, 59.0%, 0.620, respectively. For PET, the sensitivity, specificity, AUROC were 92.9%, 40.6%, 0.668, respectively. For SWE, the cut-off value to differentiate benign from malignant LNs was 35 kPa. The sensitivity, specificity and AUROC were 82.39%, 75.64%, 0.790. For US features, multivariable analysis indicated that elasticity > 35 kPa (OR: 1.76, p<0.001), short-to-long axis ratio (OR: 3.07, p<0.001), hilum-loss (OR: 1.26, p<0.001) were independent determinants of metastatic LNs. Conclusions: Ultrasound SWE complements the under detection rate of CT in metastatic cervical LNs among lung cancer patients.

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