Superficial lymph nodes involved by lymphoma in modern gray-scale ultrasound imaging

Background: Clinical evaluation by palpation of superficial lymph nodes involved by lymphoproliferative process is not sufficient. Ultrasound is a useful method of the initial differential diagnosis of lymph nodes. The aim was to assess the spectrum of ultrasound features of superficial lymphomatous nodes and possible diagnostic pitfalls. Material/Methods: Fifty five lymph nodes in 55 patients were prospectively examined in ultrasound with application of blood flow imaging modes and modern imaging techniques. Only forty lymph nodes with histopathologically proven lymphoma were selected for this analysis (3 Hodgkin, 37 non-Hodgkin). Results: 27.5% of the examined lymph nodes were longitudinal; 42.5% had an oval or round shape; 30% were oval-lobulated or lobulated. 32.5% of the nodes did not show an echogenic hilum, 20% had a normal hilum, and 25% - evidently abnormal. 12.5% of the nodes were anechoic. The general ultrasound impression of a reactive lymph node was presented by 37.5% of the lymphomatous nodes; 45% were suspicious. Among 26 patients with non-Hodgkin lymphoma with multiple lymph nodes involved, in 15 (58%) lymph nodes were modeling on each other. Conclusions: Lymphomatous nodes reveal diverse ultrasound presentations: from appearances indistinguishable from benign reactive lymph nodes to features typical of metastases. Ultrasound internal structure of lymphomatous nodes may be anechoic, causing the possibility of confusion with a cyst, especially in case of a single lymphomatous node. Multiple lymphomatous nodes with non-Hodgkin lymphoma often model on each other assuming geometrical shapes.