Value of Gray-Scale and Color Doppler Sonography in the Evaluation of Cervical Lymphadenopathy

Background: Cervical Lymphadenopathy is a relatively common finding in pediatric age group and is caused by a wide spectrum of diseases from transient infections to malignancies especially lymphomas. Objectives: Evaluation of the reliability of gray scale and Doppler Sonography in differentiation of reactive from malignant enlarged cervical lymph nodes. Materials and Methods: Thirty untreated patients with enlarged cervical lymph nodes of >3 weeks duration, were examined prospectively. All of these patients underwent clinical, laboratory and radiological evaluation including Bmode ultrasound and color Doppler sonography. Then LN biopsy was performed taking it as a gold standard. Results: According to LN biopsy, seventeen of the studied patients(57%) had reactive lymphadenopathy, while 13 patients (47%) had malignant lymph nodes 11 with lymphoma and 2 metastatic from neuroblastoma. Mean age of patients with reactive lymph nodes was 5.47 ±2.5 years, while mean age of malignant group was 8.76±3 years. There was statistically significant difference in the malignant group as regards male sex, presence of weight loss, splenomegaly, generalized lymphadenopathy, compared to the reactive group. Also there was a statistically significant difference in the malignant group as regards hemoglobin level, ESR, LDH, and the presence of mediastinal lymphadenopathy. By Ultrasound, rounded shape, sharp borders, absent hilar echogenecity, peripheral and mixed vascularity, and an L/T cutoff value <1.97 were identified as being significantly higher in the malignant group. On the contrary, resistive index RI and pulsatility index PI had no significant difference between the malignant and reactive group. L/T ratio <1.97 and absence of hilar echogenecity had a sensitivity of 92.3% and 85% respectively, and a specificity of 76.5% and 94% respectively. The combination of grey scale and color Doppler had a sensitivity of 87%, a specificity of 92%, and an accuracy of (87%). Conclusion: Combination of grey-scale and color Doppler ultrasonography is recommended for the differentiation between the malignant and benign lymphadenopathy in children. Correspondence to: Dr. Ahmed M. Kaddah, The Department of Pediatrics, Faculty of Medicine, Children Hospital, Cairo University.