Presurgical evaluation of malignant neck nodes by assessment it’s Intranodal vascularity using the color Doppler ultra sound

Abstract

Color Doppler ultra sound is an ideal imaging tool for initial assessment of
intranodular vascularity which may reflect some pathological behaviors of tumors
and lymph nodes in patients with cervical lymphadenopathy. The aim of this study
was to evaluate the usefulness of Color Doppler ultra sound in differentiating
benign from malignant cervical lymph nodes by the assessment of Nodal
vascularity. In a prospective study of 24 untreated patient with 65 cervical lymph
nodes clinically including enlarged hard and soft palpable and non palpable lymph
nodes . All these lymph nodes were evaluated with Color Doppler ultra sound as a
pre-surgical diagnostic tool, the findings were compared with histo-pathalogical
results.
Fine needle Aspiration cytology was used for 15 palpable enlarged cervical
lymph nodes, most of these lymph nodes 12 lymph nodes were associated with
reactive lymph nodes and not operated on, just follow up with antibiotic treatment
and performed only 3 lymph nodes were associated with malignant lymph nodes
which removed surgically and assessed histopathologically.
Upon Color Doppler ultra sound examination pre-operatively of 65 cervical
lymph nodes were found 20 lymph nodes as a reactive lymph nodes and 45 as
malignant lymph nodes.
After neck dissection, all lymph nodes histo-pathologically examined which
showed 22 benign lymph nodes and 43 lymph nodes containing metastases. Nodal
vasculature were classified into:
· Hilar
· Capsular
· Hilar with capsular vascularity
Results: most of the malignant nodes showed the presence of capsular vascularity and
capsular with hilar vascularity, 37.2% and 48.8% respectively, where as the
majority of the reactive nodes showed hilar vascularity 77.3% and the different was
highly significant P<0.01 when chi-square was used.
Conclusion: the distribution of intra nodal vascularity appears to be useful in
differentiating benign from malignant cervical lymph nodes by means Color
Doppler ultra sound which consider as a routine pre-surgical tool to provide the
surgeons with a valuable information that aids them to modify their surgical
management