Color Doppler sonography in the evaluation of superficial lymphomatous lymph nodes

We performed a retrospective study to document the sonographic and color Doppler characteristics of lymphomatous superficial lymph nodes.

We selected 130 individuals who underwent sonography, color Doppler imaging, fine-needle aspiration biopsy, and surgical removal of the nodes with the final diagnosis of lymphoma (87) and chronic adenitis (43). During sonography, for each node we considered the longitudinal and axial diameters, long/short axis ratio, visibility of the hilum, and the internal echogenicity of the node. During the color and power Doppler examination, we classified the nodes into 3 patterns: type I, "hilar normal"; type II, "hilar activated"; and type III, "peripheral."

Sonographic evidence was not significant. With color Doppler sonography, 97% of nodes affected by non-Hodgkin lymphoma, 94% of nodes affected by Hodgkin lymphoma, and 100% of non-neoplastic nodes showed hilar vascularity. Type I seemed more frequently associated with inflammation, and type II was more frequently associated with lymphoma.

The presence of peripheric subcapsular vessels, which is typical of metastasis, is definitely rare in lymphoma (with the possible exception of the uncommon subtypes of high-grade lymphomas). The differential diagnosis between lymphoma and lymphadenitis is frequently impossible on the basis of sonographic and color Doppler patterns alone; therefore, clinical evaluation and biopsy are generally mandatory.