Evaluation of reliability of ultrasonographic parameters in differentiating benign and metastatic cervical group of lymph nodes.

Chintamaneni Raja Lakshmi,Sujana Mulk Bhavana,M Sudhakara Rao,Sivan Sathish,A Ravikiran

doi:10.1155/2014/238740

Abstract

The aim of the current study is to determine the efficacy of ultrasound in differentiating between benign and metastatic group of cervical lymph nodes. The study included forty-five subjects who were divided into three groups with 15 in each, by stratified random sampling method. Group 1 comprised fifteen patients without signs and symptoms of any infection and neoplasms in head and neck region (control group). Group 2 included fifteen patients with signs and symptoms of malignancy in head and neck region. Group 3 consisted of fifteen patients with signs and symptoms of odontogenic infections. “MY LAB-40” ultrasound machine with linear array transducer of 7.5 MHZ frequency was used for detecting cervical lymph nodes following Hajek's classification. The patients further underwent ultrasound guided FNAC under standard aseptic protocol and samples were subjected to cytopathological evaluation. Chi square analysis and one way ANOVA test were applied to obtain the results. We concluded that ultrasound and USG FNAC can be used accurately to assess the status of lymph nodes. The ultrasonographic features of lymph nodes with round shape, absence of hilar echo, sharp nodal borders, hyperechoic internal echogenicity, and presence of intranodal necrosis were highly suggestive of metastatic cervical lymph nodes.

Highlights

Imaging techniques play a very important role in diagnosing head and neck pathologies especially those involving deeper soft tissues
Considering the internal echogenicity the present study confirmed that 60% of the metastatic cervical lymph nodes showed hyperechoic pattern of echogenicity (Figure 2) whereas normal and reactive nodes revealed 100% hypoechoic pattern of echogenicity (Figure 3) with highly significant P value (P = 0.0000)
From the current study we conclude that cervical group of lymph nodes with ultrasonographic features such as round shape, absence of hilar echo, sharp nodal borders, hypoehoic internal echogenicity and presence of intranodal necrosis were highly suggestive of metastatic cervical lymph nodes; nodal borders and echogenic hilum criteria revealed high sensitivity and specificity of 100%

Summary

Introduction

Imaging techniques play a very important role in diagnosing head and neck pathologies especially those involving deeper soft tissues. Lymphadenopathy is one such condition where critical evaluation becomes mandatory to assess the severity of the disease and to determine disease prognosis and proper treatment planning. Clinical examination of cervical lymph nodes is important in such patients but mostly remains difficult owing to their diverse location and multiple numbers. Ultrasound has higher sensitivity (96.8%) than palpation (73.3%) for detection of cervical lymph nodes [1]. CT and MRI can be used for evaluation of lymph nodes, but they are less sensitive than ultrasound in detecting nodes

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