CERVICAL LYMPHADENOPATHY - SONOGRAPHIC DIFFERENTIATION BETWEEN TUBERCULOUS NODES AND NODAL METASTASES FROM NON-HEAD AND NECK CARCINOMAS

Purpose. Clinical examination alone cannot differentiate between cervi cal tuberculous lymphadenitis and cervical nodal metastases from non-h ead and neck (NHN) carcinomas because the distributions of involved ly mph nodes are similar. We evaluated the sonographic features of cervic al lymph nodes that could be used to differentiate between the 2 categ ories of nodes. Methods. We retrospectively reviewed sonograms of abno rmal cervical lymph nodes in 47 patients with proven cervical tubercul ous lymphadenitis and in 22 patients with proven nodal metastases from NHN carcinomas. Results. Abnormal nodes in tuberculous lymphadenitis and nodal metastases from NHN carcinomas were commonly found in the su praclavicular fossa (15% and 38%, respectively) and the posterior tria ngle (70% and 41%, respectively). Statistically significant (p < 0.05) features for differential diagnosis were lymph nodes' longest diamete r, echogenicity, short-to-long axis ratio, appearance of surrounding s oft tissues, and presence of intranodal cystic necrosis, matting, and posterior enhancement. Nodal size, echogenicity, presence of an echoge nic hilum, calcification, coagulation necrosis, and sharpness of borde rs helped in identifying the abnormal lymph nodes. Conclusions. Sonogr aphic features that helped to differentiate between the 2 categories o f nodes were shape, edema of surrounding soft tissue, homogeneity, int ranodal cystic necrosis, matting, and posterior enhancement. (C) 1998 John Wiley & Sons, Inc.