Differentiation of benign from malignant superficial lymphadenopathy: the role of high-resolution US.

Abstract

Ultrasonography has proved a valuable tool for the detection of enlarged lymph nodes; however, differentiation between benign and malignant nodal disease remains a problem. High-frequency probes with improved spatial and contrast resolution display superficial nodes to advantage and also show the internal structure of the nodes. Ninety-four superficial nodes in patients with suspected nodal disease were examined by using 7.5-MHz probes to evaluate longitudinal-transverse diameter ratio (L/T), the central hilus, cortical widening, and size. Histologic diagnosis was obtained after sonographic examination in 73 nodes (five reactive nodes, 35 primary nodal malignancies, and 33 nodal metastases). The remaining 21 nodes regressed after either antibiotic or no therapy. Marked differences were observed among the proportions of benign and malignant nodes in terms of L/T, hilus, and cortex; the latter two structures, however, must be interpreted together. Eccentric cortical widening was seen in only malignant nodes. The distribution of nodal size was not significantly (P greater than .1) different for benign and malignant nodes. No differences were observed between primary and secondary nodal malignancies. The sonographic criteria evaluated in this study assist in the differentiation of benign from malignant superficial lymph nodes.

Clinical Value of Real Time Elastography in Patients with Unexplained Cervical Lymphadenopathy: Quantitative Evaluation

“…The widely-accepted US criteria for identifying a malignant LN includes round shape (L/ S<2), absence of hyperechoic hilum, peripheral or mixed vascular patterns (Vassallo et al, 1992; Ahuja and Ying, :http://dx.doi.org/10.7314/APJCP.2014.15.13…”

“…A node with a ratio of long to short diameter (L/S) <2 was defined as round shape, and a ratio of L/S≥2 as oval shape. The widely-accepted US criteria for identifying a malignant LN includes round shape (L/S<2), absence of hyperechoic hilum, peripheral or mixed vascular patterns (Vassallo et al, 1992;Ahuja and Ying, 2003). LNs who met one of the above criteria will do RTE for further diagnosis.…”

Diagnosis of axillary nodal metastases by ultrasound-guided core biopsy in primary operable breast cancer

“…However, the US study by Vassallo et al (1992) and a more recent in vitro study using high-resolution CT by Uematsu et al (2001) have shown that nodal shape, that is, a longitudinal by transverse axis ratio of less than 2, and abnormal morphology of the cortex with a thickness of more than 2 mm are the two most reliable criteria in predicting malignancy in vivo. We adopted these criteria in our study to identify abnormal nodes and selectively biopsy them.…”

US-guided Core Needle Biopsy of Axillary Lymph Nodes in Patients with Breast Cancer: Why and How to Do It

“…An abnormal lymph node has a thickened or eccentrically bulging cortex and a diminished or absent hilum (Figs 3-5) (22,23). The thickened cortex should be the target at biopsy.…”