VASCULAR PATHOLOGY OF MALIGNANT CERVICAL LYMPHADENOPATHY - QUALITATIVE AND QUANTITATIVE ASSESSMENT WITH POWER DOPPLER ULTRASOUND

BACKGROUND. Malignant Vascular pathology has traditionally been studie d with invasive angiography or in vitro immunohistochemistry. The obje ctive of this study was to investigate the vascular patterns and vascu lar density of benign and malignant cervical lymphadenopathy using pow er Doppler ultrasound combined with a computed quantitative image proc essing system. METHODS. Investigations of 189 cervical lymph node lesi ons were undertaken prospectively using a 5-10 MHz linear array transd ucer in power mode. The types of vascular patterns displayed with powe r Doppler ultrasound, after sweep-scanning over the whole lymph node, were classified as hilar, spotted, peripheral, or mixed. Quantitative assessment of vascularity was made by sampling three parallel planes o f each lymph node. A computed image processing system automatically ca lculated the density of vascular signals (called the ''vascularity ind ex'' in this study) within the lymph node plane. RESULTS. Malignant ly mph node lesions were shown to have higher vascularity indices (0.169 +/- 0.147, P < 0.01). The vascular patterns of benign lesions were mos tly of avascular or hilar type (in 83% of cases). Malignant lesions we re characterized by patterns of mixed (47%), spotted (20%), or periphe ral type (11%). When vascular pattern (nonhilar type) and vascularity index (maximum greater than or equal to 0.09) were combined, the speci ficity for diagnosing malignant lymphadenopathy was as high as 97%. Va riance in tumor vascularity was noted in both the benign and malignant soups. CONCLUSIONS. Power Doppler ultrasound combined with a computed image processing system provided an objective tool for assessing tumo r vascularity quantitatively. Using this modality, the vascular pathol ogy of malignant lymphadenopathy was found to be characterized by high er Vascular density and aberrant vascular patterns. (C) 1998 American Cancer Society.