IMC Journal of Medical Science
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Ibrahim Medical College Journal of Medical ScienceMd. Mizanur RahmanASQM SadequeEliza OmarSonjoy Kumar Bhakta https://www.imcjms.com/registration/journal_full_text/139
2016-11-09 15:19:37Original ArticleIbrahim 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.
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