Lymphadenopathy: differentiation of benign from malignant disease--color Doppler US assessment of intranodal angioarchitecture.
OBJECTIVE
To differentiate reactive from malignant lymphadenopathy by using color Doppler ultrasonographic (US) findings of intranodal blood vessels.


METHODS
Color Doppler US was performed in 117 lymph nodes in 100 consecutive patients before performance of surgical biopsy (47 nodes), neck dissection (62 nodes), or high-speed core biopsy (eight nodes). The presence of malignant changes in intranodal angioarchitecture (focal perfusion defects, aberrant course of central vessels, displacement of intranodal vessels, subcapsular vessels) was evaluated in each node. Inter- and intraobserver variability were evaluated.


RESULTS
Histopathologic examination demonstrated 48 reactive lymph nodes (longest diameter +/- standard deviation, 13.5 mm +/- 6.0), 56 nodal metastases (longest diameter, 19.2 mm +/- 8.8), 12 malignant lymphomas (longest diameter, 23.2 mm +/- 10.5), and one node infiltrated by Langerhans cell histiocytosis. At color Doppler US, 103 (88%) nodes were classified correctly, with a specificity of 77% and a sensitivity of 96%. Reproducibility was 90%-96% (kappa = 0.79-0.91, P < .001).


CONCLUSIONS
Color Doppler US is a reliable and reproducible method for help in the differentiation between reactive and malignant alterations of superficial lymph nodes by using findings of intranodal angioarchitecture.
Tschammler
A
A
Department of Radiology, University of Würzburg, Germany.
Ott
G
G
Schang
T
T
Seelbach-Goebel
B
B
Schwager
K
K
Hahn
D
D
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D001808:Blood Vessels / Q000000981:diagnostic imaging; D003937:Diagnosis, Differential; D005069:Evaluation Studies as Topic; D005260:Female; D006646:Histiocytosis, Langerhans-Cell / Q000000981:diagnostic imaging / Q000473:pathology; D006801:Humans; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000098:blood supply / Q000000981:diagnostic imaging*; D008206:Lymphatic Diseases / Q000000981:diagnostic imaging* / Q000473:pathology; D008207:Lymphatic Metastasis / Q000000981:diagnostic imaging* / Q000473:pathology; D008223:Lymphoma / Q000000981:diagnostic imaging / Q000473:pathology; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D011446:Prospective Studies; D012039:Regional Blood Flow / Q000502:physiology; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D018615:Ultrasonography, Doppler, Color