My. Choi et al., DISTINCTION BETWEEN BENIGN AND MALIGNANT CAUSES OF CERVICAL, AXILLARY, AND INGUINAL LYMPHADENOPATHY - VALUE OF DOPPLER SPECTRAL WAVE-FORM ANALYSIS, American journal of roentgenology, 165(4), 1995, pp. 981-984
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.