Ultrasound and Doppler in Assessment of Cervical Lymphadenopathy

Objective and Background: Tuberculous lymphadenitis and metastatic cervical nodes are common in Asians and are often indistinguishable clinically. Because their treatment depends on prompt diagnosis, we undertook this study to evaluate if ultrasound, colored, pulsed and power Doppler sonography could distinguish the pathologic abnormalities including tuberculous, metastatic, reactive and lymphomatous lymphadenopathy. Design: Analytic, case control study. Material and Methods: Ultrasound and Doppler examinations of reactive, tuberculous, lymphomatous and metastatic nodes were done and open biopsy or FNAC considered as a gold standard. Intranodal distribution of vessels and the intranodal vascular resistance were compared among these four groups. All examinations were performed by the same sonologist to eliminate interobserver variation. Results: Intranodal vascular distribution in tuberculous nodes was varied and simulated both benign and malignant disease. Avascularity of nodes and displacement of hilar vascularity were frequent in tuberculous nodes. Capsular pattern of vascularity is seen in malignant lymphadenopathy. Metastatic nodes (resistive index RI, 0.92) had a higher vascular resistance than did tuberculous nodes (RI, 0.69±0.07) and lymphomatous nodes (RI, 0.6710.05). Tuberculous nodes had a relatively similar vascular resistance as found in reactive nodes (RI, 0.6910.1). Conclusion: Sonographic coupled with Doppler examinations can help in differential diagnosis of cervical lymphadenopathy, however, final diagnosis by biopsy still needed in some cases of atypical criteria which have relatively high false +ve and false -ve results.