Fatty changes as a misleading factor in the evaluation with ultrasound of superficial lymph nodes

Defining the lymph node burden in a Northern European population without malignancy: the potential effect of geography in determining a need for FNA?

“…Generally, fat tissue replaces normal parenchyma so that nodal size remains constant, although size increase has been reported 29–31 . In an ultrasound study of 247 lymph nodes with a centrally echogenic pattern detected in 110 patients undergoing traditional ultrasound for cancer staging, the ratio of the peripheral hypoechoic ring (immunologically active parenchyma) and the central echogenic area (fat) was shown to be lower in patients with diabetes mellitus and was shown to decrease with increasing patient BMI 32 . Although we did not find any significant difference between lymph node echopattern or size in patients who are overweight compared with those who are not overweight in the current study, it is conceivable that an increase of the centrally echogenic fat in lymph nodes may lead to their being more readily recognizable on EUS.…”

Critical Analysis of the Ultrasonographic Criteria for Diagnosing Lymph Node Metastasis in Patients With Cutaneous Melanoma

“…Melanoma metastases mostly affect axillary and inguinal stations, where the US appearances of normal and abnormal lymph nodes are somewhat different. Normal inguinal nodes are recognizable in almost all patients and typically show an elongated shape with a thin cortex 2 , 46 . Additionally, melanoma shows morphologic features that are somewhat different, although far from specific, from those encountered in other malignancies, such as the tendency to affect the lymph node focally (microscopic deposits progressively growing into focal intranodal nodules), the high percentage of small intranodal tumor deposits (even below US resolution, known as micrometastases), and the presence of very low‐level echoes due to the poorly reflecting melanin content 5 , 6 , 38 …”

“…Instead, particularly in areas such as the axilla and, even more, the inguinal region, lymph nodes are recognizable in almost all healthy individuals (Figure 1). 2 , 46 It should be considered that some morphologic details were difficult to identify with 1980s and 1990s equipment. Consequently, diagnosis of malignancy was mostly based on changes in the shape and loss of the central echoic hilum.…”

Controversies Regarding the Utility of Lymphadenectomy in Endometrial Cancer

“…A recent study confirmed this phenomenon for superficial lymph nodes in the cervical, axillary and inguinal regions. The fatty degeneration of lymph nodes makes their identification unreliable with either imaging or palpation at the time of surgery or during gross pathologic examination (Arango et al, 2000;Giovagnorio et al, 2005). Consequently, the value of lymph node counts in the elderly and in obese women with endometrial cancer is highly dependent on the thoroughness of the pathology technician.…”