DIFFERENTIAL-DIAGNOSIS OF LYMPH-NODE LESIONS - A SEMIQUANTITATIVE APPROACH WITH COLOR DOPPLER ULTRASOUND

The aim of this study was to evaluate reactively enlarged cervical lym ph nodes and nodal metastases in patients with squamous cell carcinoma , as well as nodes involved by malignant lymphoma, by means of colour Doppler ultrasound (CDUS) and to describe perfusion sites for each nod al group in order to determine if typical flow patterns exist for node s with different pathology. In a prospective study, 63 untreated patie nts with palpable cervical lymph node enlargement (n = 208) underwent examination with CDUS. The sites of perfusion were subdivided into thr ee groups: central, peripheral and hilar perfusion. The intensity of p erfusion was subjectively quantified in a semiquantitative scale from 0 (no perfusion) to III (high perfusion). Finally, the overall perfuse d area of the lymph nodes was measured and the percentage of perfused nodal area was calculated. CDUS showed perfusion in 178 of 208 lymph n odes. Histological examination showed 49 reactively enlarged lymph nod es, 82 containing metastases and 47 with lymphoma. Reactively enlarged lymph nodes showed characteristically intense hilar perfusion (91.8%) , whereas nodal metastases had mainly peripherally located flow (84.1% ) of intensity grades I-III. Lymph nodes invaded by malignant lymphoma were highly perfused, showing colour signals in the centre as well as in the nodal periphery (78.7%). In conclusion, perfusional patterns m ay provide useful additional information in the differential diagnosis of cervical lymphadenopathy.