Abstract
AimTo evaluate the role of ultrasonography for differentiating cervical lymphadenopathy due to tuberculosis, metastasis and lymphoma.MethodsUltrasonography of the neck nodes was carried out prior to FNAC in 192 patients using a 10 mHz linear transducer. The sonographic findings were then correlated with the definitive tissue diagnosis obtained by FNAC or lymph node biopsy.ResultsThe most significant distinguishing feature was strong internal echoes seen in 84% of tubercular lymph nodes. This finding was found in only 11% of metastatic nodes and absent in lymphomatous nodes. The other findings such as L/S ratio, irregular margins, hypoechoic center, fusion tendency, peripheral halo and absent hilus were helpful in differentiating reactive from diseased nodes but showed considerable overlap in the 3 groups of tubercular, metastatic and lymphoma lymph nodes.ConclusionUltrasonography is noninvasive and can give useful clues in the diagnosis of cervical lymphadenopathy. It should be interpreted in conjunction with FNAC result. Ideally ultra-sonographic guided FNAC should be obtained from the sonographically most representative node. In FNAC indeterminate cases, sonographic features may obviate the need for an invasive lymph node biopsy.
Highlights
Cervical lymph nodes are frequently involved in a number of disease conditions
Fine needle aspiration cytology is used for evaluating enlarged cervical lymph nodes and has a high degree of sensitivity and specificity
204 patients with clinically palpable and untreated cervical lymph nodes visited our Out Patient Department. Out of these 192 patients were included in the study with tissue diagnosis of reactive lymph node, tubercular, metastatic or lymphoma involving cervical lymph nodes
Summary
Cervical lymph nodes are frequently involved in a number of disease conditions. The most commonly seen causes of cervical lymphadenopathy are tuberculosis, distant metastasis and lymphoma. Fine needle aspiration cytology is used for evaluating enlarged cervical lymph nodes and has a high degree of sensitivity and specificity. In our experience in almost 20% of patients FNACs may give an equivocal report, which would not contribute to the treatment. Ultrasonography has often been used to map out and characterize cervical lymph nodes specially for differentiating tubercular from malignant lymph nodes. The present study was designed to evaluate the role of ultrasonography for differentiating cervical lymphadenopathy of various causes
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