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Subject Area

Cardiothoracic Surgery

Article Type

Original Study

Abstract

Objective The aim of the present study was to identify the role of color Doppler ultrasonography in differentiating benign and malignant enlarged cervical lymph nodes. Background Cervical lymphadenopathy is a common presenting symptom and sign for a variety of diseases ranging from subtle infections to life-threatening head and neck malignancies. Ultrasound is a useful imaging tool for the initial evaluation of cervical lymph nodes because it has high sensitivity (98%) and specificity (95%), particularly when combined with fine-needle aspiration cytology. Patients and methods The present study included 40 (27 male and 13 female) patients with cervical lymphadenopathy. Cases were divided into two main groups: the inflammatory group and the neoplastic group. The inflammatory group was further divided into the nonspecific group and the tuberculous group. The neoplastic group was further divided into the primary group and the metastatic group. The lymph nodes were subjected to sonographic and Doppler studies, which were correlated with clinical and pathological diagnoses obtained either by lymph node biopsy or after surgical excision whenever possible. Results Regarding the vascular pattern of each lymph node, our study showed that there was a different pattern of vascularity for each type of lymphadenopathy. Regarding the resistivity index, this study also showed that the sensitivity and specificity of the resistivity index for detecting malignant lymph nodes were 50 and 100%, respectively. Therefore, the value of spectral Doppler ultrasonography evaluation of intranodal vascular resistance is limited in routine clinical practice. Conclusion High-resolution ultrasonography has an important role in differentiating benign and malignant lymphadenopathy based on the shape (longitudinal/transverse ratio), hila, cortical thickness, cortical echogenicity, intranodal necrosis, pattern of vascularity, and resistivity index of the nodes.

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