Objectives: Different approaches have been made to differentiate benign from malignant cervical lymphadenopathy by Ultrasound examination. Assessment of nodal status is essential in patients with head and neck carcinomas as it predicts prognosis and helps in the selection of treatment options. The present study was designed to evaluate the role of ultrasonography in the assessment of malignant cervical lymph nodes. Grey scale Ultrasound assesses the nodal size, shape, border, internal architecture (echogenicity and necrosis).
The vascular pattern of lymph nodes is evaluated with Color Doppler Ultrasound.
Methods: 117 cervical masses evaluated by ultrasonography in 83 patients over a period of 29 mounths (between January 2008 and June 2010) were evaluated for the presence of intranodal vascular pattern, which was considered benign when it traversed through the node without disruption.
Results: Of the 117 cervical tumors evaluated, 73 were found to be malignant on pathologic review. Malign vascular markings were present in 93/117 lymph nodes evaluated. The presence of malign vascular pattern had a sensitivity of 97.3% and a negative predictive value of 91.7%. Malignant Gray scale Ultrasound martkings had a sensitivity of 23.3% and a positive predictive value of 100%.
Conclusions: The presence of normal intranodal blood flow was associated with a benign diagnosis in 91.7% of the masses evaluated. The addition of this Color Doppler Ultrasound finding improves the ability of ultrasonography to predict the likelihood of malignant involvement.