The Efficacy of Colour Doppler Ultrasound in Differentiating Malignant and Nonmalignant Head and Neck Lymph Node Enlargement

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Cervical lymphadenopathy is a common presenting symptom for a variety of disorders. Differentiation of malignant and non- malignant lymphadenopathy has important clinical and therapeutic implications. The purpose of our study was to assess the efficacy of colour Doppler ultrasound (CDUS) in differentiating malignant and non-malignant cervical lymphadenopathy. 30 patients with clinical evidence of Head and Neck lymph node enlargement 15 patients with clinically suspected malignant/metastatic head and neck lymph node enlargement and 15 patients with clinically suspected reactive/non-malignant head and neck lymph node enlargement] were evaluated with ultrasound and the largest or most prominent node was subjected to CDUS examination. CDUS was performed for 30 out of 126 head and neck lymph nodes. Histopathological/Cytological confirmations were obtained by fine needle aspiration cytology or excisional biopsy. To assess the efficacy of CDUS, a comparison between clinical features, CDUS features and cytological/histological features of the lymph nodes was done. The results thus obtained were statistically analyzed. Clinical examination identified 99 lymph nodes in 30 patients. Ultrasonogram additionally detected 27 lymph nodes. The statistically significant ‘p’ value (p 0.5, loss of echogenic hilum, sharp border and hypoechogenicity. Correlation of vascular pattern of CDUS with pathological diagnosis showed that peripheral and mixed flow pattern for malignant nodes were highly significant with ‘p’ value of 0.000 (p < 0.01). The sensitivity and specificity was 93% and 93%, respectively. The hilar vascular pattern if taken as a criteria for identification of non-malignant nodes then the specificity was 100% and the sensitivity was 46.6%. Thus nodal vascular pattern can be used to differentiate malignant and nonmalignant lymph node enlargement. The presence of avascular flow pattern needs further evaluation. CDUS examination along with clinical examination and grey scale sonography can obviate the need for biopsy/FNAC of lymph nodes.