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Ultrasound Review of Metastatic Lymphadenopathy

Year 2013, Volume: 38 Issue: 2, 196 - 201, 01.06.2013

Abstract

Metastatic Lymphadenopathy is a common occurrence now with the earlier detection possible due to advances in imaging sciences. Although, at times the site of original malignancy is known; there are instances when the primary source of malignancy remains unknown. Ultrasound has the potential to non invasively evaluate the affected lymph nodes. Hence we reviewed the ultrasound findings in all fine needle aspiration cytology proven cases of metastatic lymphadenopathy that presented in the imaging department in the last 12 months. Multiple criteria on Grey Scale ultrasound imaging and on Color Doppler ultrasound imaging were used to label metastatic lymphadenopathy. Round nodes without any matting, presence of intranodal necrosis, intranodal calcifications, increased vascularity and elevated Doppler Pulsatility and Resisitivity Indices were the hallmarks of metastatic lymphadenopathy which enabled correct diagnosis with a sensitivity of 85.25% and a sensitivity of 98.36 %. In our review, the most sensitive and specific criteria was the Roundness Index on Gray scale imaging and Resistance to Perfusion on Color Doppler imaging. This review shows how, ultrasound can satisfactorily diagnose metastatic lymphadenopathy and can therefore be used in the diagnosis as well as follow up of such cases.

References

  • Som P. Lymph Nodes of the Neck. Radiology. 1987;165:593-600.
  • Stevens A, Lowe J. Human Histology-Immune System. 1997; 2: 117-35.
  • Arey LB. Human Histology-The Lymph Nodes. 1974; 41: 148-51.
  • Ross MM, Romrell LJ, Kaye GI. Histology –A text and Atlas-Lymph Nodes. 1995; 3: 342-6.
  • DePena CA, Tassel PV, Lee YA. Lymphoma of Head and Neck. Radiologic Clinics of North America.1990; 28:723-43.
  • Ahuja A, Ying M, Yang T et al. The Use of Sonography in Differentiating Cervical Lymphomatous Lymph Nodes from Cervical Metastatic Lymph Nodes. Clinical Radiology. 1996; 51:186-90.
  • Ying M, Ahuja AT, Evans R et al. Cervical Lymphadenopathy: Sonographic Differentiation between Tuberculous Nodes and Nodal Metastases from Non-Head and Neck Carcinomas. Journal of Clinical Ultrasound. 1998; 8: 383-89.
  • Ahuja A, Ying M., Evans R et al. The Application of Ultrasound Criteria for Malignancy in Differentiating Tuberculous Cervical Adenitis from Metastatic Nasopharyngeal Carcinoma. Clinical Radiology. 1995;50: 391-5.
  • Steinkemp HJ, Maurer J, Cornebl M, Recurrent Cervical Lymphadenopathy: Differential diagnosis with color-duplex sonography. Eur Arch Otorhinolaryngol. 1994; 251: 404-9.
  • Koischwitz D, Gritzmann D. Ultrasound Of The Neck. Radiologic Clinics Of North America. 2000;38: 1029-45.
  • Na CG, Lim AK, Byun GS et al. Differential diagnosis of Cervical Lymphadenopathy: Usefulness of Color Doppler Sonography. The American Journal of Radiology. 1997;168:1311-6.
  • Sakai O, Curtin H, Romo LV et al. Lymph Node Pathology Benign Proliferative, Lymphoma, And Metastatic Disease. Radiological Clinics of North America. 2000;38:979-98.
  • Gritzmann N, Hollerweger A, Macheiner P et al. Sonography of Soft Tissue Masses of the Neck. Journal of Clinical Ultrasound. 2002;30:356-73.
  • Wu, Chang, Hsu et al. Usefulness of Doppler Spectral Analysis and Power Doppler Sonography in the differentiation of cervical Lymphadenopathies. American Journal of Roentgenology. 1998; 171:503-9.
  • Steinkemp HJ, Mueffelmann M, Bock JC et al. Differential diagnosis of lymph node lesions: a semi quantitative approach with color Doppler ultrasound. The British Journal of Radiology. 1998;71: 828-33.
  • Evans RM, Ahuja A, Meterweli C. The Linear Echogenic Hilus in Cervical LymphadenopathyA Sign of Benignity or Malignancy. Clinical Radiology. 1993; 47: 262-4.
  • Vassallo P, Wernecke K, Roos N et al. Differentiation of Benign from Malignant Superficial Lymphadenopathy: The Role of High –Resolution US.Radiology. 1992;183: 215Choi M Y ,Lee JW,Jang KJ.Distinction between Benign ans Malignant causes of
  • Cervical, Axillary and Inguinal Lymphadenopathy:Value of Doppler Spectral Waveform Analysis. 1995;165: 981-4
  • Yazışma Adresi / Address for Correspondence: Dr. Sushil Ghanshyam Kachewar Rural Medical College PIMS (DU), Loni, Maharashtra, INDIA-413 736 geliş tarihi/received :24.10.2012 kabul tarihi/accepted:20.11.2012

Ultrasound Review of Metastatic Lymphadenopathy

Year 2013, Volume: 38 Issue: 2, 196 - 201, 01.06.2013

Abstract

Metastatik lenfadenopatiler görüntüleme tekniklerindeki gelişmeler sayesinde daha yaygın olarak görülmektedir. Her ne kadar malign bölge çoğu kez bilinsede malign dokunun temel kökeninin belirlenemediği durumlarda vardır. Ultrasonografi hastalıklı lenf nodlarının noninvaziv olarak değerlendirme potansiyeline sahiptir. Bu bağlamda, bizde görüntüleme bölümümüze son 12 ayda gelmiş iğne aspirasyon sitolojisi ile metastatik lenfadenopatileri doğrulanmış vakaların ultrasonografik bulguları değerlendirdik. Metastatik lenfadenopatilerin işaretlenmesinde birçok kriter gözönünde bulundurulmak suretiyle gri skala ve renkli doppler ultrasonografik görüntüleme metodları kullanılarak değerlendirilmiştir. Sertleşme göstermeyen yuvarlak nodlar, nodüler nekroz oluşumu, nodüler kalsifikasyon, artan vaskularizasyon, artan Doppler pulsalitesi ve rezistans indeksleri metastatik lenfadenopatilerin karakterizasyonunun temelini oluşturmakla beraber doğru teşhisi oranını yaklaşık %85.25 ile %98.36 arasındasır. Derlememizdeki en duyarlı ve spesik kriterler gri skala görüntülemesindeki yuvarlaklık indeksi ve renkli doppler görüntülemesindeki perfüzyon rezistansıdır. Bu derleme ayrıca ultrasonografinin metastatik lenfadenopatilerin teşhisindeki doğruluğu ve dolayısıyla bu tip vakaların teşhis ve takibindeki faydalarını vurgulamaktadır.

References

  • Som P. Lymph Nodes of the Neck. Radiology. 1987;165:593-600.
  • Stevens A, Lowe J. Human Histology-Immune System. 1997; 2: 117-35.
  • Arey LB. Human Histology-The Lymph Nodes. 1974; 41: 148-51.
  • Ross MM, Romrell LJ, Kaye GI. Histology –A text and Atlas-Lymph Nodes. 1995; 3: 342-6.
  • DePena CA, Tassel PV, Lee YA. Lymphoma of Head and Neck. Radiologic Clinics of North America.1990; 28:723-43.
  • Ahuja A, Ying M, Yang T et al. The Use of Sonography in Differentiating Cervical Lymphomatous Lymph Nodes from Cervical Metastatic Lymph Nodes. Clinical Radiology. 1996; 51:186-90.
  • Ying M, Ahuja AT, Evans R et al. Cervical Lymphadenopathy: Sonographic Differentiation between Tuberculous Nodes and Nodal Metastases from Non-Head and Neck Carcinomas. Journal of Clinical Ultrasound. 1998; 8: 383-89.
  • Ahuja A, Ying M., Evans R et al. The Application of Ultrasound Criteria for Malignancy in Differentiating Tuberculous Cervical Adenitis from Metastatic Nasopharyngeal Carcinoma. Clinical Radiology. 1995;50: 391-5.
  • Steinkemp HJ, Maurer J, Cornebl M, Recurrent Cervical Lymphadenopathy: Differential diagnosis with color-duplex sonography. Eur Arch Otorhinolaryngol. 1994; 251: 404-9.
  • Koischwitz D, Gritzmann D. Ultrasound Of The Neck. Radiologic Clinics Of North America. 2000;38: 1029-45.
  • Na CG, Lim AK, Byun GS et al. Differential diagnosis of Cervical Lymphadenopathy: Usefulness of Color Doppler Sonography. The American Journal of Radiology. 1997;168:1311-6.
  • Sakai O, Curtin H, Romo LV et al. Lymph Node Pathology Benign Proliferative, Lymphoma, And Metastatic Disease. Radiological Clinics of North America. 2000;38:979-98.
  • Gritzmann N, Hollerweger A, Macheiner P et al. Sonography of Soft Tissue Masses of the Neck. Journal of Clinical Ultrasound. 2002;30:356-73.
  • Wu, Chang, Hsu et al. Usefulness of Doppler Spectral Analysis and Power Doppler Sonography in the differentiation of cervical Lymphadenopathies. American Journal of Roentgenology. 1998; 171:503-9.
  • Steinkemp HJ, Mueffelmann M, Bock JC et al. Differential diagnosis of lymph node lesions: a semi quantitative approach with color Doppler ultrasound. The British Journal of Radiology. 1998;71: 828-33.
  • Evans RM, Ahuja A, Meterweli C. The Linear Echogenic Hilus in Cervical LymphadenopathyA Sign of Benignity or Malignancy. Clinical Radiology. 1993; 47: 262-4.
  • Vassallo P, Wernecke K, Roos N et al. Differentiation of Benign from Malignant Superficial Lymphadenopathy: The Role of High –Resolution US.Radiology. 1992;183: 215Choi M Y ,Lee JW,Jang KJ.Distinction between Benign ans Malignant causes of
  • Cervical, Axillary and Inguinal Lymphadenopathy:Value of Doppler Spectral Waveform Analysis. 1995;165: 981-4
  • Yazışma Adresi / Address for Correspondence: Dr. Sushil Ghanshyam Kachewar Rural Medical College PIMS (DU), Loni, Maharashtra, INDIA-413 736 geliş tarihi/received :24.10.2012 kabul tarihi/accepted:20.11.2012
There are 19 citations in total.

Details

Primary Language Turkish
Journal Section Research
Authors

Sushil Ghanshyam Kachewar This is me

Smita Balwant Sankaye This is me

Publication Date June 1, 2013
Published in Issue Year 2013 Volume: 38 Issue: 2

Cite

MLA Kachewar, Sushil Ghanshyam and Smita Balwant Sankaye. “Ultrasound Review of Metastatic Lymphadenopathy”. Cukurova Medical Journal, vol. 38, no. 2, 2013, pp. 196-01.