An overview of neck node sonography

RATIONALE AND OBJECTIVES. Gray scale and power Doppler sonography are commonly used to evaluate cervical lymph nodes. This study was undertaken to identify which of the features used in ultrasound of cervical lymph nodes is readily applicable in routine clinical practice. METHODS. Two hundred and eight-six patients diagnosed with cervical lymphadenopathy were included in the study. The largest node in each patient was included in the study and the nature of the node was assessed by fine-needle aspiration cytology. Lymph nodes were assessed for their gray scale and Doppler sonographic features. RESULTS. Metastatic, lymphomatous, and tuberculous nodes were round (63-94%) and without echogenic hilus (57-91%). Sharp borders were found in metastatic and lymphomatous nodes (56-100%), but uncommon in tuberculosis (49%). Capsular or mixed vascularity is common in metastatic, lymphomatous, and tuberculous nodes but not found in reactive nodes. Except metastatic nodes from papillary carcinoma of the thyroid that showed low resistance, metastatic nodes had a higher vascular resistance than reactive nodes. Micronodular echo pattern is common in lymphomatous nodes. Hyperechogenicity and punctate calcification are typical features for metastatic nodes from papillary carcinoma of the thyroid. Intranodal cystic necrosis, adjacent soft tissue edema, matting and displaced hilar vascularity are common features in tuberculosis. CONCLUSIONS. Using gray scale and power Doppler sonography, metastatic, lymphomatous, and tuberculous nodes can be differentiated from reactive nodes. Metastatic nodes from papillary carcinoma, lymphoma, and tuberculosis can be identified. However, it is difficult to differentiate metastatic nodes from squamous cell carcinomas, nasopharyngeal carcinoma, and infraclavicular carcinomas, and differentiate metastatic nodes (nonthyroid primary) from tuberculous lymphadenitis.