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Evaluation of cervical lymphadenopathy by ultrasound in comparision with fnac

Authors:Sindhoori Komma, Munirathna.N, TN Suresh, Purnima Hegde, Navin Kumar
Int J Biol Med Res. 2014; 5(4): 4448-4454  |  PDF File

Abstract

AIMS AND OBJECTIVES: 1. To study and differentiate neoplastic(malignant) and nonneoplastic(reactive and tubercular)cervical lymph nodes by High resolution ultrasonography 2. To correlate the diagnostic accuracy of ultrasound with FNAC in differentiating neoplastic (malignant ) and nonneoplastic (reactive and tubercular) cervical lymphadenopathy MATERIAL AND METHODS: Data was collected from a total of 83 cases referred for ultrasound of neck to the Department of Radiodiagnosis, Sri R.L. Jalappa Hospital and Research Center over a period of 16 months from December 2011 to April 2013 , with 5-10 MH linear transducer using SEIMENS G 40 /G 50/ Acuson Ax 300 ultrasound equipment. 90 Lymph nodes were assessed using grey scale and colour Doppler parameters like : nodal level and site, nodal size, nodal Shape, nodal L/S ratio, nodal border, nodal hilum, nodal echotexture, nodal necrosis, nodal matting and nodal angioarchitecture [hilar vessels, focal absence of perfusion, capsular vessels (peripheral),displacement, mixed flow] .A provisional diagnosis was suggested after the ultrasound examination and these findings were correlated with Fine Needle Aspiration Cytology / Histopathological findings. RESULTS : A our study out of 41 non neoplastic nodes (reactive and tubercular) only 37 nodes were identified as nonneoplastic(reactive / tubercular) on ultrasound prior to FNAC/ histopathology . Out of 49 possible neoplastic (malignant nodes) detected on ultrasound only 38 lymph nodes turned out to be neoplastic on FNAC/ histopathology. Lymph node with oval shape ( L/S ratio > 2) echogenic hilum, homogenous echotexture and hilar vascularity were considered as significant parameters in detecting non neoplastic(reactive) lymph nodes ,which showed matting with soft tissue edema were considered nonneoplastic lymphnodes(tubercular lymphnodes) .Nodes which were Round shape( L/S ratio < 2), absent hilum, heterogenous echotexture, capsular vessels, mixed vessels, displacement of vessels and focal absence of perfusion were considered as significant parameters in detecting neoplastic(malignant) lymph nodes. Correlation of sonographic findings with Fine Needle Aspiration Cytology / Histopathological findings. Sensitivity and Specificity of ultrasound in differentiating neoplastic from non neoplastic cervical lymphadenopathy was found to be 90% and 74% respectively. CONCLUSIONS: This study concludes that: 1) High resolution ultrasonographic examination proved as a valuable primary investigation to identify lymph nodes and differentiate nonneoplastic and neoplastic lymphadenopathy. 2) Combination of ultrasonographic features and vascular pattern of the lymph nodes have a high sensitivity, specificity in differentiating neoplastic and non neoplastic lymphadenopathy.