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. |
