DIFFERENTIAL-DIAGNOSIS OF CERVICAL LYMPHADENOPATHY - USEFULNESS OF COLOR DOPPLER SONOGRAPHY

OBJECTIVE. The purpose of this study was to evaluate the usefulness of color Doppler sonography in differentiating benign from malignant cer vical lymphadenopathy. MATERIALS AND METHODS. We used color Doppler so nography to evaluate 117 lymph nodes in 105 patients. The patients wer e pathologically and clinically confirmed to have benign reactive lymp hadenitis (n=28), tuberculosis (n=17), lymphoma (n=14), and metastasis (n=46). The patterns of hilar vascularity, central nodal vascularity, and peripheral vascularity were assessed. The highest resistive index and pulsatility index in 116 lymph nodes were measured from spectral waveforms. Histologic findings of nodal vessels were analyzed in 14 no des and compared with findings on color Doppler sonograms. RESULTS. Th irty-two (94%) of 34 nodes with benign reactive disease showed normal patterns of nodal vascularity: central hilar vascularity, radial symme tric central vascularity, and no peripheral vascularity. At least one of six abnormal patterns of vascularity (eccentric of absent hilar vas cularity; deformed radial, aberrant multifocal, or absent central vasc ularity; and peripheral vascularity) was observed in 98% (65/66) of no des with malignant disease and in all tuberculous nodes. We establishe d cutoff values of 0.8 for the resistive index and 1.5 for the pulsati lity index that were 100% specific for malignancy. However, sensitivit ies for these cutoff values were 47% and 55%, respectively. Also histo logic examinations showed that most flow signals in nodes with maligna nt disease represented arterioles or veins in the septa between tumor nests or near the capsule. CONCLUSIONS. Unlike nodes with benign react ive disease, 98% of nodes with malignant disease and 100% of tuberculo us nodes showed abnormal patterns of nodal vascularity. Also, high val ues for the resistive and pulsatility indexes were highly specific for malignant lymphadenopathy. Color Doppler sonography combined with ana lysis of spectral waveforms was useful in differentiating benign from malignant cervical lymphadenopathy.