Abstract
Objective:To investigate the value of grey scale and Doppler ultrasonography in the assessment of metastatic and lymphomatous cervical lymph nodes.Methods:One hundred and nineteen malignant cervical lymph nodes in 119 patients diagnosed as malignant according to grey scale, color Doppler and spectral Doppler ultrasonography features were included in this study. The sizes, shape, echo pattern, echogenic hilus, nodal border, cystic necrosis and coagulation necrosis, vascular distribution pattern, resistivity and pulsatility index values of lymph nodes were noted. All patients had histopathological diagnosis.Results:The final diagnosis of the 42 lymph nodes was lymphoma, and of the 77 lymph nodes was carcinoma metastasis (33 thyroid carcinoma metastasis and 44 squamous cell carcinoma metastasis). While a hyperechoic pattern and calcification were detected in the lymph nodes originating from thyroid carcinoma as 39% and 33%, respectively, a reticular pattern (26%) and low resistive and pulsatility indices were detected in lymph nodes originating from lymphoma. These criteria were statistically significant for the differential diagnosis (p<0.05). Size, shape, hypoechoic echo pattern, absence of echogenic hilus, nodal border, cystic necrosis, coagulation necrosis and vascular distribution pattern were not found to be significant for the detection of a primary tumour.Conclusion:Hyperechoic echo pattern, reticular pattern, calcification, low resistivity and pulsatility indices are useful parameters for the differential diagnosis of malignant cervical lymph nodes. These ultrasonography critaria can be used for assesment and management of unknown primary malign neck nodes.
Highlights
Malignant lymph nodes of the neck mainly consist of metastasis and lymphoma
The presence of lymph node metastasis is important as it affects treatment planning and prognosis
The findings of this study are in accordance with the literature as the round shape, hypoechoic pattern, absence of echogenic hilus, sharp border, peripheal and mixed type flow pattern, high RI and PI values were critaria that support malignant lymph node [8]
Summary
Malignant lymph nodes of the neck mainly consist of metastasis and lymphoma. Nodal metastases are common and generally related with both skin and mucosal carcinomas of the head and neck region. Cervical lymph nodes are common site for both Hodgkin’s and non Hodgkin’s lymphoma. It is difficult to make a differential diagnosis for cervical lymph nodes. There are numerous published reports on the usage of grey scale US, color and spectral Doppler US to distinguish between benign and malignant cervical lymph nodes [2,3,4]. The role of US in the differentiation of benign nodes from malignant ones is well established. Limited studies are available for differentiating of the nature of malignant disease by means of these examinations [5, 6]
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