Original article| Volume 22, ISSUE 6, P515-520, August 2022

The benefit of superb microvascular imaging and shear wave elastography in differentiating metastatic axillary lymphadenopathy from lymphadenitis



      The purpose of this study is to detect and compare the diagnostic performances of vascularity index (VI) via superb microvascular imaging (SMI) and shear wave elastography (SWE) in metastatic axillary lymphadenopathy and lymphadenitis.

      Materials and methods

      The study is based on 45 female patients who were ultrasonographed due to swelling in the axilla and underwent SWE and SMI before tru-cut biopsy, between August 2019 and February 2021. The patients had a total of 53 lymph nodes (LNs), 38 of these were metastatic and 15 were lymphadenitis.


      The results showed that mean volumes, value of cortex thickness, elasticity and velocity values, and mean VI values were significantly higher in metastatic LAP group compared to lymphadenitis group. Correlation analysis showed that both VI (r: 0.44) and elastography (r: 0.52) values were positively correlated with the cortex thickness, while elastography values were strongly correlated with volume (r: 0.42) and short diameter (r: 0.40). For differentiating lymphadenitis and metastatic LAP, the optimal cut-off VI value was 8.55 while the optimal cut-off elastography value was 31.8 kPa.


      In conclusion, combined grayscale ultrasonography evaluation of lymph nodes with SWE and SMI increase the diagnostic performance in distinguishing lymphadenitis-metastatic LAP.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Clinical Breast Cancer
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Shirakawa T
        • Miyamoto Y
        • Yamagishi J
        • Fukuda K
        • Tada S.
        Color/power Doppler sonographic differential diagnosis of superficial lymphadenopathy: metastasis, malignant lymphoma, and benign process.
        J Ultrasound Med. 2001; 20: 525-532
        • Diao X
        • Zhan J
        • Chen L
        • Chen Y
        • Cao H.
        Role of superb microvascular imaging in differentiating between malignant and benign solid breast masses.
        Clin Breast Cancer. 2020; 20: 786-793
        • Park AY
        • Seo BK
        • Woo OH
        • et al.
        The utility of ultrasound superb microvascular imaging for evaluation of breast tumour vascularity: comparison with colour and power Doppler imaging regarding diagnostic performance.
        Clin Radiol. 2018; 73: 304-311
        • Yongfeng Z
        • Ping Z
        • Wengang L
        • Yang S
        • Shuangming T.
        Application of a novel microvascular imaging technique in breast lesion evaluation.
        Ultrasound Med Biol. 2016; 42: 2097-2105
        • Bayramoglu Z
        • Caliskan E
        • Karakas Z
        • et al.
        Diagnostic performances of superb microvascular imaging, shear wave elastography and shape index in pediatric lymph nodes categorization: a comparative study.
        Br J Radiol. 2018; 9120180129
        • Choi YJ
        • Lee JH
        • Baek JH.
        Ultrasound elastography for evaluation of cervical lymph nodes.
        Ultrasonography. 2015; 34: 157
        • Youk JH
        • Son EJ
        • Kim JA
        • Gweon HM.
        Pre-operative evaluation of axillary lymph node status in patients with suspected breast cancer using shear wave elastography.
        Ultrasound Med Biol. 2017; 43: 1581-1586
        • Bhatia KS
        • Cho CC
        • Tong CS
        • Yuen EH
        • Ahuja AT.
        Shear wave elasticity imaging of cervical lymph nodes.
        Ultrasound Med Biol. 2012; 38: 195-201
        • Suh CH
        • Choi YJ
        • Baek JH
        • Lee JH.
        The diagnostic performance of shear wave elastography for malignant cervical lymph nodes: a systematic review and meta-analysis.
        Eur Radiol. 2017; 27: 222-230
        • Yang WT
        • Chang J
        • Metreweli C.
        Patients with breast cancer: differences in color Doppler flow and gray-scale US features of benign and malignant axillary lymph nodes.
        Radiology. 2000; 215: 568-573
        • Choi YJ
        • Ko EY
        • Han BK
        • Shin JH
        • Kang SS
        • Hahn SY.
        High-resolution ultrasonographic features of axillary lymph node metastasis in patients with breast cancer.
        Breast. 2009; 18: 119-122
        • Kwak JY
        • Kim EK
        • Kim MJ
        • Choi SH
        • Son E
        • Oh KK.
        Power Doppler sonography: evaluation of solid breast lesions and correlation with lymph node metastasis.
        Clin Imaging. 2008; 32: 167-171
        • Yang WT
        • Metreweli C
        • Lam PK
        • Chang J.
        Benign and malignant breast masses and axillary nodes: evaluation with echo-enhanced color power Doppler US.
        Radiology. 2001; 220: 795-802
        • Abe H
        • Schmidt RA
        • Kulkarni K
        • Sennett CA
        • Mueller JS
        • Newstead GM.
        Axillary lymph nodes suspicious for breast cancer metastasis: sampling with US-guided 14-gauge core-needle biopsy—clinical experience in 100 patients.
        Radiology. 2009; 250: 41-49
        • Bhatia KS
        • Cho CC
        • Yuen YH
        • Rasalkar DD
        • King AD
        • Ahuja AT.
        Real-time qualitative ultrasound elastography of cervical lymph nodes in routine clinical practice: interobserver agreement and correlation with malignancy.
        Ultrasound Med Biol. 2010; 36: 1990-1997
        • Zaleska-Dorobisz U
        • Pawluś A
        • Szymańska K
        • Łasecki M
        • Ziajkiewicz M.
        Ultrasound elastography–review of techniques and its clinical applications in pediatrics–part 2.
        Adv Clin Exp Med. 2015; 24: 725-730
        • Nazarian LN.
        Can sonoelastography enable reliable differentiation between benign and metastatic cervical lymph nodes?.
        Radiology. 2007; 243: 1-2
        • Choi JJ
        • Kang BJ
        • Kim SH
        • et al.
        Role of sonographic elastography in the differential diagnosis of axillary lymph nodes in breast cancer.
        J Ultrasound Med. 2011; 30: 429-436
        • Chang JM
        • Moon WK
        • Cho N
        • et al.
        Clinical application of shear wave elastography (SWE) in the diagnosis of benign and malignant breast diseases.
        Breast Cancer Res Treat. 2011; 129: 89-97
        • Evans A
        • Whelehan P
        • Thomson K
        • et al.
        Quantitative shear wave ultrasound elastography: initial experience in solid breast masses.
        Breast Cancer Res. 2010; 12 (1-1)
        • Youk JH
        • Gweon HM
        • Son EJ
        • Han KH
        • Kim JA.
        Diagnostic value of commercially available shear-wave elastography for breast cancers: integration into BI-RADS classification with subcategories of category 4.
        Eur Radiol. 2013; 23: 2695-2704
        • Ryoo I
        • Suh S
        • You SH
        • Seol HY.
        Usefulness of microvascular ultrasonography in differentiating metastatic lymphadenopathy from tuberculous lymphadenitis.
        Ultrasound Med Biol. 2016; 42: 2189-2195
        • Sim JK
        • Lee JY
        • Hong HS.
        Differentiation between malignant and benign lymph nodes: role of superb microvascular imaging in the evaluation of cervical lymph nodes.
        J Ultrasound Med. 2019; 38: 3025-3036
        • Chae EY
        • Yoon GY
        • Cha JH
        • Shin HJ
        • Choi WJ
        • Kim HH.
        Added value of the vascular index on superb microvascular imaging for the evaluation of breast masses: comparison with grayscale ultrasound.
        J Ultrasound Med. 2021; 40: 715-723