Malignant lymph node - morphology and Doppler analysis

Case contributed by Dr Charudutt Jayant Sambhaji
Modality: Ultrasound

see below

Case Discussion

Lymphadenopathy is quite common, and it is many a time very difficult to differentiate malignant lymphadenopathy from reactive lymphadenopthy.

The  images of the case in discussion show  some of the features that favour malignancy like loss of central hilum, peripheral vasculature, non tapering vessels & high resistance spectral waveform(R.I.=0.88).

Several other gray scale and colour doppler features favour malignancy in a lymph node.

Gray scale parameters that favour malignancy

  1. Size : larger – more likely malignant
  2. Shape : Round , L/T < 2
  3. Heterogenous echotexture
  4. Loss of central fatty hilum / thinning of hilum
  5. Eccentric / concentric thickening of cortex
  6. Microcalcification
  7. Necrosis – cystic / Coagulative
  8. Ill defined capsular margins - invasion

     Color Doppler / Power Doppler features that favour malignancy

  1. Peripheral / mixed peripheral–central blood vessels
  2. High resistance waveform
  3. RI > 0.8,  PI > 1.5
  4. Abberent vessels – Displaced parent vessels, subcapsular vasculature, unperfused areas, Non tapering vessels
  5. The increase in resistivity in a malignant lymph node is attributed to increased cellularity within an infiltrated lymph node. However, malignant lymph nodes with necrotic change may show low resistance flow due to loss in the cellularity  following necrosis & this needs to be kept in mind while interpreting this sign.
  6. when used in combination the above signs can help differentiate a malignant lymphadenopathy from reactive lymphadenpathy and recommend an excision biopsy.
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Case Information

rID: 5923
Case created: 29th Mar 2009
Last edited: 26th Nov 2015
System: Head & Neck
Inclusion in quiz mode: Included

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