Review of ultrasonography of malignant neck nodes: greyscale, Doppler, contrast enhancement and elastography

Abstract Assessment of neck lymph nodes is essential in patients with head and neck cancers for predicting the patient’s prognosis and selecting the appropriate treatment. Ultrasonography is a useful imaging tool in the assessment of neck lymph nodes. Greyscale ultrasonography assesses the size, distribution, and internal architecture of lymph nodes. Doppler ultrasonography evaluates the intranodal vascular pattern and resistance of lymph nodes. Contrast-enhanced ultrasonography provides information on lymph node parenchymal perfusion. Elastography allows qualitative and quantitative assessment of lymph node stiffness. This article reviews the value of greyscale, Doppler and contrast-enhanced ultrasonography as well as elastography in the assessment of malignant nodes in the neck.

[1]  J. Guimarães,et al.  Thyroglobulin measurements in washout of fine needle aspirates in cervical lymph nodes for detection of papillary thyroid cancer metastases. , 2010, Arquivos brasileiros de endocrinologia e metabologia.

[2]  A. Ahuja,et al.  Vascularity and grey-scale sonographic features of normal cervical lymph nodes: variations with nodal size. , 2001, Clinical radiology.

[3]  A. Ahuja,et al.  Grey-scale sonography in assessment of cervical lymphadenopathy: review of sonographic appearances and features that may help a beginner. , 2000, The British journal of oral & maxillofacial surgery.

[4]  Z H Adibelli,et al.  Differentiation of benign and malignant cervical lymph nodes: value of B-mode and color Doppler sonography. , 1998, European journal of radiology.

[5]  Ann D King,et al.  Real-time qualitative ultrasound elastography of cervical lymph nodes in routine clinical practice: interobserver agreement and correlation with malignancy. , 2010, Ultrasound in medicine & biology.

[6]  A. Ahuja,et al.  Sonographic appearance and distribution of normal cervical lymph nodes in a Chinese population. , 1996, Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine.

[7]  G. Gooding.  Malignant carotid invasion: sonographic diagnosis. , 1993, ORL; journal for oto-rhino-laryngology and its related specialties.

[8]  M. Metzger,et al.  Preoperative cervical lymph node size evaluation in patients with malignant head/neck tumors: comparison between ultrasound and computer tomography , 2009, Journal of Cancer Research and Clinical Oncology.

[9]  R. Evans,et al.  Ultrasound and fine needle aspiration cytology in the staging of neck lymph nodes in oral squamous cell carcinoma. , 2000, The British journal of oral & maxillofacial surgery.

[10]  A. Ahuja,et al.  Power Doppler sonography of normal cervical lymph nodes. , 2000, Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine.

[11]  J. Laméris,et al.  Supraclavicular lymph node metastases in carcinoma of the esophagus and gastroesophageal junction: assessment with CT, US, and US-guided fine-needle aspiration biopsy. , 1991, Radiology.

[12]  A. Ahuja,et al.  The use of sonography in differentiating cervical lymphomatous lymph nodes from cervical metastatic lymph nodes. , 1996, Clinical radiology.

[13]  A. Ahuja,et al.  Accuracy of sonographic vascular features in differentiating different causes of cervical lymphadenopathy. , 2004, Ultrasound in medicine & biology.

[14]  A. Ahuja,et al.  Repeatability of power Doppler sonography of cervical lymph nodes. , 2002, Ultrasound in medicine & biology.

[15]  C. Juan,et al.  Detection of suspicious malignant cervical lymph nodes of unknown origin: diagnostic accuracy of ultrasound-guided fine-needle aspiration biopsy with nodal size and central necrosis correlate. , 2007, Canadian Association of Radiologists journal = Journal l'Association canadienne des radiologistes.

[16]  P. Som,et al.  Lymph nodes of the neck. , 1987, Radiology.

[17]  S. Weber,et al.  Evaluation of metastases and reactive lymph nodes in Doppler sonography using an ultrasound contrast enhancer. , 1997, Investigative radiology.

[18]  H. Harnsberger,et al.  Computed tomography of cervical and retropharyngeal lymph nodes: normal anatomy, variants of normal, and applications in staging head and neck cancer. Part II: pathology. , 1983, Radiology.

[19]  Heinrich Iro,et al.  Neck lymph nodes: prediction by computer-assisted contrast medium analysis? , 2007, Ultrasound in medicine & biology.

[20]  A. J. Langaroodi,et al.  Evaluation of the Sonographic Features of Metastatic Cervical Lymph Nodes in Patients With Head and Neck Malignancy , 2011, The Journal of craniofacial surgery.

[21]  A. Ahuja,et al.  Reliability of Shear Wave Ultrasound Elastography for Neck Lesions Identified in Routine Clinical Practice , 2012, Ultraschall in der Medizin - European Journal of Ultrasound.

[22]  F. Mandelli,et al.  The role of high resolution pulsed and color Doppler ultrasound in the differential diagnosis of benign and malignant lymphadenopathy , 1999, Cancer.

[23]  J. Laméris,et al.  Ultrasound-guided fine-needle aspiration biopsy of neck nodes. , 1991, Archives of otolaryngology--head & neck surgery.

[24]  R. Felix,et al.  Differential diagnosis of lymph node lesions: a semiquantitative approach with colour Doppler ultrasound. , 1998, The British journal of radiology.

[25]  H. Harnsberger,et al.  Computed tomography of cervical and retropharyngeal lymph nodes: normal anatomy, variants of normal, and applications in staging head and neck cancer. Part I: normal anatomy. , 1983, Radiology.

[26]  Hui Wang,et al.  Value of ultrasound elastography in assessment of enlarged cervical lymph nodes. , 2012, Asian Pacific journal of cancer prevention : APJCP.

[27]  A. Lawrence,et al.  Primary papillary thyroid carcinoma presenting as cervical lymphadenopathy: the operative approach to the "lateral aberrant thyroid". , 1993, The American surgeon.

[28]  C. Balu-Maestro,et al.  Lymphomatous superficial lymph nodes: US detection. , 1987, Radiology.

[29]  A. Ahuja,et al.  Metastatic cervical nodes in papillary carcinoma of the thyroid: ultrasound and histological correlation. , 1995, Clinical radiology.

[30]  M. Shozushima,et al.  Ultrasound diagnosis of lymph node metastasis in head and neck cancer. , 1990, Dento maxillo facial radiology.

[31]  A. Ahuja,et al.  A practical approach to ultrasound of cervical lymph nodes , 1997, The Journal of Laryngology & Otology.

[32]  R. Jeffrey,et al.  Lesions of the head and neck in patients with AIDS: CT and MR findings. , 1988, AJR. American journal of roentgenology.

[33]  P. Bearcroft,et al.  Does a joint ultrasound guided cytology clinic optimize the cytological evaluation of head and neck masses? , 2000, Clinical radiology.

[34]  T. Lehmann,et al.  Color-coded duplex sonography of the cervical lymph nodes: improved differential diagnostic assessment after administration of the signal enhancer SH U 508A (Levovist)® , 2000, European Archives of Oto-Rhino-Laryngology.

[35]  A. Ahuja,et al.  The linear echogenic hilus in cervical lymphadenopathy--a sign of benignity or malignancy? , 1993, Clinical radiology.

[36]  A. Ahuja,et al.  Sonographic evaluation of cervical lymphadenopathy: is power Doppler sonography routinely indicated? , 2003, Ultrasound in medicine & biology.

[37]  A. Ahuja,et al.  Diagnostic accuracy of sonographic criteria for evaluation of cervical lymphadenopathy. , 1998, Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine.

[38]  Y. Ariji,et al.  Power Doppler sonography of cervical lymph nodes in patients with head and neck cancer. , 1998, AJNR. American journal of neuroradiology.

[39]  F. Hsieh,et al.  Usefulness of Doppler spectral analysis and power Doppler sonography in the differentiation of cervical lymphadenopathies. , 1998, AJR. American journal of roentgenology.

[40]  Ying Xiao,et al.  Ultrasound elastography: Its potential role in assessment of cervical lymphadenopathy. , 2010, Academic radiology.

[41]  Y. Sugama,et al.  Ultrasonographic evaluation of neck and supraclavicular lymph nodes metastasized from lung cancer. , 1992, Internal medicine.

[42]  J. Laméris,et al.  Metastatic Neck Disease: Palpation vs Ultrasound Examination , 1989 .

[43]  R. Lindberg.  Distribution of cervical lymph node metastases from squamous cell carcinoma of the upper respiratory and digestive tracts , 1972, Cancer.

[44]  T. Amagasa,et al.  Ultrasonic diagnosis of oral and neck malignant lymphoma. , 1992, The Bulletin of Tokyo Medical and Dental University.

[45]  Tatsuya Higashi,et al.  Cervical lymph node metastases: diagnosis at sonoelastography--initial experience. , 2007, Radiology.

[46]  Michael Ying,et al.  An Overview of Neck Node Sonography , 2002, Investigative radiology.

[47]  A. Ahuja,et al.  Power Doppler sonography of cervical lymphadenopathy. , 2001, Clinical radiology.

[48]  N. Tohnosu,et al.  Ultrasonographic evaluation of cervical lymph node metastases in esophageal cancer with special reference to the relationship between the short to long axis ratio (S/L) and the cancer content , 1989, Journal of clinical ultrasound : JCU.

[49]  A. Ahuja,et al.  Distribution of intranodal vessels in differentiating benign from metastatic neck nodes. , 2001, Clinical radiology.

[50]  N. Roos,et al.  In–Vitro High–Resolution Ultrasonography of Benign and Malignant Lymph Nodes: A Sonographic-Pathologic Correlation , 1993, Investigative radiology.

[51]  Masaki Furukawa,et al.  Diagnosis of lymph node metastases of head and neck cancer and evaluation of effects of chemoradiotherapy using ultrasonography , 2010, International Journal of Clinical Oncology.

[52]  G. Snow,et al.  Modern imaging techniques and ultrasound-guided aspiration cytology for the assessment of neck node metastases: a prospective comparative study , 2004, European Archives of Oto-Rhino-Laryngology.

[53]  A. Ahuja,et al.  'Pseudocystic' appearance of non-Hodgkin's lymphomatous nodes: an infrequent finding with high-resolution transducers. , 2001, Clinical radiology.

[54]  J. Attie,et al.  Thyroid carcinoma presenting as an enlarged cervical lymph node. , 1993, American journal of surgery.

[55]  K. Wernecke,et al.  Differentiation of benign from malignant superficial lymphadenopathy: the role of high-resolution US. , 1992, Radiology.

[56]  P. Som,et al.  Detection of metastasis in cervical lymph nodes: CT and MR criteria and differential diagnosis. , 1992, AJR. American journal of roentgenology.

[57]  N. Perrier,et al.  Cystic lymph nodes in the lateral neck as indicators of metastatic papillary thyroid cancer. , 2011, Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists.

[58]  R. Felix,et al.  Recurrent cervical lymphadenopathy: differential diagnosis with color-duplex sonography , 2004, European Archives of Oto-Rhino-Laryngology.

[59]  F. Candiani,et al.  Sonography of abnormal lymph nodes in vitro: correlation of sonographic and histologic findings. , 1990, AJR. American journal of roentgenology.

[60]  J. Oestmann,et al.  Contrast-enhanced color Doppler sonography for evaluation of enlarged cervical lymph nodes in head and neck tumors. , 2000, AJR. American journal of roentgenology.

[61]  A. Jacquier,et al.  [Cervical lymph nodes]. , 2008, Journal de radiologie.

[62]  Katsuhide Ito,et al.  Accuracy of sonographic elastography in the differential diagnosis of enlarged cervical lymph nodes: comparison with conventional B-mode sonography. , 2008, AJR. American journal of roentgenology.

[63]  T. Amagasa,et al.  US and CT evaluation of cervical lymph node metastasis from oral cancer. , 1991, Journal of cranio-maxillo-facial surgery : official publication of the European Association for Cranio-Maxillo-Facial Surgery.

[64]  Y. Ko,et al.  Differential diagnosis of cervical lymphadenopathy: usefulness of color Doppler sonography. , 1997, AJR. American journal of roentgenology.

[65]  S. Leung,et al.  The sonographic appearance and significance of cervical metastatic nodes following radiotherapy for nasopharyngaeal carcinoma. , 1996, Clinical radiology.

[66]  Anil T Ahuja,et al.  Shear wave elasticity imaging of cervical lymph nodes. , 2012, Ultrasound in medicine & biology.

[67]  J. Willner,et al.  The prognostic significance of the supraclavicular lymph node metastases in breast cancer patients. , 1994, International journal of radiation oncology, biology, physics.

[68]  W. Lawson,et al.  The varied presentations of papillary thyroid carcinoma cervical nodal disease: CT and MR findings. , 1994, AJNR. American journal of neuroradiology.

[69]  S. Sone,et al.  Ultrasonic evaluation of cervical metastatic lymphadenopathy. , 1988, Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine.

[70]  A. Wu,et al.  [Supraclavicular lymph node metastasis from carcinoma of the uterine cervix after radiotherapy--analysis of 219 patients]. , 1988, Zhonghua zhong liu za zhi [Chinese journal of oncology].

[71]  M. Louw,et al.  Ultrasonography-guided fine-needle aspiration for the assessment of cervical metastases. , 2000, Archives of otolaryngology--head & neck surgery.

[72]  S. Thawley,et al.  Lymphoma of the Head and Neck , 1978, The Laryngoscope.

[73]  G. Snow,et al.  Sonographically guided aspiration cytology of neck nodes for selection of treatment and follow-up in patients with N0 head and neck cancer. , 1999, AJNR. American journal of neuroradiology.

[74]  A. Yuan,et al.  Differentiation of benign and malignant cervical lymph nodes with color Doppler sonography. , 1994, AJR. American journal of roentgenology.

[75]  Abhishek Gupta,et al.  Sonographic assessment of cervical lymphadenopathy: Role of high‐resolution and color Doppler imaging , 2010, Head & neck.

[76]  E. Mišeikytė-Kaubrienė,et al.  Cystic lymph node metastasis in papillary thyroid carcinoma. , 2008, Medicina.

[77]  J. Laméris,et al.  Ultrasound and ultrasound‐guided fine needle aspiration biopsy of supraclavicular lymph nodes in patients with esophageal carcinoma , 1991, Cancer.

[78]  J. Laméris,et al.  Improved assessment of supraclavicular and abdominal metastases in oesophageal and gastro-oesophageal junction carcinoma with the combination of ultrasound and computed tomography. , 1993, The British journal of radiology.

[79]  A. Ahuja,et al.  Longitudinal colour doppler study of superficial lymph nodes in non-Hodgkin's lymphoma patients on chemotherapy. , 2000, Clinical radiology.

[80]  A. Ahuja,et al.  The application of ultrasound criteria for malignancy in differentiating tuberculous cervical adenitis from metastatic nasopharyngeal carcinoma. , 1995, Clinical Radiology.

[81]  E. Salomonowitz,et al.  Lymph nodes of the neck: evaluation with US. , 1986, Radiology.

[82]  J. Machi.  Patterns of internal echoes in lymph nodes in the diagnosis of lung cancer metastasis. , 1993, World journal of surgery.

[83]  F. Ferro,et al.  Evaluation of Lymph Node Perfusion Using Continuous Mode Harmonic Ultrasonography With a Second‐Generation Contrast Agent , 2004, Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine.

[84]  A. Ahuja,et al.  Cervical lymphadenopathy: Sonographic differentiation between tuberculous nodes and nodal metastases from non–head and neck carcinomas , 1998, Journal of clinical ultrasound : JCU.

[85]  J. Swartz,et al.  Imaging of the neck: nodal disease. , 1991, Critical reviews in diagnostic imaging.

[86]  K. Geisinger,et al.  Virchow's node revisited. Analysis with clinicopathologic correlation of 152 fine-needle aspiration biopsies of supraclavicular lymph nodes. , 1995, Archives of pathology & laboratory medicine.