الفهرس 
Aim of the WorkOnly 14 pages are availabe for public view
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Abstract
Ultrasonography is one of the most available and practical methods for the detection and evaluation of cervical lymph nodes in clinical practice. It can display the size, location, shape, outline and blood flow distribution of these lymph nodes.
Unfortunately, an overlap in diagnostic criteria between benign and malignant lymph nodes cannot be avoided if we rely on grey-scale and Doppler sonography alone. Hence arises the need to add more criteria such as those provided by sonoelastography to improve detection of whether the examined lymph node is benign or malignant. Moreover, it can also be very beneficial in detecting lymph node metastasis, guiding which lymph node is best for biopsy, facilitating follow-up and also decreasing the number of unnecessary biopsies.
Sonoelastography depends on the fact that a tumor or a suspicious cancerous tissue is stiffer than the background of normal soft tissue. Elastographic images are given 1- 4 elasticity scores based on the percentage and distribution of the lymph node areas with high stiffness (blue area). Scores 1 and 2 are considered benign, while scores 3 and 4 are considered malignant. Elasticity score has a sensitivity of 85.2%, a specificity of 90.9% and an accuracy of 86.8%.
Strain ratio is a more recent elastographic tool. This method allows the assessment of elasticity distribution and shows differences in hardness between diseased tissue and normal tissue. A strain ratio more than 1.9 is an excellent indicator of malignancy in cervical lymph nodes with a sensitivity of 92.6%, a specificity of 90.9% and an accuracy of 92.1% and can reduce the number of unnecessary biopsies when assessing cervical lymph nodes.
In conclusion, sonoelastography is a promising imaging technique that can provide assistance in the differentiation between benign and malignant lymph nodes. It can be helpful in selection of suspicious lymph nodes that should be examined at cytological or histopathological examination, for accurate preoperative staging and individual therapy in patients suspected with malignancy.
Future prospective studies applying elastography on a larger number of patients are recommended to confirm the results of the present study and to establish the diagnostic accuracy of this technique.