Nonpalpable lymph nodes of the neck: Assessment with US and US‐guided fine‐needle aspiration biopsy

Abstract

Ultrasound (US) and US-guided fine-needle aspiration biopsy (FNA) were performed in 91 nonpalpable neck nodes of 70 patients, 93% of which had known malignancy. Various sonographic findings were evaluated for predicting malignancy. The accuracy of US-guided FNA for detecting malignancy was 88%, with 96% sensitivity and 94% specificity. The ratio of minimal to maximal axial diameters of a node was most valid for predicting malignancy with US. A ratio of more than 0.55 yielded the highest accuracy (80%) (92% sensitivity, 63% specificity). Addition of any other factors to this criterion did not improve its accuracy. US and US-guided FNA are accurate for the assessment of nonpalpable neck nodes. Lymph nodes with a round configuration should be biopsied in patients with known malignancy.

Value of Ultrasound Elastography in Assessment of Enlarged Cervical Lymph Nodes

“…Short-axis diameter < 8 mm was the criterion as benign and ≥8mm as malignant; regular shape was the criterion as benign and irregular sharp as malignant; clear border was considered as benign and unclear border as malignant; L/T ≥ 2 was considered as benign and < 2 as malignant; present of hilum was considered as benign and absent as malignant; homogeneous ehcogenicity was considered as benign and heterogeneous echogenicity as malignant (Solbiati et al, 1992;Takashima et al, 1997;Ahuja and Ying, 2002;Castelins et al, 2003).…”

Are We Justified in Supplementing Elastography With High Resolution Ultrasonography for Differentiating Between Benign and Malignant Cervical Lymph Nodes?

“…[9][10][11][12][13][14] With short axis diameter cut-off of 10 mm, 20 of 64 lymph nodes were labelled as malignant (38 were actually malignant on HPE). Sensitivity and specificity of 71% and 50% noted respectively with insignificant p-value (0.08), whereas in a study by Lyschick et al 7 using a cut-off diameter of 8 mm the accuracy was 65%, seen to be slightly better when smaller sizes were used.…”

“…Sensitivity and specificity of 75% and 56% respectively with a significant p-value (0.011) was similar to previous studies supporting the round shape for malignant nodes. 7,10,11 Irregularity of margins in the lymph nodes as a criteria for malignancy had a poor sensitivity and specificity in our study. All the 64 lymph nodes examined showed absence of hila.…”

“…[9][10][11][12][13][14] The accuracy of short axis diameter in our study was 59% and p value of 0.08 using cut-off diameter of 1 cm, whereas in a study by Lyschick et al 7 using a cut-off diameter of 8 mm the accuracy was 65%, seen to be slightly better when smaller sizes were used. The S/L Ratio of ≤0.6 mm for benign nodes had accuracy of 65%, p value of 0.011 was similar to previous studies supporting the round shape for malignant nodes.…”

“…The S/L Ratio of ≤0.6 mm for benign nodes had accuracy of 65%, p value of 0.011 was similar to previous studies supporting the round shape for malignant nodes. 7,10,11 Irregularity of margins in the lymph nodes as criteria for malignancy had a poor sensitivity and specificity in our study. In our study, the accuracy of lymph node margin as criteria to diagnose benign and malignant nodes was only about 53% with insignificant p value, suggesting that margins were no longer useful criteria.…”