DISTINCTION BETWEEN BENIGN AND MALIGNANT CAUSES OF CERVICAL, AXILLARY, AND INGUINAL LYMPHADENOPATHY - VALUE OF DOPPLER SPECTRAL WAVE-FORM ANALYSIS

OBJECTIVE. Vessels in inflamed lymph nodes are dilated compared with v essels in lymph nodes involved with metastases, which may be compresse d by tumor cells. Accordingly, we hypothesized that the Doppler spectr al waveform might be different in lymph nodes involved by benign disea se and those involved by metastases. We compared spectral waveforms of benign and malignant superficial lymphadenopathy to determine the val ue of color Doppler sonography in distinguishing between the two. SUBJ ECTS AND METHODS. Palpable superficial lymph nodes (41 cervical, one a xillary, one inguinal) of 43 untreated patients were prospectively eva luated with color Doppler sonography. We measured resistive index, pul satility index, peak systolic velocity, and end diastolic velocity fro m the fastest or next fastest arterial signal in the lymph node that s howed the most vigorous flow. Final diagnosis was established by patho logic examination (n = 24) and clinical follow-up (n = 19). RESULTS. C olor Doppler sonography showed blood flow in all cases. The mean resis tive index was 0.92 +/- 0.23 in lymph nodes involved with metastases a nd 0.59 +/- 011 in lymph nodes affected by benign processes. The mean pulsatility index was 2.66 +/- 1.59 in lymph nodes involved with metas tases and 0.90 +/- 0.23 in lymph nodes affected by benign processes. L ymph nodes involved with metastases showed a characteristic high resis tive index (>1.0) and a high pulsatility index (>1.5) in 10 of 13 case s. Lymph nodes affected by benign processes showed a low resistive ind ex (<0.8) and a low pulsatility index (<1.5) in all cases. The resisti ve indexes and pulsatility indexes were significantly different (p < . 005) between lymph nodes affected by benign versus malignant disease. The mean peak systolic velocity was 25 +/- 11.7 cm/ sec in lymph nodes involved with metastases and 24 +/- 16 cm/sec in lymph nodes affected by benign processes. The mean end diastolic velocity was 2 +/- 6.7 cm /sec in lymph nodes involved with metastases and 10 +/- 9.5 cm/sec in lymph nodes affected by benign processes. Although the peak systolic v elocities were not significantly different, the end diastolic velociti es were significantly different (p < .005) between the two types of ly mph nodes. CONCLUSION. Our results suggest that superficial lymphadeno pathy due to benign and malignant diseases can be distinguished with a high degree of accuracy (p < .005) by means of spectral waveform anal ysis. Color Doppler sonography is a useful adjunct to routine sonograp hy. Lymph nodes with a high resistive index are almost always involved by metastases.