Abstract
Introduction: Cervical region is the commonest area of lymphadenopathy which is easily accessible to ultrasound and Doppler study. The morphological and vascular-architectural differences among various nodal diseases aids in differentiating benign from malignant causes.
 Methods: The study was done on the 108 patients referred to Department of Radiology andImaging, TUTH for ultrasound of cervical lymphadenopathy who subsequently underwentFNAC examination. Gray scale evaluation for morphology of the nodes along with Doppler evaluation for resistive index (RI), pulsatility index (PI) and Peak systolic velocity (PSV) were done and correlated with FNAC findings.
 Results: Among the 108 lymph nodes, 24 were proven to be malignant on FNAC. Features such as S/L ratio >0.5, absence of echogenic hilum, and abnormal vascular pattern demonstrated sensitivities of 96%, 92%, and 87%, specificities of 74%, 65% and 77% and positive predictive values (PPVs) of 51%, 43%, and 55% respectively. The cutoff values for RI, PI and PSV were found to be 0.705, 1.34 and 17.5 cm/s with sensitivities of 96%, 96% and 87%, specificities of 95%, 99% and 88% and positive predictive values (PPVs) of 85%, 95% and 70% respectively.
 Conclusion: Ultrasound findings of S/L ratio, absence of echogenic hilum, abnormal vascular pattern and Doppler indices revealed good sensitivity, specificity, and accuracy in differentiating benign and malignant lymph nodes.
Highlights
Cervical region is the commonest area of lymphadenopathy which is accessible to ultrasound and Doppler study
A prospective quantitative study was done on 108 patients > 16 yrs who were referred to Department of Radiology and Imaging, TUTH for ultrasound of cervical lymphadenopathy and subsequently underwent FNAC of the nodes
The significance of differences in short axis to long axis (S/L) ratio, vascularity pattern and Doppler indices in benign and malignant lymph nodes along with the cut off values of Doppler indices were assessed with ROC (Receiver operating characteristic) curve
Summary
Cervical region is the commonest area of lymphadenopathy which is accessible to ultrasound and Doppler study. Cervical lymph nodes with the advantage of being in superficial location have better spatial resolution on ultrasound and are superior to CT and MRI.[1] There will be morphological and vasculararchitectural differences among various nodal diseases which aid in differentiating benign from malignant causes. The normal vascular morphology in metastatic nodes is destroyed by neoplastic infiltration, whereas in inflammatory disease there will be dilatation of the intranodal vessels. These changes can be depicted with the use of color or power Doppler indices like RI, PI and PSV.[2] Accurate differentiation between benign and malignant lymph nodes can decrease the number of patient undergoing unnecessary invasive procedures like FNAC and biopsy
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