Cervical lymphadenopathy: Sonographic differentiation between tuberculous nodes and nodal metastases from non-head and neck carcinomas

Purpose. Clinical examination alone cannot differentiate between cervical tuberculous lymphadenitis and cervical nodal metastases from nonhead and neck (NHN) carcinomas because the distributions of involved lymph nodes are similar. We evaluated the sonographic features of cervical lymph nodes that could be used to differentiate between the 2 categories of nodes. Methods. We retrospectively reviewed sonograms of abnormal cervical lymph nodes in 47 patients with proven cervical tuberculous lymphadenitis and in 22 patients with proven nodal metastases from NHN carcinomas. Results. Abnormal nodes in tuberculous lymphadenitis and nodal metastases from NHN carcinomas were commonly found in the supraclavicular fossa (15% and 38%, respectively) and the posterior triangle (70% and 41%, respectively). Statistically significant (p r < 0.05) features for differential diagnosis were lymph nodes' longest diameter, echogenicity, short-to-long axis ratio, appearance of surrounding soft tissues, and presence of intranodal cystic necrosis, matting, and posterior enhancement. Nodal size, echogenicity, presence of an echogenic hilum, calcification, coagulation necrosis, and sharpness of borders helped in identifying the abnormal lymph nodes. Conclusions. Sonographic features that helped to differentiate between the 2 categories of nodes were shape, edema of surrounding soft tissue, homogeneity, intranodal cystic necrosis, matting, and posterior enhancement.