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

Ziver Ayata Melda Apaydın Makbule Varer Ayşegül Sarsılmaz Çağlar Çallı Türkan Rezanko Atasever

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.

Keywords

B-mode ultrasonography, cervical lymphadenopathy, color Doppler ultrasonography, power Doppler ultrasonography

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

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

Keywords

B-mod ultrasonografi, servikal lenfadenopati, renkli Doppler ultrasonografi, power Doppler ultrasonografi

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