Differentiation of benign and malignant cervical lymph nodes: Value of B-mode and color Doppler sonography

Objective: To evaluate the efficacy of color Doppler sonography in detectin g possible differences in blood flow patterns and B-mode sonographic charac teristics between malignant and benign cervical lymph nodes. Patients and m ethods: During a period of 10 months, the palpable cervical lymph nodes of 39 patients were prospectively evaluated with B-mode and color Doppler sono graphy. The echogenity, contour, ratio of longitudinal diameter to the tran sverse diameter and the presence of a hilus were evaluated by B-mode sonogr aphy. Capsullary and intranodal arterial flow rates were measured and maxim al systolic, end-diastolic, mid-systolic flow velocities with pulsatility, resistivity and acceleration indices were obtained. Final diagnosis was est ablished by excisional biopsy (n:34) and clinical follow-up (n:5). Results: The lymph nodes in 20 cases were malignant and in 19 cases were benign. Th e B-mode contour characteristics and presence of a hilus in malignant and b enign lymph nodes were statistically significant (P < 0.05), but there were no significant differences between the ratio of longitudinal diameter to t he transverse diameter (P > 0.05), echogenity (P > 0.05) and the diameters of lymph nodes (P > 0.05). Flow patterns were obtained in 14 malignant (70% ) and 10 benign (52.6%) cases. The maximal systolic, end diastolic, mid-sys tolic flow velocities and pulsatility, resistivity, acceleration indices di d not differ statistically (P > 0.05). Conclusion: In the differentiations of benign and malignant cervical lymph nodes, the B-mode and color Doppler sonography are limited methods and can not replace biopsy. (C) 1998 Elsevie r Science Ireland Ltd. All rights reserved.