Differential diagnosis of cervical lymphadenopathy: usefulness of color Doppler sonography.

Na, Dong Gyu; Lim, Hyo Keun; Byun, Hong Sik; Kim, Hong Dae; Ko, Young Hyeh; Baek, Jeong Hwan

doi:10.2214/ajr.168.5.9129432

Cited by 231 publications

(265 citation statements)

References 11 publications

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“…More detailed classification patterns were described by Na et al [10] and Tschammler et al [11]. Tschammler et al added descriptions of features that are typical of reactive nodes: the presence of a longitudinal vessel, peripheral branches originating from the longitudinal vessels, small intranodal color dots representing short vessel segments [11].…”

Section: Discussionmentioning

confidence: 99%

“…Na et al added more detailed descriptions: deformed radial and aberrant multifocal patterns [10]. Apart from the presence of subcapsular vessels, Tschammler et al reported the following findings as typical of malignant lymph nodes: displaced (curved) intranodal vessels, focal absence of perfusion, and aberrant vessels (one or more central vessels, excluding longitudinal vessel branches, forming an angle of 30 with the skin surface or with the longitudinal axis of the lymph node) [11].…”

Section: Discussionmentioning

confidence: 99%

“…Misdiagnosis of lymphomatous lymph nodes as reactive due to the presence of central or hilar blood flow can have much more serious repercussions. Lymphomatous lymph nodes in studies based on the classification of node vascularity as central, peripheral, or mixed, lymphomatous and metastatic nodes often fall into the ''mixed'' category (71% and 85%, respectively, according to Na et al) [10]. Tschammler et al reported the presence of one or more vascular sonographic signs of malignancy in 92% of the lymphomas they analyzed and in a similar percentage of the lymph node metastases (96%) [11].…”

Section: Discussionmentioning

confidence: 99%

“…Default settings were used for other study parameters. The vascular architecture was classified on the basis of Na and Tschammler classifications [10,11] with certain modifications. We assessed the following aspects in each node: -presence of a longitudinal vessel within the node (with or without branches) (Fig.…”

Section: Methodsmentioning

confidence: 99%

“…In the majority of previous publications, the patterns were classified in general terms, e.g., peripheral pattern, hilar pattern, or mixed pattern [4,9]. More detailed classifications were introduced by Na et al [10] and Tschammler et al [11].…”

Section: Introductionmentioning

confidence: 99%

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Vascular patterns in superficial lymphomatous lymph nodes: A detailed sonographic analysis

Białek

Jakubowski

Szczepanik

et al. 2007

Journal of Ultrasound

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KEYWORDSLymph nodes; Lymphoma; Ultrasound; Power Doppler; Vessel pattern.Abstract Purpose: To identify the vascular patterns found in superficial lymph nodes with histologically confirmed lymphomatous involvement and to determine their value in the sonographic diagnosis of lymphadenopathy. Methods and materials: The study involved the prospective classification of vascular patterns observed during power Doppler and/or color Doppler studies of superficial lymph nodes scheduled for resection. Forty patients (27 men and 13 women, aged 22e84 years; mean age: 58 years) with pathologically proven lymphoma were selected for this study (26 cervical, 13 axillary and 1 inguinal). Results: A longitudinal vessel with or without branches (pattern I) was found in 14 lymphomatous nodes. Six contained short vessel segments distributed in the hilum area or centrally (pattern II), five had multiple vessels, partially branching, entering the node in a few rows from its longitudinal side (pattern III), seven presented multiple vessels that branched irregularly or chaotically with avascular areas (pattern IV), and eight had a peripheral vessel distribution (pattern V). Therefore, 50% of the lymphomatous nodes had vascular patterns regarded as characteristic of reactive lymph nodes (patterns I and II), and 37.5% had patterns normally described in lymph nodes with metastatic involvement (patterns IV and V); other lymphomatous lymph nodes had ambiguous vascular patterns that have not been previously classified (pattern III). Conclusion: The angioarchitecture of superficial lymphomatous lymph nodes varies widely and is difficult to classify. It may resemble that reported in normal or reactive lymph nodes or patterns that are associated with metastases. The finding of a normal or benign vascular pattern in a lymph node with suspected lymphomatous involvement does not eliminate the need for a diagnostic biopsy. Sommario Scopo: Valutazione dei possibili pattern vascolari dei linfonodi superficiali interessati da linfoma confermato da esame istologico allo scopo di ottenere un elemento aggiuntivo nella diagnosi differenziale ecografica tra patologie interessanti i linfonodi. Materiali e metodi: È stata effettuata una classificazione ecografica prospettica di pattern vascolari color e power Doppler di 55 linfonodi superficiali programmati per resezione. Sono stati selezionati per questo studio 40 pazienti con diagnosi istologica di linfoma (26 linfonodi cervicali, 13 ascellari e 1 inguinale). Il gruppo di pazienti studiato era comprensivo di 27 uomini e 13 donne, età 22e84 anni (età media: 58 anni). Risultati: È stato trovato un vaso lungitudinale con o senza ramificazioni (pattern I) in 14 linfoadenopatie; piccoli segmenti vascolari distribuiti nell'area dell'ilo o nella zona centrale del linfonodo (pattern II) in 6 linfoadenopatie. Vasi multipli, parzialmente ramificati, che entrano nel linfonodo in alcune file dal lato longitudinale (pattern III) sono stati riscontrati in 5 linfonodi mentre vasi multipli che si ramificano irregolarmente o...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Vascular patterns in superficial lymphomatous lymph nodes: A detailed sonographic analysis

Białek

Jakubowski

Szczepanik

et al. 2007

Journal of Ultrasound

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Thyroid metastasis from rectal carcinoma coexisting with hashimoto's thyroiditis: Gray-scale and power Doppler sonographic findings

Takashima

Takayama

Wang

et al. 1998

J. Clin. Ultrasound

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Vascular pathology of malignant cervical lymphadenopathy

Hsu

Chang

et al. 1998

Cancer

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BACKGROUND Malignant vascular pathology has traditionally been studied with invasive angiography or in vitro immunohistochemistry. The objective of this study was to investigate the vascular patterns and vascular density of benign and malignant cervical lymphadenopathy using power Doppler ultrasound combined with a computed quantitative image processing system. METHODS Investigations of 189 cervical lymph node lesions were undertaken prospectively using a 5‐10 MHz linear array transducer in power mode. The types of vascular patterns displayed with power Doppler ultrasound, after sweep‐scanning over the whole lymph node, were classified as hilar, spotted, peripheral, or mixed. Quantitative assessment of vascularity was made by sampling three parallel planes of each lymph node. A computed image processing system automatically calculated the density of vascular signals (called the "vascularity index" in this study) within the lymph node plane. RESULTS Malignant lymph node lesions were shown to have higher vascularity indices (0.169 ± 0.147, P < 0.01). The vascular patterns of benign lesions were mostly of avascular or hilar type (in 83% of cases). Malignant lesions were characterized by patterns of mixed (47%), spotted (20%), or peripheral type (11%). When vascular pattern (nonhilar type) and vascularity index (maximum ≥0.09) were combined, the specificity for diagnosing malignant lymphadenopathy was as high as 97%. Variance in tumor vascularity was noted in both the benign and malignant groups. CONCLUSIONS Power Doppler ultrasound combined with a computed image processing system provided an objective tool for assessing tumor vascularity quantitatively. Using this modality, the vascular pathology of malignant lymphadenopathy was found to be characterized by higher vascular density and aberrant vascular patterns. Cancer 1998;83:1189‐1196. © 1998 American Cancer Society.

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Differential diagnosis of cervical lymphadenopathy: usefulness of color Doppler sonography.

Cited by 231 publications

References 11 publications

Vascular patterns in superficial lymphomatous lymph nodes: A detailed sonographic analysis

Vascular patterns in superficial lymphomatous lymph nodes: A detailed sonographic analysis

Thyroid metastasis from rectal carcinoma coexisting with hashimoto's thyroiditis: Gray-scale and power Doppler sonographic findings

Vascular pathology of malignant cervical lymphadenopathy

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