Background: Cervical lymphadenopathy is a commonly encountered clinical problem. Patients either present with palpable neck masses or with malignancy of the head and neck where the preoperative detection of the involved nodes is essential. Ultrasound and color/power Doppler are used to localize the node and evaluate their multiplicity, size, shape (roundness index), hilum status, margin, calcification, necrosis (>3 mm), and perilymphnodal edema. Color and power Doppler is used to know the pattern of vascularity and doppler indices [resistive index (RI) and pulsatility index (PI)].
Objective: To determine the role of ultrasound and color/power Doppler in the differentiatiation of benign and malignant nodes and in tapering the differential diagnosis.
Materials and Methods: Eighty lymph nodes were evaluated with ultrasound and color Doppler and correlated later with histopathology reports over a period of 18 months (May 2013 to November 2014) referred to Department of Radiology at Katuri Medical College and Hospital. Roundness index ( 0.8 ,and PI > 1.5 were the criteria taken to diagnose the malignant involvement of the lymph node.
Results: Of the 80 lymph nodes examined, 22 are proved to be malignant on histopathology examination. Features such as roundness index, absence of hilum, and vascular pattern demonstrated sensitivities of 91%, 86%, and 86% and positive predictive values (PPVs) of 71%, 73%, and 86%, respectively. Among these features, pattern of vascularity and Doppler indices showed high PPV.
Conclusions: Ultrasound and color Doppler findings of roundness index, absence of hilum, vascular pattern, and impedance values revealed good PPV, sensitivity, specificity, and accuracy reaching 90% in differentiating benign from malignant lymph nodes.
Key words: Ultrasound, color doppler, cervical lymphadenopathy, benign, malignant
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