Cervical lymphadenopathy, Color Doppler, Power Doppler, Ultrasonography
Citation Information :
Baliarsingh D, Agrawal V, Hota A, Panigrahi R. Evaluation of Cervical Lymphadenopathy by Ultrasonography Using Color and Power Doppler and Comparison with Histopathology. Int J Otorhinolaryngol Clin 2022; 14 (3):85-91.
To evaluate and determine the efficacy of ultrasound and Doppler for differentiating among various benign and malignant causes of cervical lymphadenopathy. Out of 88 cases, the final tissue diagnosis on the basis of histopathology was found to be tubercular in 35 (40%), reactive/inflammatory in 30 (34%), metastatic in 16 (18%), and lymphoma in seven (8%) cases with cervical lymphadenopathy. In our study, metastatic nodes were present in all neck lymph node levels but most commonly being the involvement of levels I, II, III, and V with most common primary site being oral cavity. Ninety percent of tubercular nodes were less than 3 cm in size, whereas majority of metastatic nodes were more than 3 cm in size with 40% of cases having size greater than 6 cm. Reactive nodes had L/S ratio of 2.1 ± 0.8, tubercular nodes had 1.7 ± 0.5, lymphomatous nodes had 1.6 ± 0.4, and metastatic nodes had 1.1 ± 0.4. Sixty-two percent of tubercular nodes and 44% of metastatic nodes had sharp border. Eighty-seven percent of metastatic nodes and 71% of lymphomatous nodes had absent hilus, while only 28% of tubercular nodes had absent hilus and 90% of reactive nodes had widened hilus. Fourteen percent of tubercular and 6% of metastatic nodes showed intranodal calcification. Seventy-one percent of tubercular and 68% of metastatic nodes had intranodal necrosis with cystic necrosis being commoner, and only 13% of reactive nodes showed intranodal cystic necrosis. Eighty-two percent of tubercular and 75% of metastatic nodes had matting. Twelve percent of metastatic nodes and 28% of tubercular nodes showed peripheral vascularity, whereas 87% of metastatic nodes and 71% of tubercular nodes showed mixed vascularity, and 60% of reactive nodes showed hilar vascularity. In our study of differentiating non-neoplastic from neoplastic lymphadenopathy on the basis of ultrasonography and Doppler with final histopathology, a sensitivity of 92.3%, specificity of 86.9%, PPV of 95.2%, and NPV 80.0% was found.
Baatenburg de Jong RJ, Rongen RJ, Lameris JS, et al. Metastatic neck disease. Palpation vs ultrasound examination. Arch Otolaryngol Head Neck Surg 1989;115(6):689–690. DOI: 10.1001/archotol.1989.01860300043013.
Som PM. Detection of metastasis in cervical lymph nodes: CT and MR criteria and differential diagnosis. Am J Roentgenol 1992;158(5): 961–969. DOI: 10.2214/ajr.158.5.1566697.
Ahuja A, Ying M. Grey-scale sonography in assessment of cervical lymphadenopathy: review of sonographic appearances and features that may help a beginner. Br J Oral Maxillofac Surg 2000;38(5): 451–459. DOI: 10.1054/bjom.2000.0446.
Baatenburg de Jong RJ, Rongen RJ, Verwoerd CD, et al. Ultrasound-guided fine-needle aspiration biopsy of neck nodes. Arch Otolaryngol Head Neck Surg 1991;117(4):402–404. DOI: 10.1001/archotol.1991.01870160056008.
Castenholz A. (1990) Architecture of the Lymph Node with Regard to Its Function. In: Grundmann E., Vollmer E. (eds) Reaction Patterns of the Lymph Node. Current Topics in Pathology, vol 84/1. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-75519-4_1.
Hall FG. The functional anatomy of lymph nodes. In: Stansfeld AG & d'Ardenne AJ, editors. Lymph node biopsy interpretation. London: Churchill Livingstone; 1992. p. 3–28. ISBN: 0443040729, 9780443040726. https://scholar.google.com/scholar_lookup?title=The%20functional%20anatomy%20of%20lymph%20nodes&pages=3-28&publication_year=1992&author=Hall%2CFG
Hajek PC, Salomonowitz E, Turk R, et al. Lymph nodes of the neck: evaluation with US. Radiology 1986;158(3):739–742. DOI: 10.1148/radiology.158.3.3511503.
Ahuja A, Ying M. Sonographic evaluation of cervical lymphadenopathy. Ultrasound Med Biol 2003;29(3):353–359. https://doi.org/10.1016/S0301-5629(02)00759-7.
Komma S, Munirathna N, Suresh TN, et al. Evaluation of cervical lymphadenopathy by ultrasound in comparison with fnac. Int J Biol Med Res 2014;5(4):4448–4454. http://www.biomedscidirect.com/archives.php?issueid=24.
Ying M, Ahuja A. Sonography of neck lymph nodes. Part I: Normal lymph nodes. Clin Radiol 2003;58(5):351–358. DOI: 10.1016/s0009-9260(02)00584-6.
Na DG, Lim HK, Byun HS, et al. Differential diagnosis of cervical lymphadenopathy: usefulness of color Doppler sonography. AJR 1997;168(5);1311–1316. DOI: 10.2214/ajr.168.5.9129432.
Vassallo P, Wernecke K, Roos N. Differentiation of benign from malignant superficial lymphadenopathy: the role of high resolution US. Radiology 1992;183(1):215–220. DOI: 10.1148/radiology.183.1.1549675.
Bressani DS, Lattuada E. Ultrasonographic evaluation of cervical lymph nodes in preoperative staging of esophageal neoplasm. Dentomaxillofac Radiol 1998;19:165–170. DOI: 10.1007/s002619900338.
Chandak P, Degwekar S, Bhowte RR et al. An evaluation of efficacy of ultrasonography in the diagnosis of head and neck swellings. Dentomaxillofac Radiol 2011;40(4):213–221. DOI: 10.1259/dmfr/68658286.
Ying M, Ahuja A, Brook F. Accuracy of sonographic vascular features in differentiating different causes of cervical lymphadenopathy. Ultrasound Med Biol 2004;30(4):441–447. DOI: 10.1016/j.ultrasmedbio.2003.12.009.
Ho SS, Metreweli C, Ahuja AT. Does anybody know how we should measure Doppler parameters in lymph nodes? Clin Radiol 2001;56(2):124–126. DOI: 10.1053/crad.2000.0588.