KERATINIZATION AND NECROSIS - MORPHOLOGIC ASPECTS OF LYMPHATIC METASTASES IN ULTRASOUND

RATIONALE AND OBJECTIVES. The authors performed a retrospective study in ultrasound to investigate new aspects in the sonomorphology of lymp h node metastases of the neck, In this study, it could be demonstrated the first time that the histologic characteristics of the metastases determine the sonographic appearance, In addition to criteria such as the longitudinal/transversal quotient, sonomorphology could support a more precise differential diagnosis of neck lymph nodes. METHODS. In 1 05 of 145 patients with histologically proved head and neck carcinomas , 187 lymph node metastases were detected by ultrasound, Sonomorpholog y was compared with the corresponding histology, RESULTS. Five sonomor phologic groups could be differentiated, (1) Thirty-one percent of the metastases were homogenous, (2) Concerning the more complex morpholog y of lymph node metastases in ultrasound, echolucent forms could be di fferentiated from echogenic textures: low- or nondifferentiated and no nkeratinizing metastases appeared echolucent and cyst-like, with dorsa l signal amplification, (3) Nonkeratinizing lymphomas with necrosis sh owed single or multiple echolucent intranodal lesions, (4) In correlat ion with an increasing keratinization, the echogenecity of the lymph n odes increased and intranodal echogenic inclusions appeared, (5) An ex tended keratinization correlated with a central echogenecity. CONCLUSI ONS. The morphologic assessment of lymph nodes in ultrasound allows fo r primary histologic and prognostic evaluation of lymph node metastase s.