Malignant lymph nodes in the neck include metastases and lymphoma. Cervical nodal metastases are common in patients with head and neck cancers, and their assessment is important as it affects treatment planning and prognosis. Neck nodes are also a common site of lymphomatous involvement and an accurate diagnosis is essential as its treatment differs from other causes of neck lymphadenopathy. On ultrasound, grey scale sonography helps to evaluate nodal morphology, whilst power Doppler sonography is used to assess the vascular pattern. Grey scale sonographic features that help to identify metastatic and lymphomatous lymph nodes include size, shape and internal architecture (loss of hilar architecture, presence of intranodal necrosis and calcification). Soft tissue oedema and nodal matting are additional grey scale features seen in tuberculous nodes or in nodes that have been previously irradiated. Power Doppler sonography evaluates the vascular pattern of nodes and helps to identify the malignant nodes. In addition, serial monitoring of nodal size and vascularity are useful features in the assessment of treatment response.

Ultrasound of malignant cervical lymph nodes.

Purpose: To prospectively estimate the accuracy of sonoelastography in the differentiation of benign and metastatic cervical lymph nodes (LNs) in patients suspected of having thyroid or hypopharyngeal cancer, with histologic nodal findings as the reference standard. Materials and Methods: The study protocol was approved by the hospital review board; each patient gave written informed consent. One hundred forty-one peripheral neck LNs (60 metastatic, 81 metastasis free) in 43 consecutive patients (22 men, 21 women; mean age, 58 years ± 13 [standard deviation]) were examined. Patients referred for surgical treatment of suspected thyroid or hypopharyngeal cancer were examined with gray-scale ultrasonography (US), power Doppler US, and sonoelastography. At gray-scale and power Doppler US, the following LN characteristics were evaluated: short-axis diameter, short-to-long-axis diameter ratio, echogenicity, calcifications, and vascularity. A four-point rating scale was used to evaluate the US elastograms for LN...

Cervical Lymph Node Metastases: Diagnosis at Sonoelastography—Initial Experience

Purpose
Clinical examination alone cannot differentiate between cervical tuberculous lymphadenitis and cervical nodal metastases from non–head and neck (NHN) carcinomas because the distributions of involved lymph nodes are similar. We evaluated the sonographic features of cervical lymph nodes that could be used to differentiate between the 2 categories of nodes.

Methods
We retrospectively reviewed sonograms of abnormal cervical lymph nodes in 47 patients with proven cervical tuberculous lymphadenitis and in 22 patients with proven nodal metastases from NHN carcinomas.

Results
Abnormal nodes in tuberculous lymphadenitis and nodal metastases from NHN carcinomas were commonly found in the supraclavicular fossa (15% and 38%, respectively) and the posterior triangle (70% and 41%, respectively). Statistically significant (p < 0.05) features for differential diagnosis were lymph nodes' longest diameter, echogenicity, short-to-long axis ratio, appearance of surrounding soft tissues, and presence of intranodal cystic necrosis, matting, and posterior enhancement. Nodal size, echogenicity, presence of an echogenic hilum, calcification, coagulation necrosis, and sharpness of borders helped in identifying the abnormal lymph nodes.

Conclusions
Sonographic features that helped to differentiate between the 2 categories of nodes were shape, edema of surrounding soft tissue, homogeneity, intranodal cystic necrosis, matting, and posterior enhancement. © 1998 John Wiley & Sons, Inc. J Clin Ultrasound 26:383–389, 1998.

Cervical lymphadenopathy: sonographic differentiation between tuberculous nodes and nodal metastases from non-head and neck carcinomas

A total of 130 superficial lymph nodes were evaluated using color Doppler flow imaging (CDFI) in order to differentiate benign from malignant lymphadenopathy. The patterns of intranodal flow signals detected at standardized conditions by CDFI were classified using eight self-defined criteria and were correlated with the histopathological or clinical diagnosis. Nonparametric discriminant analysis showed that four vascular were suspicious of malignancy: (a) avascular areas, (b) displacement of intranodal vessels, (c) accessory peripheral vessels and (d) aberrant course of central vessels. Of the neoplastic lymph nodes (n = 73), 96% showed at least one pathological vascular pattern. Malignancy could be excluded in 95% of 57 reactive lymph nodes using these four criteria. Most reactive lymph nodes in contrast demonstrated a vascular hilus and/or vessels running at the long axis of the lymph node with branches to the cortex. There was a diagnostic accuracy of 41-82% in the additionally evaluated sonomorphological (size, shape, echogenicity) and Doppler (increased Pourcelot's or pulsatility indices) criteria. The definitive interpretation of the promising results of this retrospective study requires confirmation of examiner independency as well as a prospective evaluation.

Vascular patterns in reactive and malignant lymphadenopathy.

Although the role of high resolution ultrasound (US) in evaluating cervical nodes is well established, it is often combined with fine needle aspiration cytology (FNAC). As a result, US appearances that help in distinguishing the various causes of cervical adenopathy are often overlooked and not emphasized. The aim of this study is to re-emphasize to the sonologist the US clues that may help in differentiating the aetiology of abnormal cervical nodes.We, therefore, present the spectrum of US appearances of lymph nodes. One hundred and forty patients (702 abnormal nodes) with known pathology were compared with 100 normal subjects (1211 nodes).After identifying an abnormal node, US features that further help in distinguishing between the various pathologies are the distribution of lymphadenopathy, echogenicity, calcification, distal enhancement, intranodal cystic necrosis, matting and soft tissue oedema.

A practical approach to ultrasound of cervical lymph nodes

The sonographic evaluation of lymph nodes is based primarily on evaluation of their shape and size. Recently, however, the availability of high-frequency transducers has made consideration of internal structure possible. An important objective is to determine whether node enlargement is due to inflammatory or neoplastic processes. To determine the accuracy of sonography for this purpose, we obtained in vitro sonograms of 53 enlarged lymph nodes excised from 41 patients during surgery for neoplastic or nonneoplastic disease. The sonograms were obtained with 7.5- and 10-MHz transducers. They were interpreted by a radiologist who was unaware of the clinical diagnosis. The nodes were subsequently processed for anatomohistologic study; findings were compared side by side. In 26 of the 53 nodes, sonograms showed an identifiable central echogenic line, which on histologic specimen corresponded to the internal part of the medulla where the lymphatic sinuses converge. All these nodes were benign. Two other nodes h...

https://www.ajronline.org/doi/pdfplus/10.2214/ajr.155.6.2122673

Sonography of abnormal lymph nodes in vitro: correlation of sonographic and histologic findings.

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Sonography of abnormal lymph nodes in vitro: correlation of sonographic and histologic findings.