Evaluation of Cervical Lymphnodes by Ultrasonography in Correlation With Fnac

Abstract

AIMS AND OBJECTIVES:To study and differentiate neoplastic (Malignant) and nonneoplastic (Reactive and tubercular)cervical lymph nodes by High resolution ultrasonography. To correlate the diagnostic accuracy of ultrasound with FNAC in differentiating neoplastic (malignant) and nonneoplastic (reactive and tubercular) cervical lymphadenopathy. MATERIAL AND METHODS: Data was collected from a total of 100 cases referred for ultrasound of neck to the Department of Radiodiagnosis, Sri R. L. Jalappa Hospital and Research Center over a period of 24 months from January 2012 to January 2014, with 5-10 MH linear transducer using SEIMENS G 40/G 50/ Acuson Ax 300 ultrasound equipment. Lymph nodes were assessed using grey scale and colour Doppler parameters like: nodal level and site, size, shape, L/S ratio, border, hilum, echotexture, necrosis, matting and angioarchitecture [hilar vessels, capsular vessels (peripheral) and mixed flow]. A provisional diagnosis was suggested after the ultrasound examination and these findings were correlated with Fine Needle Aspiration Cytology/ Histopathological findings. RESULTS: In our study out of 45 non neoplastic nodes (reactive and tubercular) only 41 nodes were identified as nonneoplastic (reactive/ tubercular) on ultrasound prior to FNAC/ histopathology. Out of 55 possible neoplastic (malignant nodes) detected on ultrasound only 46 lymph nodes turned out to be neoplastic on FNAC/ histopathology. Lymph node with oval shape (L/S ratio > 2) echogenic hilum, homogenous echotexture and hilar vascularity were considered as significant parameters in detecting non-neoplastic (reactive) lymph nodes, which showed matting with soft tissue edema were considered nonneoplastic lymphnodes (Tubercular lymphnodes). Nodes which were Round shape (L/S ratio < 2), absent hilum, heterogeneous echotexture, hilar, capsular vessels and mixed vascularity were considered as significant parameters in detecting neoplastic (malignant) lymph nodes. Correlation of sonographic findings with Fine Needle Aspiration Cytology/ Histopathological findings was performed. Sensitivity and Specificity of ultrasound in differentiating neoplastic from non-neoplastic cervical lymphadenopathy was found to be 90% and 74% respectively. CONCLUSIONS: This study concludes that: 1) High resolution ultrasonographic examination proved as a valuable primary investigation to identify lymph nodes and differentiate nonneoplastic and neoplastic lymphadenopathy. 2) Combination of ultrasonographic features with vascular pattern of the lymph nodes have a high sensitivity, specificity in differentiating neoplastic and non-neoplastic lymphadenopathy.

Phantom Nodules Detected by Ultrasound Examination of the Neck: The Possibility of Ectopic Cervical Thymic Tissue in Adults

“…Differential diagnoses for small nodules located in the perithyroidal region include an enlarged parathyroid gland, lymph node, accessory thyroid nodule or ectopic thyroid tissue, carotid body paraganglioma, nerve sheath tumor, venous vascular malformation, and lipoma. Enlarged parathyroid glands due to adenoma, hyperplasia, or cysts are hypoechoic lesions 4 23 , as are lymph nodes 24 25 26 . The presence of an echogenic hilus and hilar vascularity on Doppler imaging assists in the identification of lymph nodes 26 .…”

“…Enlarged parathyroid glands due to adenoma, hyperplasia, or cysts are hypoechoic lesions 4 23 , as are lymph nodes 24 25 26 . The presence of an echogenic hilus and hilar vascularity on Doppler imaging assists in the identification of lymph nodes 26 . The echogenicity of accessory thyroid nodules or ectopic thyroid tissues, which exhibit vascular flow, is the same as that of the thyroid 27 .…”