Sushil Ghanshyam KACHEWAR, Smita Balwant SANKAYE

Ultrasound Review of Metastatic Lymphadenopathy

Metastatik lenfadenopatiler görüntüleme tekniklerindeki gelişmeler sayesinde daha yaygın olarak görülmektedir. Her ne kadar malign bölge çoğu kez bilinsede malign dokunun temel kökeninin belirlenemediği durumlarda vardır. Ultrasonografi hastalıklı lenf nodlarının noninvaziv olarak değerlendirme potansiyeline sahiptir. Bu bağlamda, bizde görüntüleme bölümümüze son 12 ayda gelmiş iğne aspirasyon sitolojisi ile metastatik lenfadenopatileri doğrulanmış vakaların ultrasonografik bulguları değerlendirdik. Metastatik lenfadenopatilerin işaretlenmesinde birçok kriter gözönünde bulundurulmak suretiyle gri skala ve renkli doppler ultrasonografik görüntüleme metodları kullanılarak değerlendirilmiştir. Sertleşme göstermeyen yuvarlak nodlar, nodüler nekroz oluşumu, nodüler kalsifikasyon, artan vaskularizasyon, artan Doppler pulsalitesi ve rezistans indeksleri metastatik lenfadenopatilerin karakterizasyonunun temelini oluşturmakla beraber doğru teşhisi oranını yaklaşık %85.25 ile %98.36 arasındasır. Derlememizdeki en duyarlı ve spesik kriterler gri skala görüntülemesindeki yuvarlaklık indeksi ve renkli doppler görüntülemesindeki perfüzyon rezistansıdır. Bu derleme ayrıca ultrasonografinin metastatik lenfadenopatilerin teşhisindeki doğruluğu ve dolayısıyla bu tip vakaların teşhis ve takibindeki faydalarını vurgulamaktadır.

Anahtar Kelimeler:

Lenf nodu metastazları; Ultrasonografi; Gri Skala, Renkli Doppler Görüntülemesi

Ultrasound Review of Metastatic Lymphadenopathy

Metastatic Lymphadenopathy is a common occurrence now with the earlier detection possible due to advances in imaging sciences. Although, at times the site of original malignancy is known; there are instances when the primary source of malignancy remains unknown. Ultrasound has the potential to non invasively evaluate the affected lymph nodes. Hence we reviewed the ultrasound findings in all fine needle aspiration cytology proven cases of metastatic lymphadenopathy that presented in the imaging department in the last 12 months. Multiple criteria on Grey Scale ultrasound imaging and on Color Doppler ultrasound imaging were used to label metastatic lymphadenopathy. Round nodes without any matting, presence of intranodal necrosis, intranodal calcifications, increased vascularity and elevated Doppler Pulsatility and Resisitivity Indices were the hallmarks of metastatic lymphadenopathy which enabled correct diagnosis with a sensitivity of 85.25% and a sensitivity of 98.36 %. In our review, the most sensitive and specific criteria was the Roundness Index on Gray scale imaging and Resistance to Perfusion on Color Doppler imaging. This review shows how, ultrasound can satisfactorily diagnose metastatic lymphadenopathy and can therefore be used in the diagnosis as well as follow up of such cases.

Keywords:

Lymph node metastases; Ultrasound; Gray Scale Colour Doppler, Imaging.,

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Yazışma Adresi / Address for Correspondence: Dr. Sushil Ghanshyam Kachewar Rural Medical College PIMS (DU), Loni, Maharashtra, INDIA-413 736 geliş tarihi/received :24.10.2012 kabul tarihi/accepted:20.11.2012