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Sonography of Lymph Nodes in the Neck

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Abstract

Lymph nodes occur frequently in the neck area. In most cases, they are benign, but it is always necessary to consider lymph node enlargement in combination with the patient’s history, clinical signs, laboratory findings, and imaging results. In some cases, the application of interventional techniques such as ultrasound-guided fine-needle aspiration (USFNA) or ultrasound-guided core biopsy (USCB), contrast-enhanced ultrasound (CEUS), or lymphadenectomy with histology is required.

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Authors and Affiliations

  1. Department of ENT, Head, Neck, and Plastic Surgery, Semmelweis University, Hamburg, Germany

    Jens E. Meyer

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  1. Department of Otorhinolaryngology Head and Neck Surgery, KRH Nordstadt Clinic-Academic Hospital, Hannover, Germany

    Hans J. Welkoborsky

  2. Department of Otorhinolaryngology and Plastic Head and Neck Surgery, Klinikum Bad Salzungen GmbH, Bad Salzungen, Germany

    Peter Jecker

5.1 Electronic Supplement Material

Color Doppler ultrasonography of reactive CLNs depicting the hilum sign (M4V 3085 kb)

Ultrasound-guided core biopsy (USCB) cytology to test in a polymerase chain reaction for M. tuberculosis genes providing a favorable alternative to surgical sampling while offering a similar diagnostic accuracy (WMV 24224 kb)

CLN in stage IV of a non-tuberculous mycobacterial infection (AVI 167289 kb)

In contrast, the appearance of irregular borders points toward extracapsular spread (ECS) and is therefore a safe sign of malignancy (AVI 65583 kb)

Metastatic lymph nodes usually have a peripheral or mixed (hilar and peripheral) vascularization which is thought to be related to tumor neoangiogenesis and recruitment of capsular vessels, whereas keratinization and intranodal necrosis often cause diminishing of hilar vessels (WMV 11881 kb)

Mixed vascularization of metastatic HNSCC CLN.

Power Doppler ultrasonographic evaluation of nodal vascular pattern has been reported to have high sensitivity and specificity for differentiating metastatic from reactive nodes. However, power Doppler ultrasonography is useful in patients in whom grayscale ultrasonography is equivocal (AVI 58489 kb)

The application of power Doppler ultrasonography in the assessment of cervical nodes might not be necessary for all cases in routine clinical practice. However, power Doppler ultrasonography is useful in patients for whom grayscale ultrasonography is equivocal, and it improves diagnostic accuracy (AVI 69223 kb)

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Meyer, J.E. (2019). Sonography of Lymph Nodes in the Neck. In: Welkoborsky, H., Jecker, P. (eds) Ultrasonography of the Head and Neck. Springer, Cham. https://doi.org/10.1007/978-3-030-12641-4_5

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