Original contribution
Sonographic evaluation of cervical lymphadenopathy: is power Doppler sonography routinely indicated?

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Abstract

Routine sonographic examination of neck nodes now includes both grey-scale and Doppler sonography. Although the addition of Doppler sonography to the well-established practice of grey-scale sonography increases the amount of information obtained by sonography, it also increases the examination time, particularly if spectral Doppler and estimation of vascular resistance is performed. This study was, therefore, undertaken to evaluate whether Doppler sonography is routinely indicated in every case or its use should be limited to those cases where grey-scale sonography is equivocal. We evaluated the grey-scale and power Doppler sonograms of 101 fine-needle aspiration cytology (FNAC)-proven metastatic nodes and 72 FNAC-proven nonmetastatic nodes. All lymph nodes were evaluated with grey-scale and power Doppler sonography. The shape, echogenicity, internal architecture, vascular distribution and vascular resistance of the lymph nodes were evaluated. Grey-scale sonographic features evaluated in this study had a high sensitivity (95%) and specificity (83%) in classifying metastatic and nonmetastatic nodes. Metastatic and nonmetastatic lymph nodes that could not be classified by grey-scale sonography demonstrated Doppler features that helped in their correct identification. Power Doppler sonography is not necessary for every case in routine clinical practice, but is essential and useful in patients where grey-scale sonography is equivocal. In this study, power Doppler sonography aided in the diagnosis in 5% and 17% of patients with metastatic and nonmetastatic nodes, respectively.

Introduction

Assessment of cervical lymph nodes is essential for patients with head and neck carcinomas because it helps to determine the prognosis and select appropriate treatment Baatenburg de Jong et al 1989, Ishii et al 1991, Vassallo et al 1992. The presence of a metastatic node in one side of the neck reduces the 5-year survival rate to half of that of a patient without a metastatic node, and the presence of bilateral metastatic neck nodes reduces the survival rate to 25% (Som 1992).

The role of grey-scale sonography in evaluation of cervical lymphadenopathy is well established. Grey-scale sonography evaluates the morphology, internal architecture, size and shape of the lymph nodes van den Brekel et al 1990, Vassallo et al 1992, Vassallo et al 1993, Ahuja et al 1997, Baatenburg de Jong et al 1998. Power Doppler sonography allows evaluation of vascular distribution of cervical lymph nodes, and estimation of vascular resistance of intranodal vessels. There are a number of reports discussing the use of Doppler ultrasound (US) in evaluation of neck nodes Adibelli et al 1998, Ariji et al 1998, Wu et al 1998a, Wu et al 2000, Dragoni et al 1999. Our previous study documented an overview of the sonographic appearances of different cervical lymphadenopathies (Ahuja and Ying 2002). The addition of power Doppler sonography of neck nodes does add to the examination time, which increases by 2 min if the use of Doppler is restricted to evaluating distribution only. However, if vascular indices are evaluated, the time taken is approximately 10 min per node. This study was, therefore, undertaken to answer a clinical problem; that is, is power Doppler sonography routinely indicated in all cases or should its use be limited to cases where grey-scale sonography was equivocal?

Section snippets

Materials and methods

We retrospectively evaluated neck node sonograms of 101 patients with known carcinoma of the head and neck or other regions, and fine-needle aspiration cytology (FNAC)-proven malignant lymph nodes in the neck. Another group consisted of 72 patients with no known carcinoma (in the head and neck or any other regions), and FNAC-proven reactive lymph nodes. These patients subsequently had follow-up in the outpatient department and remained well otherwise. The lymph nodes of these two groups of

Results

A total of 173 lymph nodes were included in the study. They ranged in size from 4 mm to 36 mm in maximum short axis diameter. There were 36 (87.8%) metastatic nodes from SCC, 25 (96.2%) metastatic nodes from NPC, 28 (82.3%) metastatic nodes from infraclavicular carcinomas and 30 (41.7%) reactive nodes with a maximum short axis diameter greater than or equal to 8 mm.

Table 1 shows the number of metastatic and nonmetastatic nodes that were correctly classified solely by grey-scale sonography,

Discussion

Sonography of neck nodes in routine clinical practice consists of two parts, grey-scale sonography and Doppler sonography. The role of grey-scale sonography in evaluation of cervical nodes is well established Bruneton et al 1984, Baatenburg de Jong et al 1989, Chang et al 1990, van den Brekel et al 1990, Ahuja et al 1997, Ying et al 1998, and power Doppler sonography has also been reported to be an imaging tool that provides further information about the vasculature of cervical nodes and helps

Conclusion

Grey-scale sonography has a high accuracy in classifying metastatic and nonmetastatic nodes. Therefore, power Doppler sonography may not be indicated in every case in routine practice, but should be used for those cases where grey-scale sonography is equivocal.

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    Dr. Ying’s present address is Department of Optometry and Radiography, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong.

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