Publications of Faculty of Medicine:The Role of Colour Doppler in Differentiation between Benign and Malignant Cervical Lymphadenopathy: Abstract

The Role of Colour Doppler in Differentiation between Benign and Malignant Cervical Lymphadenopathy
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Objectives: The present study aimed to differentiate between benign and malignant cervical lymphadenopathy clinically and by the use of colour and power Doppler sonographic examination to study intranodal vascular distribution and intranodal vascular resistance in correlation to the final histopathological examination. Patients and Methods: The study included one hundred patients with cervical lymphadenopathy (40 females and 60 males).All the Patients were subjected to full history taking , complete clinical examination (including general and local examination of the enlarged lymph nodes (LN) and to which group they belong) and ultrasonographic(US)examination {including nodal size, shape(by measuring the longitudinal(Long axis)and transverse(Short axis) diameters and L/T ratio was calculated for each node ), hilus, as well as cortex, echogenicty of the lymph node, intranodal necrosis and matting of lymph nodes} as well as colour and power Doppler examination (including vascular pattern and vascular indices) were performed. Histopathological confirmations were obtained by fine needle aspiration cytology (FNAC) and/or excision biopsy. Results: The study included 100 patients, 40 females and 60 males with age ranged from 10 to 60 years. Clinical examinations detected 55 patients (55%) with clinical findings suggestive of benign cervical LN enlargement and 45 patients (45%) with clinical findings suggestive of malignant cervical LN enlargement. Ultrasonographic examination of the nodal cortex detected that narrow cortex was founded only in benign lymph nodes (45 of 53 lymph nodes 84.9%) and concentric cortical widening had been founded in malignant lymph nodes (8 of 15 lymph nodes 53.3%) and also in benign lymph nodes with hypertrophied peripheral lymphatic follicles (7 of 53 lymph nodes 13.2%). Concerning the shape of the lymph node, there was significant difference between malignant and benign nodes with tendency of benign nodes to be oval (L/ T > 2) and malignant nodes to be round (L/ T <2).Colour Doppler examination with the use of resistivity index detected malignant lymph nodes with sensitivity and specificity of 80% and 87.1% respectively and regarding the vascular patterns it was founded that, the hilar vascular pattern predominated in benign lesions, it was seen in 84.3% of benign lymph nodes, while subcapsular vessels predominated in the malignant lesions, it was seen in 81.7% of malignant lymph nodes. Correlation of the results of clinical examination, ultrasonographic appearance and colour Doppler findings with the final histopathological examination showed that out of 100 patients (with a total number of 130 involved lymph nodes), 45 patients had inflammatory lymph nodes, 18 patients had tuberculous LN, 20 patients had metastatic LN and 17 patients with primary lymph node affection.