Sonographic diagnosis of tuberculous lymphadenitis in the neck

The aim of this study was to assess the diagnostic accuracy of individual sonographic features and sonographic diagnosis for patients with a clinical suspicion of tuberculous lymphadenitis in the neck.

From January 2010 to December 2011, 79 patients who underwent neck sonography and sonographically guided fine-needle aspiration with tuberculosis polymerase chain reaction analysis for clinical suspicion of tuberculous lymphadenitis in the neck were enrolled in the study. The sonographic features of each patient were retrospectively investigated by a single radiologist using a picture archiving and communication system, and a sonographic diagnosis according to the number of sonographic features was developed. Follow-up sonography, polymerase chain reaction, core needle biopsy, or excision biopsy of lymph nodes from the neck was used for the final diagnosis.

The diagnoses of the 79 patients were finally confirmed as tuberculous lymphadenitis (n = 40), suppurative lymphadenitis (n = 2), Kikuchi disease (n = 12), metastatic lymph nodes (n = 9), and nonspecific lymphadenitis (n = 16). No sonographic features with both high sensitivity and specificity were found. In a receiver operating characteristic analysis of sonographic diagnosis, the category of 2 or more sonographic features showed the highest area under the curve. When the "2 or more" category was selected, the sensitivity, specificity, positive and negative predictive values, and accuracy of sonography for diagnosis of tuberculous lymphadenitis were 95.0%, 79.5%, 82.6%, 93.9%, and 87.3%, respectively.

Although no sonographic feature had both high sensitivity and specificity for detection of tuberculous lymphadenitis, the diagnostic accuracy of the "2 or more" category was higher than those of other categories.