The Role of Ultrasonography for Differentiating and Management of Malignant Cervical Lymph Nodes

Objective: To investigate the value of grey scale and Doppler ultrasonography in the assessment of metastatic and lymphomatous cervical lymph nodes. Methods: One hundred and nineteen malignant cervical lymph nodes in 119 patients diagnosed as malignant according to grey scale, color Doppler and spectral Doppler ultrasonography features were included in this study. The sizes, shape, echo pattern, echogenic hilus, nodal border, cystic necrosis and coagulation necrosis, vascular distribution pattern, resistivity and pulsatility index values of lymph nodes were noted. All patients had histopathological diagnosis. Results: The final diagnosis of the 42 lymph nodes was lymphoma, and of the 77 lymph nodes was carcinoma metastasis (33 thyroid carcinoma metastasis and 44 squamous cell carcinoma metastasis). While a hyperechoic pattern and calcification were detected in the lymph nodes originating from thyroid carcinoma as 39% and 33%, respectively, a reticular pattern (26%) and low resistive and pulsatility indices were detected in lymph nodes originating from lymphoma. These criteria were statistically significant for the differential diagnosis (p < 0.05). Size, shape, hypoechoic echo pattern, absence of echogenic hilus, nodal border, cystic necrosis, coagulation necrosis and vascular distribution pattern were not found to be significant for the detection of a primary tumour. Conclusion: Hyperechoic echo pattern, reticular pattern, calcification, low resistivity and pulsatility indices are useful parameters for the differential diagnosis of malignant cervical lymph nodes. These ultrasonography critaria can be used for assesment and management of unknown primary malign neck nodes.