Sonographic assessment of cervical lymphadenopathy: role of high-resolution and color Doppler imaging.

BACKGROUND: The objective of this article was to study the role of high frequency ultrasound and color Doppler imaging in the diagnostic evaluation of patients with cervical lymphadenopathy.

METHODS: The present study was carried out over a period of 18 months and included 64 patients of different age groups presenting with cervical lymphadenopathy. Comprehensive sonographic examination of the neck for cervical lymph nodes was performed using the LOGIQ 500 ultrasound machine (GE Wipro Proseries). The scanning was performed with the patient in the supine position, and with the neck hyperextended using a pad or pillow under the shoulders in order to provide optimum exposure of the neck. The parameters considered in this study included: site, mean long axis (L), mean short axis (S), shape index (S/L), echotexture and homogenicity, margins, ancillary features like calcification, necrosis, posterior enhancement, matting and surrounding tissue changes, vascular pattern, and mean arterial resistive index (RI). These findings were correlated with fine-needle aspiration cytology and excisional biopsy. The nodes were classified as reactive, lymphomatous, and metastatic. The results were subjected to statistical analysis using SPSS software. A p value of < .05 was considered to be significant.

RESULTS: The results showed that malignant lymph nodes, especially metastatic nodes, are mostly accompanied with rounded shape, homogenous echotexture, peripheral vascularity, and significantly high RI. Among these sonographic findings, nodal shape (S/L ratio) and RI were more accurate for differentiating benign from malignant lymph nodes. Most of the malignant nodes had well-defined borders. Calcification, necrosis, posterior enhancement, matting, and hilar flow patterns were characteristically found in tubercular lymphadenitis. A combined ultrasound-guided and fine-needle aspiration (FNA) diagnosis had a high sensitivity (95.4%) and specificity (92.3) as compared with situations in which they were used alone.

CONCLUSION: Sonographic findings have a high accuracy in differentiating benign from malignant cervical lymph nodes. An ultrasound scan can be used as the first-line imaging tool in the diagnostic evaluation of cervical lymphadenopathy, especially in developing countries like India due to its ease, noninvasiveness, reproducibility, and cost effectiveness. It can also be used as an imaging tool for the guided aspirations. However, because of some overlapping in sonographic appearances of benign and malignant nodes, this modality may not have definite diagnostic values. But when combined with FNA, it has a very high sensitivity and specificity.