Ultrasonic evaluation of cervical metastatic lymphadenopathy.

Abstract

We investigated the location, size, and shape of cervical lymph nodes in head and neck cancer, using a 7.5-MHz ultrasound scanner. First, the different criteria for normal size were obtained for cervical lymph nodes in each region; lymph nodes greater than 9 mm in thickness in the internal jugular chain or greater than 7 mm in thickness in the submandibular and submental chains should be suspected of harboring metastatic foci. Second, meta· static nodes showed a more rounded configuration than A precise evaluation of the presence of meta· stasis to the cervical lymph nodes is mandatory in the management of head and neck malignancies. X-ray computed tomography (CT), 1 magnetic resonance imaging (MRI), and ultrasound 2 -4 have been used to evaluate lymphadenopathy in the neck. Recent reports on ultrasonography in the neck suggest its high efficiency in detecting small, nonpalpable lymphadenopathy. Although size has been used to diagnose me~ tastasis in lymph nodes, few studies have dealt with their internal structure.To determine the size and shape criteria for normal lymph nodes in each region in the neck, as well as to clarify any abnormal patterns of internal structure in metastatic lymph nodes, we conducted a correlative Received July 20, 1987, from the Departments of "Radiology, fOral Surgery. *Otolaryngology. and §Laboratory Medicine, School of Medi· cine, Shinshu University. Asahi, Matsumoto, Japan. Revised manuscript accepted for publication October 29, 1987. Address correspondence and reprint requests to Dr. F. Sakai: De· partment of Radiology, School of Medicine, Shinshu University, Asahi, Matsumoto, 390, Japan. nonmetastatic ones. Third, a comparative study of metastatic lymph nodes between the in vivo and in vitro ultrasonograms and the corresponding histopathological findings disclosed that an echogenic region in an ultrasonogram of a metastatic node was caused by coagulation necrosis, and a cystic area of liquefaction necrosis. KEY WORDS; ultrasonography, lymphadenopathy, echogenicity, size of lymph node. (/ Ultrasound Med 7: 305, 1988)

Lymph node hilus: gray scale and power Doppler sonography of cervical nodes.

“…The echogenic hilus seen on gray scale sonography of a node was previously thought to represent intranodal fat 8,9 within the lymph node. However, it is now generally accepted that the echogenic hilus is mainly the result of multiple fluid-filled sinuses, each of which acts as an acoustic interface, partially reflecting incident sound waves and imparting an echogenic structure.…”

Diagnostic accuracy of sonographic criteria for evaluation of cervical lymphadenopathy.

“…4,[10][11][12] Unlike other criteria, size, shape, echogenic hilus, and sharpness of nodal border are not specific for either normal or abnormal nodes. Thus, it is essential for sonographers to be familiar with the accuracy of these criteria in differentiating normal from abnormal nodes.…”

“…10 It should not be confused with coagulation necrosis, which may also be seen as echogenic area within the node. However, these echogenic foci are not continuous with surrounding fat.…”

Enlarged lymph nodes of the neck: evaluation with parallel extended field-of-view sonographic sequences.

“…Precise assessment of the size of cervical lymph nodes in both longitudinal and transverse directions would be possible. [10][11][12][13][14] The results of the EFOV-US slice packages also were influenced by the individual neck anatomy. "Slight" necks are more difficult to scan because of the steplike surface, in contrast to "bulky" necks, in which the transducer can be directed more easily in one and the same movement.…”