IMC Journal of Medical Science https://www.imcjms.com/ Ibrahim Medical College Journal of Medical Science <![CDATA[Ultrasound differentiation of benign and malignant cervical lymph nodes]]> Md. Mizanur RahmanASQM SadequeEliza OmarSonjoy Kumar Bhakta https://www.imcjms.com/registration/journal_full_text/139 2016-11-09 15:19:37 Original Article Ibrahim Med. Coll. J. 2009; 3(2): 40-44 1 cm were all histo-pathologically malignant and none were benign (2=39.5; df=1.0; p<0.001). Fig-2. Shows a maximal short axis diameter of 15 mm, a L/S ratio of 1.28 and was proved to be a metastatic enlarged cervical node. Margin in this node was regular with hypoechoic homogeneous echo pattern with absence of hilar echogenicity.   Sonographic Parameters used Number Benign Malignant Total 65 No % no % Maximal short axis diameter           <1 cm n=39 31 79.49 08 20.51 >1 cm n=26 0 0 26 100 L/S Ratio            2 n=31 27 87.10 04 12.90 < 2 n=34 04 11.76 30 88.24 Margin           Regular n=39 28 71.79 11 28.21 Irregular n=26 03 11.54 23 88.46 Echopattern           Homogeneous hypoechoic n=32 28 87.50 04 12.50 Heterogeneous n=33 03 9.09 30 90.91 Hilar Echogenicity           Echogenic n=43 31 72.10 12 27.90 No echogenicity n=22 0 0 22 100   All the individual parameters showed high statistical significance (p < 0.001).   Of the 32 enlarged nodes with homogeneous hypoechoic echo-pattern, 28 (87.5%) were benign and 4 (12.5%) were malignant. 33 nodes showed heterogeneous echopattern of which 30 (90.9%) were malignant and 03 (9.1%) were benign. (2=42.17; df=1.0; p<0.001). There are approximately 800 lymph nodes in the body of which 300 lie in the neck.1 In this prospective study, nodal size, shape, marginal clarity, internal echo-pattern and hilar echo-genicity were the criteria selected to differentiate benign from malignant group of enlarged cervical lymph nodes. As far as the L/S ratio was considered, among the nodes with L/S ratio <2, 30 (88.2%) were malignant and 4 (11.8%) were benign. Among the nodes with    L/S ratio  2, 27 (87.10%) were benign and 04 (12.90%) malignant. Steinkemp et al.20 found 90% of the enlarged nodes to be metastatic with L/S ratio <2. Vassallo et al.10 showed that 86% of primary nodal malignancies and 85% of nodal metastasis had L/S ratio <2. So, malignant nodes have larger axial diameter thus reducing the L/S ratio and the malignant nodes becoming more roundish. This was also found true in this series. In this study, 28 (87.5%) nodes were benign among 31 enlarged nodes with homogeneous hypoechoic internal echopattern. In contrast 30, (90.9%) were malignant among 34 enlarged nodes with heterogeneous echopattern. Toriyabe et al.16 showed 90.9% nodes with homogeneous hypoechoic pattern to be benign and 86.7% with heterogeneous echopattern to be malignant. These findings are also consistent with the findings of the present study. This study was performed using a 5.0 MHz high frequency probe. Probe with a larger frequency like 7.5 MHz might have shown the above signs more clearly, particularly the marginal clarity, internal echopattern and presence or absence of echogenic hilum. But this much can be concluded that when all the parameters are evaluated simultaneously, a better interpretation or differentiation between benign and malignant cervical nodes is possible with real time high resolution ultrasound.   References 1.   Mann CV, Russell RCG, Williams NS. Editors, Lymphatics and Lymph nodes and The Neck. 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Clin Radiol 1993; 47: 262-4. 20.  Steinkemp HJ, Cornehl M, Hosten N, Pegios N, Vogl T, Felix R. Cervical lymphadenopathy, ratio of long to short axis diameter as a predictor of malignancy. Br J Radiol 1995; 68: 266-70.]]> 2024 Ibrahim Medical College. All rights reserved.