Evaluating Different Quantitative Shear Wave Parameters of Ultrasound Elastography in the Diagnosis of Lymph Node Malignancies: A Systematic Review and Meta-Analysis.

Shear wave elastography (SWE) has shown promise in distinguishing lymph node malignancies. However, the diagnostic accuracies of various SWE parameters that quantify tissue stiffness are yet to be demonstrated. To evaluate the pooled diagnostic accuracy of different SWE parameters for differentiating lymph node malignancies, we conducted a systematic screening of four databases using the PRISMA guidelines. Lymph node biopsy was adopted as the reference standard. E max (maximum stiffness), E mean (mean stiffness), E min (minimum stiffness), and E sd (standard deviation) SWE parameters were subjected to separate meta-analyses. A sub-group analysis comparing the use of E max in cervical (including thyroid) and axillary lymph node malignancies was also conducted. Sixteen studies were included in this meta-analysis. E max and E sd demonstrated the highest pooled sensitivity (0.78 (95% CI: 0.69-0.87); 0.78 (95% CI: 0.68-0.87)), while E mean demonstrated the highest pooled specificity (0.93 (95% CI: 0.88-0.98)). From the sub-group analysis, the diagnostic performance did not differ significantly in cervical and axillary LN malignancies. In conclusion, SWE is a promising adjunct imaging technique to conventional ultrasonography in the diagnosis of lymph node malignancy. SWE parameters of E max and E sd have been identified as better choices of parameters for screening clinical purposes.