Malignant Cervical Lymphadenopathy Research Articles

Magnetization Transfer Ratio in Head and Neck Lymphadenopathy

Purpose: The purpose of this study was to determine whether the magnetization transfer ratio(MTR) differs between malignant and benign cervical lymphadenopathy. Materials and Methods: Magnetization transfer ratios were obtained from 104 lymph nodes of 43 patients. Fifty-five nodes were malignant and 49 were benign. Biopsy or cervical lymph node dissection was performed in 83 nodes, while the remaining 21 were diagnosed clinically or by follow-up imaging studies. Among the 55 malignant nodes, squamous cell carcinomas accounted for 29 cases, lymphomas for 15, undifferentiated carcinomas for four, acute myelogenous leukemia for four, and melanomas for three. The 49 benign nodes comprised 21 cases of reactive hyperplasia, 12 of Kikuchi ’s disease, nine of acute lymphadenitis, and seven of tuberculous lymphadenitis. All scans were performed using a 1.5T Magnetom Vision(Siemens, Erlangen, Germany) with phased-array or Helmholtz-type neck coil. Scanning was performed with and without magneti-zation transfer pulse(MT pulse : 11.2 T, 250 Hz band-width, off-set 2.0 KHz) using FLASH 2D sequencing. The region of interest(ROI) for signal intensity(SI) measurements was sampled at the same nodes by keeping the position, shape and size of the ROI constant for the scans before and after the MT pulse was applied. SI measurements were repeated more than three times in each node and the mean value was used to calculate MTR. In this study, however, corrected MTRs(CoMTRs) were used for correction of the effect of background noise produced by magnetic field inhomogeneity. Results: Mean CoMTRs of malignant and benign nodes were 0.33(SD:0.04) and 0.28(SD:0.05), respectively. This difference was statistically significant. At CoMTR 0.31, the sensitivity and specificity of malignant nodes were 83% and 75%, respectively. Conclusion: A CoMTR of above 0.31 suggests malignant lymphadenopathy. CoMTR is one of the MR criteria which can serve to differentiate between malignant and benign lymphadenopathy.

Vascular pathology of malignant cervical lymphadenopathy

Malignant vascular pathology has traditionally been studied with invasive angiography or in vitro immunohistochemistry. The objective of this study was to investigate the vascular patterns and vascular density of benign and malignant cervical lymphadenopathy using power Doppler ultrasound combined with a computed quantitative image processing system. Investigations of 189 cervical lymph node lesions were undertaken prospectively using a 5-10 MHz linear array transducer in power mode. The types of vascular patterns displayed with power Doppler ultrasound, after sweep-scanning over the whole lymph node, were classified as hilar, spotted, peripheral, or mixed. Quantitative assessment of vascularity was made by sampling three parallel planes of each lymph node. A computed image processing system automatically calculated the density of vascular signals (called the "vascularity index" in this study) within the lymph node plane. Malignant lymph node lesions were shown to have higher vascularity indices (0.169+/-0.147, P < 0.01). The vascular patterns of benign lesions were mostly of avascular or hilar type (in 83% of cases). Malignant lesions were characterized by patterns of mixed (47%), spotted (20%), or peripheral type (11%). When vascular pattern (nonhilar type) and vascularity index (maximum > or = 0.09) were combined, the specificity for diagnosing malignant lymphadenopathy was as high as 97%. Variance in tumor vascularity was noted in both the benign and malignant groups. Power Doppler ultrasound combined with a computed image processing system provided an objective tool for assessing tumor vascularity quantitatively. Using this modality, the vascular pathology of malignant lymphadenopathy was found to be characterized by higher vascular density and aberrant vascular patterns.

Differential diagnosis of cervical lymphadenopathy: usefulness of color Doppler sonography.

The purpose of this study was to evaluate the usefulness of color Doppler sonography in differentiating benign from malignant cervical lymphadenopathy. We used color Doppler sonography to evaluate 117 lymph nodes in 105 patients. The patients were pathologically and clinically confirmed to have benign reactive lymphadenitis (n = 28), tuberculosis (n = 17), lymphoma (n = 14), and metastasis (n = 46). The patterns of hilar vascularity, central nodal vascularity, and peripheral vascularity were assessed. The highest resistive index and pulsatility index in 116 lymph nodes were measured from spectral waveforms. Histologic findings of nodal vessels were analyzed in 14 nodes and compared with findings on color Doppler sonograms. Thirty-two (94%) of 34 nodes with benign reactive disease showed normal patterns of nodal vascularity; central hilar vascularity, radial symmetric central vascularity, and no peripheral vascularity. At least one of six abnormal patterns of vascularity (eccentric or absent hilar vascularity; deformed radial, aberrant multifocal, or absent central vascularity; and peripheral vascularity) was observed in 98% (65/66) of nodes with malignant disease and in all tuberculous nodes. We established cutoff values of 0.8 for the resistive index and 1.5 for the pulsatility index that were 100% specific for malignancy. However, sensitivities for these cutoff values were 47% and 55%, respectively. Also, histologic examinations showed that most flow signals in nodes with malignant disease represented arterioles or veins in the septa between tumor nests or near the capsule. Unlike nodes with benign reactive disease, 98% of nodes with malignant disease and 100% of tuberculous nodes showed abnormal patterns of nodal vascularity. Also, high values for the resistive and pulsatility indexes were highly specific for malignant lymphadenopathy. Color Doppler sonography combined with analysis of spectral waveforms was useful in differentiating benign from malignant cervical lymphadenopathy.

Role of ultrasonography in thyroid metastases

The ultrasound features in eight cases of metastases to the thyroid are reported. The primary tumours were bronchogenic carcinoma (4 cases), breast carcinoma (2 cases), oesophageal carcinoma (1 case) and carcinoma of the stomach (1 case). In this series, none of the metastases were from malignant melanoma or a renal neoplasm. Malignant cervical lymphadenopathy was seen in four cases, and five patients had evidence of disseminated disease.

Malignant cervical lymphadenopathy due to an unknown primary

One hundred and thirty-nine cases of metastatic carcinoma in the cervical lymph nodes from an unknown primary have been reviewed. It appears that external radiotherapy is effective in controlling local disease but the prognosis of these cases is poor as they represent disseminated disease at presentation. The crude survival rates at two and five years were 17 and 5% respectively and the overall median survival was nine months. There are no favourable prognostic signs, although there was a tendency for most long-term survivors to have a long duration of symptoms prior to hospital referral. Improved diagnostic techniques are required to elucidate the sites of the primary tumour in these cases. Computerised axial tomography may facilitate this and lead to a more radical approach to treatment.