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Evaluation of the efficacy of colour Doppler ultrasound in diagnosis of cervical lymphadenopathy

Sharad Pawar Dental College and Hospital, Sawangi (M), Wardha. Maharashtra, India

*Correspondence to: Dr Suwarna B Dangore, Department of Oral Medicine and Radiology, DMIMS, Sawangi (M), Wardha, Maharashtra 442004, India. E-mail: dangore_suwarna{at}rediffmail.com

Received 14 June 2007; revised 28 July 2007; accepted 28 July 2007

Objectives: The purpose of the study was to evaluate the efficacy of colour Doppler ultrasound (CDUS) to differentiate between benign and malignant cervical lymph nodes.

Methods: During a period of 12 months, 100 untreated patients with clinical evidence of cervical lymphadenopathy (50 patients with clinically suspected malignant/metastatic cervical lymphadenopathy and 50 patients with clinically suspected reactive/benign cervical lymphadenopathy) were prospectively evaluated with CDUS. CDUS was performed for 168 cervical lymph nodes in these 100 patients. Histopathological confirmations were obtained by fine needle aspiration biopsy and/or excisional biopsy. To evaluate the efficacy of CDUS, comparison between clinical features, CDUS features and cytological/histological features of enlarged cervical lymph nodes was then done.

Results: Initially, clinical examination evaluated 143 cervical lymph nodes. CDUS evaluation discovered additional 25 lymph nodes (143+25 = 168). Correlation of patterns of colour Doppler flow signals with pathological diagnosis showed that central flow for benign nodes and peripheral flow for malignant nodes were highly significant parameters (P < 0.01). CDUS has a higher specificity than clinical evaluation, being 94.28% and 58.76%, respectively. Accuracy of the CDUS examination was also definitely higher than clinical evaluation at 92.85% and 63.67%, respectively.

Conclusions: Nodal vascularity can be used to differentiate benign from malignant lymphadenopathy. Proper judicious CDUS examination provides an opportunity to eliminate the need for biopsy/FNAC in reactive nodes.

Keywords: cervical lymphadenopathy; colour Doppler ultrasound; histopathology