RATIONALE AND OBJECTIVES.The authors assess the value of combining high-resolution ultrasonography (HRUS) findings in a scoring scale for distinguishing malignant from reactive lymphadenopathy and explain the pathologic causes of altered nodal sonographic architecture.MATERIALS AND METHODS.Sixty-one nodes obtained from 32 consecutive patients were prospectively scanned with 7.5-MHz ultrasound probes in a waterbath. Three sonographic featuresmdash; long-to-short axis ratio (Lsol;S), hilar width, and cortical widthmdash;were graded on a 5-level scoring scale (0-4). Nodes scored 5ge; 3 were considered malignant and le; 2 benign. Subsequently, all nodes were microscctioned in a plane matching the sonograms, allowing direct sonographic-pathologic correlation.RESULTS.Eighty-two percent of nodes were correctly characterized using the above cut-off point (sensitivitycolon; 87percnt;, specificitycolon; 74percnt;). Eighty-three percent of nodes scored 4 were malignant and 95percnt; scored 0 were benign. Eighty-two percent of nodes with Lsol;S 2, 81percnt; with no hilus, and 70percnt; with eccentric cortical widening were malignant, whereas 72percnt; with Lsol;S ge; 2, 86percnt; with a wide hilus, and 91percnt; with a narrow cortex were benign. Sonographic-pathologic correlation showed that tumor infiltration results in rounded nodal shape, loss of hilar echogenicity and cortical widening, whereas reactive disease tends to preserve nodal architecture.CONCLUSION.Morphologic changes detectable using HRUS help distinguish benign from malignant lymph nodes.
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