Fig. 1
Fig. 2
Fig. 3
Fig. 4
Kappa analysis results for the compatibility of pathology results with B-mode, Doppler US and US elastography results
| Pathological diagnosis | Total | Kappa value | p | ||||||
|---|---|---|---|---|---|---|---|---|---|
| Benign | Malignant | ||||||||
| n | % | n | % | n | % | ||||
| B-mode US | Benign | 27 | 75.0 | 30 | 55.6 | 57 | 63.3 | 0.177 | 0.061 |
| Malignant | 9 | 25.0 | 24 | 44.4 | 33 | 36.7 | |||
| Total | 36 | 40.0 | 54 | 60.0 | 90 | 100.0 | |||
| Doppler US | Benign | 28 | 77.8 | 22 | 41.5 | 50 | 56.2 | 0.001 | |
| Malignant | 8 | 22.2 | 32 | 58.5 | 40 | 43.8 | 0.341 | ||
| Total | 36 | 40.0 | 54 | 60.0 | 90 | 100.0 | |||
| US elastography | Benign | 21 | 58.3 | 17 | 31.5 | 38 | 42.2 | 0.266 | 0.012 |
| Malignant | 15 | 41.7 | 37 | 68.5 | 52 | 57.8 | |||
| Total | 36 | 40.0 | 54 | 60.0 | 90 | 100.0 | |||
| B-mode US + Doppler US | Benign | 26 | 72.2 | 19 | 35.8 | 45 | 50.0 | 0.001 | |
| Malignant | 10 | 27.8 | 35 | 64.2 | 45 | 50.0 | 0.350 | ||
| Total | 36 | 40.0 | 54 | 60.0 | 90 | 100.0 | |||
| Doppler US + US elastography | Benign | 18 | 50.0 | 6 | 11.3 | 24 | 27.0 | 0.000 | |
| Malignant | 18 | 50.0 | 48 | 88.7 | 66 | 73.0 | 0.409 | ||
| Total | 36 | 40.0 | 54 | 60.0 | 90 | 100.0 | |||
| B-mode US + Doppler US + US elastography | Benign | 18 | 50.0 | 5 | 9.6 | 23 | 26.1 | 0.428 | 0.000 |
| Malignant | 18 | 50.0 | 49 | 90.4 | 67 | 73.9 | |||
| Total | 36 | 40.0 | 54 | 60.0 | 90 | 100.0 | |||
Ultrasonographic features of the examined lymph nodes according to their pathological diagnosis
| Pathological diagnosis | X2 | p | |||||
|---|---|---|---|---|---|---|---|
| Benign | Malignant | ||||||
| n | % | n | % | ||||
| Shape | Round | 2 | 5.6 | 13 | 24.1 | ||
| Ovoid | 34 | 94.4 | 41 | 75.9 | 5.333 | 0.021 | |
| Hilum | Normal fatty hilum | 17 | 47.2 | 13 | 24.1 | 5.213 | 0.022 |
| Abnormal obliterated hilum | 19 | 52.8 | 41 | 75.9 | |||
| Cortical | No | 28 | 77.8 | 46 | 85.2 | ||
| necrosis | Yes | 8 | 22.2 | 8 | 14.8 | 0.811 | 0.368 |
| Margin | Regular | 36 | 100.0 | 50 | 92.6 | 2.791 | 0.147 |
| Irregular | 0 | 0.0 | 4 | 7.4 | |||
| Edema within the adjacent tissues | No | 34 | 94.4 | 53 | 98.1 | 0.92 | 0.561 |
| Yes | 2 | 5.6 | 1 | 1.9 | |||
| Echogenicity | Hypoechoic | 34 | 94.4 | 54 | 100.0 | 2.900 | 0.163 |
| Isoechoic | 2 | 5.6 | 0 | 0.0 | |||
ROC analysis results for the power of imaging methods in predicting the pathology result of axillar lymph nodes
| Threshold value | Sensitivity | Specificity | Positive predictive value | Negative predictive value | Area under the curve | Confidence interval (95%) | P-value | |
|---|---|---|---|---|---|---|---|---|
| Long axis | >24 | 40.0 | 88.0 | 87.0 | 42.3 | 0.642 | 0.523–0.749 | 0.023 |
| Short axis | >10 | 54.0 | 84.0 | 87.1 | 47.7 | 0.73 | 0.615–0.826 | 0.000 |
| Long axisshort axis ratio | ≤1.46 | 24.0 | 100.0 | 100.0 | 39.7 | 0.624 | 0.504–0.733 | 0.060 |
| Resistive index | >0.76 | 52.9 | 80.0 | 84.4 | 45.5 | 0.621 | 0.503–0.730 | 0.055 |
| Pulsatility index | >1.26 | 66.7 | 60.0 | 76.2 | 48.4 | 0.639 | 0.518–0.748 | 0.036 |
| Acceleration rate | >0.41 | 66.7 | 52.0 | 72.7 | 44.8 | 0.573 | 0.452–0.688 | 0.295 |
| Acceleration time | ≤136 | 39.6 | 84.0 | 82.6 | 42.0 | 0.531 | 0.410–0.649 | 0.656 |
| Elastography (strain ratio) | >1.75 | 47.1 | 88.0 | 88.9 | 44.9 | 0.688 | 0.571–0.789 | 0.003 |
Elasticity scoring
| Pattern 1 | No stiff area within the lesion |
| Pattern 2 | The percentage of stiff area is less than 45% |
| Pattern 3 | The percentage of stiff area is greater than 45% |
| Pattern 4 | The lesion is mostly stiff |
| Pattern 5 | The lesion is completely stiff |
ROC analysis results for the power of imaging methods in predicting pathological diagnosis
| Sensitivity | Specificity | Positive predictive value | Negative predictive value | Area under the curve | Confidence interval (95%) | P-value | Accuracy | |
|---|---|---|---|---|---|---|---|---|
| B-mode US | 44.4 | 75.0 | 72.7 | 47.4 | 0.597 | 0.489–0.699 | 0.108 | 56.7 |
| Doppler US | 58.5 | 77.8 | 79.5 | 56.0 | 0.681 | 0.574–0.776 | 0.002 | 66.3 |
| US elastography | 68.5 | 58.3 | 71.2 | 55.3 | 0.634 | 0.526–0.733 | 0.027 | 64.4 |
| B-mode US + Doppler US | 64.2 | 72.2 | 77.3 | 57.8 | 0.682 | 0.575–0.777 | 0.002 | 67.4 |
| Doppler + US elastography US | 88.7 | 50.0 | 72.3 | 75.0 | 0.693 | 0.587–0.787 | 0.001 | 73.0 |
| B-+ mode US elastography US + Doppler US | 90.4 | 50.0 | 72.3 | 78.3 | 0.702 | 0.595–0.795 | 0.001 | 73.9 |
ROC analysis results for the power of imaging methods in predicting the pathology result of cervical lymph nodes
| Threshold value | Sensitivity | Specificity | predictive Positive value | predictive Negative value | Area under the curve | Confidence interval (95%) | P-value | |
|---|---|---|---|---|---|---|---|---|
| Long axis | >33 | 33.3 | 100.0 | 100.0 | 84.6 | 0.515 | 0.242–0.781 | 0.947 |
| Short axis | >14 | 66.7 | 90.9 | 66.7 | 90.9 | 0.742 | 0.447–0.932 | 0.232 |
| Long axis/short axis ratio | ≤2.21 | 100.0 | 54.6 | 37.5 | 100.0 | 0.788 | 0.494–0.954 | 0.040 |
| Resistive index | >0.76 | 100.0 | 54.6 | 37.5 | 100.0 | 0.742 | 0.447–0.932 | 0.102 |
| Pulsatility index | >1.34 | 100.0 | 54.6 | 37.5 | 100.0 | 0.697 | 0.402–0.906 | 0.180 |
| Acceleration rate | >0.41 | 100.0 | 54.6 | 37.5 | 100.0 | 0.727 | 0.432–0.923 | 0.106 |
| Acceleration time | >181 | 0.0 | 63.6 | 0.0 | 70.0 | 0.53 | 0.255–0.793 | 0.848 |
| Elastography (strain ratio) | >1.96 | 66.7 | 81.8 | 50.0 | 90.0 | 0.576 | 0.292–0.826 | 0.758 |