Application of neck ultrasound in the diagnosis of sarcoidosis

Abstract

Objective To explore the significance of neck ultrasound (NUS) combined with contrast-enhanced ultrasound (CEUS) in the diagnosis of sarcoidosis. Methods 88 patients with evidence of intrathoracic lymphadenopathy and suspected sarcoidosis with enlarged cervical lymph nodes underwent NUS, CEUS, fine-needle aspiration and core needle biopsy when technically feasible were retrospectively analyzed in this study. Seven characteristics such as enhanced mode (EM), resolution time, color Doppler flow imaging (CDFI), fading time, peaking state-uniformity, strengthen the area and symmetry were considered to perform the logistic regression model. Results Of 88 patients included in this study, sarcoidosis was accounted in 20 cases, tuberculosis in 23 cases, malignancy in 22 cases and inflammatory lymph node in 23 cases. There were statistically significant differences in symmetry, lymphatic hilum, homogeneity, CDFI pattern and elasticity score between the sarcoidosis and non-sarcoidosis groups via NUS. Similarly, we also acknowledged a statistically significant differences in EM, homogeneity, presence or absence of necrosis between the sarcoidosis and non-sarcoidosis groups via CEUS to further group the non-sarcoidosis into tuberculosis, malignancy or inflammatory disorder. The percentage correction of prediction was 90% (18/20). Conclusion NUS combined with CEUS has characteristic features in sarcoidosis with cervical lymph node involvement, which is helpful for its diagnosis and differential diagnosis. The binary classification model of NUS combined with CEUS features can help differentiate sarcoidosis from non-sarcoidosis groups.

Analysis of bleeding after ultrasound-guided needle biopsy of benign cervical lymph nodes

“…In this study, the incidence of intraoperative and postoperative bleeding was lower in rare lymph node diseases than in reactive lymph node hyperplasia and infectious lymph nodes. We believe that this is due to poor lymph node mobility in rare lymph node diseases, edema of the tissue surrounding the lymph nodes in sarcoidosis and necrotizing lymphadenitis, and adhesion to lymph nodes in necrotizing lymphadenitis [ 21 , 22 ]. Approximately 90% of KD cases had perilymph node infiltration [ 23 , 24 ], which is characterized by a hyperechoic ring around the lymph node and borderline and mixed color blood flow signals on US scan.…”

Lymphadenopathy in the rheumatology practice: a pragmatic approach

“…Despite not being sufficient to formulate a diagnosis, some sonographic features at EBUS have been found to be predictive of sarcoidosis, including the absence of coagulation necrosis, the presence of nodal conglomeration and the presence of the septal vessel sign in the colour Doppler mode [ 48 ]. Needle sampling of cervical lymph nodes identified by neck US is emerging as a potential alternative diagnostic tool when EBUS is poorly tolerated or difficult to access [ 49 , 50 ]. The differential diagnosis is broad, but most importantly requires ruling out the presence of lymphoma, lung cancer, and granulomatous lymphadenitis from mycobacterial or fungal organisms [ 34 ].…”