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The linear echogenic hilus in cervical lymphadenopathy--a sign of benignity or malignancy?
R M Evans1, A Ahuja, C Metreweli
1Department of Diagnostic Radiology and Organ Imaging, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin.
Insights
The linear echogenic hilus on ultrasound is not a reliable indicator of benign lymph nodes. Further cytological diagnosis is recommended to confirm lymph node status.
Area of Science:
- Radiology
- Oncology
- Pathology
Background:
- The linear echogenic hilus in lymph nodes on ultrasound has been suggested as a marker for benignity.
- This echogenic line is believed to represent converging sinuses within the lymph node medulla.
Purpose of the Study:
- To evaluate the diagnostic significance of a linear echogenic hilus in cervical lymph nodes.
- To determine if this ultrasound finding can reliably predict lymph node benignity.
Main Methods:
- Retrospective analysis of 46 cases with a linear echogenic hilus in cervical lymph nodes.
- Correlation of ultrasound findings with cytological or histological diagnoses.
Main Results:
- Malignancy was diagnosed in 58.7% of cases with a linear echogenic hilus.
- Tuberculosis was found in 15.2% and benign conditions in 26% of cases.
- The linear echogenic hilus was observed in both malignant and benign lymph nodes.
Conclusions:
- The linear echogenic hilus is not a sole criterion for lymph node benignity.
- Ultrasound-guided fine needle aspiration for cytological diagnosis is crucial for accurate assessment.
- Relying solely on the linear echogenic hilus for benignity assessment can be misleading.
Abstract:
The linear echogenic hilus seen within lymph nodes on ultrasound examination has been proposed as a sign of benignity. The echogenic line is thought to represent the converging sinuses within the medulla of the lymph node. Forty-six cases with a linear echogenic hilus within a cervical lymph node are presented, where a cytological or histological diagnosis was obtained. In 27 cases (58.7%) the diagnosis was malignancy, in seven cases (15.2%) tuberculosis and the remaining 12 cases (26%) were benign. In our experience the linear echogenic hilus should not be regarded as a sole criterion for benignity. A cytological diagnosis, preferably by an ultrasound-guided fine needle aspiration, should always be sought.
