The spectrum of benign and malignant etiologies of cervical node calcification

The purpose of this study was to determine if the presence and pattern of lymph node calcification can be used to make a limited differential diagnosis and differentiate benign from malignant disease.

Two radiologists reviewed each of 2300 neck CT scans obtained at our institution between January 1996 and July 1998 for the presence of nodal calcifications. The scans were obtained as 3-mm contiguous axial sections, and most were obtained with IV contrast material. Twenty-six scans revealed nodal calcification, which was classified as being within the node itself or along the periphery of the node. The diagnosis was established from surgical specimens for 20 patients and from CT-guided thin-needle biopsy for four patients. For two patients, the diagnosis was inferred from a previously well-documented case of the disease.

Of the 2300 scans, 26 (1%) showed nodal calcification. Of these 26, eight (31%) were from patients with benign disease; six (23%) from patients with treated diseases, including four lymphomas and one infection; and 12 (46%) from patients with malignancies, including nine cases of head and neck primary tumors and three cases of metastatic adenocarcinoma from breast and lung primary tumors.

Cervical node calcification is rare. On the basis of our limited number of cases, nodal calcification, regardless of its location within the node, is not a reliable predictor of either benign or malignant disease. However, nodal calcification does suggest a limited differential diagnosis that most commonly includes tuberculosis, treated lymphoma, and metastatic thyroid carcinoma, adenocarcinoma, or squamous carcinoma.