Diagnosis Of Superficial Lymph Nodes Research Articles

Comparison of Virtual Touch Tissue Quantification with B-Mode Sonography in the Differential Diagnosis of Superficial Lymph Nodes

Comparison of Virtual Touch Tissue Quantification with B-Mode Sonography in the Differential Diagnosis of Superficial Lymph Nodes

Mistakes in ultrasound diagnosis of superficial lymph nodes

The article discusses basic mistakes that can occur during ultrasound imaging of superficial lymph nodes. Ultrasound is the first imaging method used in the diseases of superficial organs and tissues, including lymph nodes. The causes of mistakes can be either dependent or independent of the performing physician. The first group of mistakes includes inappropriate interpretation of images of anatomical structures, while the latter group includes, among other things, similar ultrasound images of different pathologies. For instance, a lymph node, whether normal or abnormal, may be mimicked by anatomical structures, such as a partially visible, compressed vein. Lymph nodes in lymphomas may be indistinguishable from reactive lymph nodes, even when using Doppler option, as well as morphologically difficult to distinguish from metastases. Metastatic lymph nodes can mimic e.g. nodular, separated postoperative thyroid fragments, a lateral neck cyst, chemodectoma (carotid body tumor) or neuroma. The appearance of lymph nodes in granulomatous diseases, such as tuberculosis or sarcoidosis, can be very similar to that of typical metastatic lymph nodes or lymphomas. Anechoic or hypoechoic areas in a lymph node can represent necrosis or metastatic hemorrhages, but also suppuration in inflamed lymph nodes. Lymph nodes in lymphomas, metastatic and reactive lymph nodes can adopt the classical characteristics of a simple cyst. The overall ultrasound picture along with all criteria for the assessment of a lymph node should be taken into account during ultrasound imaging. It seems that the safest management is to refer patients diagnosed with lymph node abnormalities for ultrasound-guided targeted fine needle aspiration biopsy followed by a total lymph node resection for histopathological examination in the case of suspected lymphoma.

Enhanced patterns and morphology of time intensity curve with contrast-enhanced ultrasound in the diagnosis of superficial lymph nodes

Objective To evaluate enhanced patterns of contrast-enhanced ultrasound (CEUS) and the morphology of time intensity curve (TIC) of enlarged superficial lymph nodes. Methods In a retrospective study,ultrasonography and CEUS were performed in 131 patients with superficial lymphadenopathy. Characteristics of color Doppler ultrasound,enhanced patterns of CEUS and the morphology of TIC were analyzed. The ultrasound findings were compared with the histology (metastatic lymph nodes,lymphoma,reactive lymph nodes and lymphoid tuberculosis). Results Enhanced patterns of CEUS: Metastatic lymph nodes and lymphoid tuberculosis mostly showed heterogeneous and concentric enhancement with perfusion defects. Reactive lymph nodes mostly showed centrifugal and homogeneous enhancement without perfusion defects. Most lymphoma showed a rapid,homogeneous enhancement and a few with perfusion defects. The differences between metastatic lymph nodes and reactive lymph nodes,metastatic lymph nodes and lymphoma,lymphoid tuberculosis and reactive lymph nodes,lymphoid tuberculosis and lymphoma were markedly significant(P<0.05). Morphology of TIC: metastatic lymph nodes mostly showed a slow descending branch of the curve and the curve was not consistent with the curve of the artery. Lymphoma,reactive lymph nodes and lymphoid tuberculosis mostly showed a steep descending branch of the curve and the curve was consistent with the curve of the artery. There were significant difference between metastatic lymph nodes and reactive lymph nodes,lymphoma,or lymphoid tuberculosis respectively (P<0.05). Conclusions Characteristics of enhanced patterns and the morphology of TIC during CEUS could provide more information for differential diagnosis of enlarged superficial lymph nodes. Key words: Contrast-enhanced ultrasound; Lymph nodes; Diagnosis,differential

The Role of Contrast-Enhanced Gray-Scale Ultrasonography in the Differential Diagnosis of Superficial Lymph Nodes

Lymph node micrometastases are common, but too often in clinical practice lack the tools for their accurate prebiopsy detection. The gray-scale contrast-enhanced ultrasonography technique permits high-resolution imaging of both the arterial and parenchymal phase and allows visualization of diffuse and partial alterations of nodal perfusion even in lymph nodes with a maximum diameter smaller than 1 cm. The gray-scale contrast-enhanced ultrasonography can supply further useful information in case where doubt has arisen with conventional techniques. The results obtained show that it affords highly accurate differentiation between benign and metastatic lymph nodes.

The value of ultrasound elastography in differential diagnosis of superficial lymph nodes

The study evaluated the value of ultrasound elastography in differentiating the benign and malignant superficial lymph nodes. A total of 112 subjects, including 82 patients with enlarged lymph nodes and 30 healthy volunteers, were recruited. All the subjects were examined by B-mode ultrasonography, power Doppler ultrasonography and elastography. Most of the patients were histopathologically confirmed by needle aspiration cytology and some patients were diagnosed by clinical data combined with follow-up findings. The sensitivity, specificity and accuracy of B-mode ultrasonography were 59.8%, 76.5% and 67.1%, those of the blood flow classification by power Doppler ultrasonography 77.0%, 82.3% and 79.4% and those of elastographic classification 74.7%, 97.1% and 84.5%, respectively. The elasticity of the lymph nodes was quantitatively measured and defined as stiffness value. When the stiffness value of 2.395 was taken as the cutoff point, the sensitivity and specificity of elastography were 78.41% and 98.51%, and the Youden index reached the highest, with the value being 0.7692. The stiffness values of two indeterminate benign lymph nodes, the elastrographic findings of which were rated as patterns 2 and 3, were below the cutoff point. The elastographic findings of 10 malignant lymph nodes were also classified as pattern 2 or 3. Only one of them had the stiffness values below the cutoff point. It was concluded that ultrasound elastography is a novel, noninvasive and convenient tool for the differentiation of the nature of the superficial lymph nodes in clinical practice.