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Differential diagnosis in cervical lymphadenopathies: efficacy of B-mode, color and power Doppler ultrasonography

Year 2009, Volume: 19 Issue: 4, 173 - 178, 18.08.2009

Abstract

Objectives: Our purpose was to investigate cervical lymphadenopathies by using color Doppler spectral analysis and power Doppler ultrasonography methods as well as B-mode ultrasound and to classify them as malignant or benign lesions and to compare the results with the histopathological findings. Patients and Methods: Sixty nine lymph nodes of 69 patients were evaluated with color and power Doppler ultrasonography as well as B-mode ultrasonography. The shape and dimensions of the lymph nodes were assessed with B-mode ultrasonography; their vascularization pattern with power Doppler sonography and with color Doppler spectral analysis. Vascular pattern was evaluated according to the vascularization of the lymph node. Vascular resistive index and pulsatility index were assessed by at least three flow samplings. We measured resistive index, pulsatility index, peak systolic velocity, and end diastolic velocity. Results of Doppler analysis were compared with clinical findings and histopathologic results. Nodes were grouped as metastasis, lymphoma, tuberculosis, and reactive benign lymphadenopathies with respect to ultrasonographic results. Results: Forty four of 69 lymph nodes were found to be malignant histopathologically. In color Doppler analysis, most malign metastatic lymphadenopathies showed peripheral 76.4% , and the rest of them 23.6% showed peripheral and hilar mix vascularization. Most benign lymphadenopathies 88% and lymphomatous lymphadenopathies 85% had hilar vascularization. In tuberculous lymphadenopathies, 50% of them showed avascular pattern and the rest of them had variable type of vascularization. A resistive index greater than ≥0.7 indicated a malignant metastatic lymphadenopathy and a resistive index <0.5 was consistent with benign lesions. In lymphomatous and tuberculous lymphadenopathies resistive index values were between 0.6-0.7. The sensitivity of the resistive index for distinguishing inflammatory from neoplastic lymphadenopathies was 84.6%, the specificity 100% and the diagnostic accuracy 95.7% p<0.001 . Conclusion: In addition to B-mode ultrasonography findings, vascularity pattern assessment and spectral analytilic measurements with color and power Doppler ultrasonography has an important contribution for the differential diagnosis of cervical lympadenopathies.

References

  • Som PM, Curtin HD, Mancuso AA. An imaging- based classification for the cervical nodes designed as an adjunct to recent clinically based nodal clas- sifications. Arch Otolaryngol Head Neck Surg 1999; 125:388-96.
  • Som PM, Brandwein MS. Lymph nodes. In Som PM, Curtin HD, editors. Head and neck imaging. 4th ed. St Louis: Mosby; 2003. p. 1865-1934.
  • Valvassori GE, Becker M. Other infrahyoid neck lesions. In: Mafee MF, Valvassori GE, Becker M, edi- tors. Imaging of the head and neck. 2nd ed. New York: Thieme; 2005. p. 793-4.
  • Brnic Z. Doppler ultrasonography of superficial lymph nodes. Lijec Vjesn 2004;126:185-93. [Abstract]
  • Hatipoğlu E, Aksoy S, Cimilli T, Karahasanoğlu A, Bayramoğlu S, Çuhal BD. Servikal lenfadenomegalili olgularda renkli Doppler ultrasonografi bulguları- nın değerlendirilmesi ve histopatolojik korelasyonu. Bakırköy Tıp Dergisi 2008;4:14-9.
  • Cinar U, Yiğit O, Topuz E, Akgül G, Unlü M, Başak M, et al. Comparison of palpation, ultrasound and com- puted tomography in the valuation of lymphatic neck metastasis. [Article in Turkish] Kulak Burun Bogaz Ihtis Derg 2002;9:126-30.
  • Steinkamp HJ, Wissgott C, Rademaker J, Felix R. Current status of power Doppler and color Doppler sonography in the differential diagnosis of lymph node lesions. Eur Radiol 2002;12:1785-93.
  • Giovagnorio F, Galluzzo M, Andreoli C, De CM, David V. Color Doppler sonography in the evaluation of superficial lymphomatous lymph nodes. J Ultrasound Med 2002;21:403-8.
  • Na DG, Lim HK, Byun HS, Kim HD, Ko YH, Baek JH. AJR Differential diagnosis of cervical lymphadenopa- thy: usefulness of color Doppler sonography. Am J Roentgenol 1997;168:1311-6.
  • Schulte-Altedorneburg G, Demharter J, Linné R, Droste DW, Bohndorf K, Bücklein W. Does ultrasound contrast agent improve the diagnostic value of colour and power Doppler sonography in superficial lymph node enlargement? Eur J Radiol 2003;48:252-7.
  • Choi MY, Lee JW, Jang KJ. Distinction between benign and malignant causes of cervical, axillary, and ingui- nal lymphadenopathy: value of Doppler spectral wave- form analysis. AJR Am J Roentgenol 1995;165:981-4.
  • Ahuja AT, Ying M, Ho SY, Antonio G, Lee YP, King AD, Wong KT. Ultrasound of malignant cervical lymph nodes. Cancer Imaging 2008;8:48-56.
  • Dangore SB, Degwekar SS, Bhowate RR. Evaluation of the efficacy of colour Doppler ultrasound in diagnosis of cervical lymphadenopathy. Dentomaxillofac Radiol 2008;37:205-12.
  • Brnic Z, Hebrang A. Usefulness of Doppler waveform analysis in differential diagnosis of cervical lymph- adenopathy. Eur Radiol 2003;13:175-80.
  • Na DG, Lim HK, Byun HS, Kim HD, Ko YH, Baek JH. Differential diagnosis of cervical lymphadenopathy: usefulness of color Doppler sonography. AJR Am J Roentgenol 1997;168:1311-6.
  • Tschammler A, Beer M, Hahn D. Differential diagnosis of lymphadenopathy: power Doppler vs color Doppler sonography. Eur Radiol 2002;12:1794-9.

Servikal lenfadenopatilerin ayırıcı tanısında B-mod, renkli ve power Doppler ultrasonografinin etkinliği

Year 2009, Volume: 19 Issue: 4, 173 - 178, 18.08.2009

Abstract

Amaç: Bu çalışmada, servikal lenfadenopatiler, B-mod ultrasonografinin yanı sıra renkli Doppler spektral analizi ve power Doppler ultrasonografi yöntemi ile incelenerek malign ya da benign olarak sınıflandırıldı ve sonuçlar histopatolojik bulgularla karşılaştırıldı.Hastalar ve Yöntemler: Altmış dokuz hastanın lenfadenopatisi B-mod ultrasonografinin yanı sıra renkli ve power Doppler ultrasonografi ile incelendi. B-mod ultrasonografi ile lenf nodunun boyutu ve şekli, power Doppler ultrasonografi ile lenfadenopatinin kanlanma paterni, renkli Doppler spektral analizde de ölçümsel değerlendirmeleri yapıldı. Kanlanma paterni lenf nodunun kanlanma özelliklerine göre değerlendirildi. Vaskülarite indeksi ve rezidiv indeks en az üç kez ölçülerek değerlendirildi. Rezidiv indeks, pulsatilite indeksi, peak sistolik ve end diyastolik velosite ölçümleri yapıldı. Elde edilen Doppler analiz bulguları klinik bulgu ve histopatolojik sonuçlarla karşılaştırıldı. Lenfadenopatiler yayılım, lenfoma, tüberküloz ve reaktif benign lenfadenopati yönünden ultrasonografik olarak sınıflandırıldı.Bulgular: İncelenen 69 lenf nodunun 44’ü ultrasonografik ve histolojik olarak malign bulundu. Renkli Doppler analizde, çoğu metastatik lenfadenopatilerde periferal %76.4 ; geri kalanın da %23.6 periferal ve hiler miks vaskülarizasyon saptandı. Benign lenfadenopatilerin çoğunda %88 ve lenfatomatöz lenfadenopatilerde %85 hiler vaskülarizasyon görüldü. Tüberküloz lenfadenopatilerin %50’sinde avasküler patern geri kalanında ise çeşitli kanlama tipleri bulunmaktaydı. Rezidiv indeksin ≥0.7 olması malign

References

  • Som PM, Curtin HD, Mancuso AA. An imaging- based classification for the cervical nodes designed as an adjunct to recent clinically based nodal clas- sifications. Arch Otolaryngol Head Neck Surg 1999; 125:388-96.
  • Som PM, Brandwein MS. Lymph nodes. In Som PM, Curtin HD, editors. Head and neck imaging. 4th ed. St Louis: Mosby; 2003. p. 1865-1934.
  • Valvassori GE, Becker M. Other infrahyoid neck lesions. In: Mafee MF, Valvassori GE, Becker M, edi- tors. Imaging of the head and neck. 2nd ed. New York: Thieme; 2005. p. 793-4.
  • Brnic Z. Doppler ultrasonography of superficial lymph nodes. Lijec Vjesn 2004;126:185-93. [Abstract]
  • Hatipoğlu E, Aksoy S, Cimilli T, Karahasanoğlu A, Bayramoğlu S, Çuhal BD. Servikal lenfadenomegalili olgularda renkli Doppler ultrasonografi bulguları- nın değerlendirilmesi ve histopatolojik korelasyonu. Bakırköy Tıp Dergisi 2008;4:14-9.
  • Cinar U, Yiğit O, Topuz E, Akgül G, Unlü M, Başak M, et al. Comparison of palpation, ultrasound and com- puted tomography in the valuation of lymphatic neck metastasis. [Article in Turkish] Kulak Burun Bogaz Ihtis Derg 2002;9:126-30.
  • Steinkamp HJ, Wissgott C, Rademaker J, Felix R. Current status of power Doppler and color Doppler sonography in the differential diagnosis of lymph node lesions. Eur Radiol 2002;12:1785-93.
  • Giovagnorio F, Galluzzo M, Andreoli C, De CM, David V. Color Doppler sonography in the evaluation of superficial lymphomatous lymph nodes. J Ultrasound Med 2002;21:403-8.
  • Na DG, Lim HK, Byun HS, Kim HD, Ko YH, Baek JH. AJR Differential diagnosis of cervical lymphadenopa- thy: usefulness of color Doppler sonography. Am J Roentgenol 1997;168:1311-6.
  • Schulte-Altedorneburg G, Demharter J, Linné R, Droste DW, Bohndorf K, Bücklein W. Does ultrasound contrast agent improve the diagnostic value of colour and power Doppler sonography in superficial lymph node enlargement? Eur J Radiol 2003;48:252-7.
  • Choi MY, Lee JW, Jang KJ. Distinction between benign and malignant causes of cervical, axillary, and ingui- nal lymphadenopathy: value of Doppler spectral wave- form analysis. AJR Am J Roentgenol 1995;165:981-4.
  • Ahuja AT, Ying M, Ho SY, Antonio G, Lee YP, King AD, Wong KT. Ultrasound of malignant cervical lymph nodes. Cancer Imaging 2008;8:48-56.
  • Dangore SB, Degwekar SS, Bhowate RR. Evaluation of the efficacy of colour Doppler ultrasound in diagnosis of cervical lymphadenopathy. Dentomaxillofac Radiol 2008;37:205-12.
  • Brnic Z, Hebrang A. Usefulness of Doppler waveform analysis in differential diagnosis of cervical lymph- adenopathy. Eur Radiol 2003;13:175-80.
  • Na DG, Lim HK, Byun HS, Kim HD, Ko YH, Baek JH. Differential diagnosis of cervical lymphadenopathy: usefulness of color Doppler sonography. AJR Am J Roentgenol 1997;168:1311-6.
  • Tschammler A, Beer M, Hahn D. Differential diagnosis of lymphadenopathy: power Doppler vs color Doppler sonography. Eur Radiol 2002;12:1794-9.
There are 16 citations in total.

Details

Primary Language Turkish
Journal Section Research Article
Authors

Ziver Ayata This is me

Melda Apaydın This is me

Makbule Varer This is me

Ayşegül Sarsılmaz This is me

Çağlar Çallı This is me

Türkan Rezanko Atasever This is me

Publication Date August 18, 2009
Published in Issue Year 2009 Volume: 19 Issue: 4

Cite

APA Ayata, Z., Apaydın, M., Varer, M., Sarsılmaz, A., et al. (2009). Servikal lenfadenopatilerin ayırıcı tanısında B-mod, renkli ve power Doppler ultrasonografinin etkinliği. The Turkish Journal of Ear Nose and Throat, 19(4), 173-178.
AMA Ayata Z, Apaydın M, Varer M, Sarsılmaz A, Çallı Ç, Atasever TR. Servikal lenfadenopatilerin ayırıcı tanısında B-mod, renkli ve power Doppler ultrasonografinin etkinliği. Tr-ENT. August 2009;19(4):173-178.
Chicago Ayata, Ziver, Melda Apaydın, Makbule Varer, Ayşegül Sarsılmaz, Çağlar Çallı, and Türkan Rezanko Atasever. “Servikal Lenfadenopatilerin ayırıcı tanısında B-Mod, Renkli Ve Power Doppler Ultrasonografinin etkinliği”. The Turkish Journal of Ear Nose and Throat 19, no. 4 (August 2009): 173-78.
EndNote Ayata Z, Apaydın M, Varer M, Sarsılmaz A, Çallı Ç, Atasever TR (August 1, 2009) Servikal lenfadenopatilerin ayırıcı tanısında B-mod, renkli ve power Doppler ultrasonografinin etkinliği. The Turkish Journal of Ear Nose and Throat 19 4 173–178.
IEEE Z. Ayata, M. Apaydın, M. Varer, A. Sarsılmaz, Ç. Çallı, and T. R. Atasever, “Servikal lenfadenopatilerin ayırıcı tanısında B-mod, renkli ve power Doppler ultrasonografinin etkinliği”, Tr-ENT, vol. 19, no. 4, pp. 173–178, 2009.
ISNAD Ayata, Ziver et al. “Servikal Lenfadenopatilerin ayırıcı tanısında B-Mod, Renkli Ve Power Doppler Ultrasonografinin etkinliği”. The Turkish Journal of Ear Nose and Throat 19/4 (August 2009), 173-178.
JAMA Ayata Z, Apaydın M, Varer M, Sarsılmaz A, Çallı Ç, Atasever TR. Servikal lenfadenopatilerin ayırıcı tanısında B-mod, renkli ve power Doppler ultrasonografinin etkinliği. Tr-ENT. 2009;19:173–178.
MLA Ayata, Ziver et al. “Servikal Lenfadenopatilerin ayırıcı tanısında B-Mod, Renkli Ve Power Doppler Ultrasonografinin etkinliği”. The Turkish Journal of Ear Nose and Throat, vol. 19, no. 4, 2009, pp. 173-8.
Vancouver Ayata Z, Apaydın M, Varer M, Sarsılmaz A, Çallı Ç, Atasever TR. Servikal lenfadenopatilerin ayırıcı tanısında B-mod, renkli ve power Doppler ultrasonografinin etkinliği. Tr-ENT. 2009;19(4):173-8.