Presence of lymph node vasculature: a new EUS criterion for benign nodes?
OBJECTIVE
Lymph nodes normally have prominent centrally located blood vessels, which may become obliterated with tumor infiltration. The presence of intranodal vasculature has been noted to coincide with benign cytology. We sought to determine the test characteristics of the presence of intranodal mediastinal vasculature during endoscopic ultrasound (EUS).


METHODS
67 mediastinal lymph nodes evaluated by EUS in 66 patients over a 1-year period were evaluated for the presence of intranodal vasculature, which was considered benign when it traversed through the node without disruption.


RESULTS
Of the 67 lymph nodes evaluated, 29 (43%) were found to be malignant on cytopathologic review. Benign vascular markings were present in 15/67 (22.4%) lymph nodes evaluated. All 15 (100%) of these nodes were found to have benign fine-needle aspiration (FNA) results. The presence of benign vasculature had a negative predictive value of 100%.


CONCLUSIONS
The presence of intranodal vasculature was universally associated with a benign diagnosis. The addition of this EUS finding improves the ability to characterize lymph nodes and predict the likelihood of malignant involvement.
Hall
Joshua D
JD
Digestive Health Center of Excellence, University of Virginia Health System, Box 800708, Charlottesville, VA 22908-0708, USA.
Kahaleh
Michel
M
White
Grace E
GE
Talreja
Jayant
J
Northup
Patrick G
PG
Shami
Vanessa M
VM
D000230:Adenocarcinoma / Q000000981:diagnostic imaging / Q000473:pathology; D044963:Biopsy, Fine-Needle; D019160:Endosonography / Q000379:methods*; D004938:Esophageal Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology; D005260:Female; D006801:Humans; D016015:Logistic Models; D008198:Lymph Nodes / Q000098:blood supply* / Q000000981:diagnostic imaging* / Q000473:pathology; D008206:Lymphatic Diseases / Q000000981:diagnostic imaging* / Q000473:pathology; D008297:Male; D008482:Mediastinum; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology