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

Abstract

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...

Quantitative Multiparametric Ultrasound (mpUS) in the Assessment of Inconclusive Cervical Lymph Nodes

“…CEUS analysis did not show any significant results, although one would expect clear visualization differences in the vascularization patterns of benign and malignant CLN, with one of the most common US–B-Mode criterion for malignancy being the absence of the hilus sign [ 27 ]. An explanation for the absence of conclusive CEUS results in our cohort could be the large amount of metastatic CLN with partial necrosis, which understandably has an influence on the quantitative determination of the vascularization patterns and parametric assessment of whole-lesion perfusion.…”

Role of immunoreactive patterns of lymph nodes in neck dissection cases of oral squamous cell carcinoma: a clinical and histopathological study

“…The amount of vascularity depends on the tumor type and extent. In cases of metastatic nodes, there is mixed or peripheral vascularity along with loss of architecture in hilar vessels21. Thus, these changes are an important factor in diagnosing malignancy in a LN22.…”

Do otherwise well, healthy children with palpable cervical lymph nodes require investigation with neck ultrasound?

“…Moreover, no single sonographic criterion is able to determine the aetiology of an enlarged lymph node10 11 given that there are several overlapping sonographic characteristics among benign, malignant and infectious CLN, summarised in table 2 12 13. A combination of sonographic features may favour one diagnosis over another depending on the clinical context but it is also well recognised that ultrasound cannot reliably differentiate between reactive hyperplasia and lymph nodes involved by lymphoma 14 15. This further reinforces the limitations of ultrasound as a diagnostic tool in the assessment of palpable CLN and cervical lymphadenopathy.…”