RSS-Feed abonnieren
DOI: 10.1055/s-0033-1356153
Conventional ultrasound for lymph node evaluation, update 2013
Konventionelle Lymphknotensonografie, Update 2013Publikationsverlauf
08. April 2013
04. November 2013
Publikationsdatum:
13. Februar 2014 (online)
![](https://www.thieme-connect.de/media/zfg/201402/lookinside/thumbnails/10.1055-s-0033-1356153-1.jpg)
Abstract
Conventional ultrasound is regarded as the first method of choice to evaluate lymph node disease due to its high resolution. The combination of various features obtained from the patients history including age, acute or chronic onset, symptoms, and a knowledge of underlying systemic diseases as well as imaging criteria, most importantly B-mode (gray-scale) and colour Doppler imaging (CDI) are the basis for the differential diagnosis of lymphadenopathy. New ultrasound techniques such as elastography and contrast-enhanced ultrasound may provide further information. In addition, ultrasound evaluation of lymph nodes is an essential adjunct to the clinical investigation in staging of malignant neoplasia and lymphoma. In this paper the current literature is reviewed regarding conventional B-mode and Doppler ultrasound for the evaluation of lymphadenopathy. The ultrasound criteria for the differential diagnosis of enlarged and structurally altered lymph nodes are summarized and also limitations are described.
Zusammenfassung
Sonografische Techniken sind die Methode der Wahl zur bildgebenden Abklärung der Lymphadenopathie. Die sonografische Lymphknotendiagnostik schließt B-Bild- und Farbdopplerkriterien genauso ein wie das Wissen um die Patientenanamnese, das Alter, den akuten oder chronischen Verlauf der Erkrankung sowie Erkenntnisse über Symptome und die Begleiterkrankungen. Elastografische und kontrastverstärkte Methoden können weitere Informationen beisteuern. Der Ultraschall hat sich für die Diagnosestellung und auch zum Staging von malignen Erkrankungen einschließlich von Lymphomen etabliert. In dem vorliegenden Übersichtsartikel werden die klinischen Aspekte der sonografischen Lymphknotendiagnostik diskutiert. Dabei wird sowohl eine Übersicht über konventionelle B-Bild- und Dopplerkriterien gegeben als auch die Differentialdiagnose von vergrößerten Lymphknoten erörtert. Die Limitationen der Lymphknotendiagnostik werden aufgezeigt.
-
References
- 1 Sumi M, Ohki M, Nakamura T. Comparison of sonography and CT for differentiating benign from malignant cervical lymph nodes in patients with squamous cell carcinoma of the head and neck. Am J Roentgenol Am J Roentgenol 2001; 176: 1019-1024
- 2 Leicher-Duber A, Bleier R, Duber C et al. Cervical lymph node metastases: a histologically controlled comparison of palpation, sonography and computed tomography. Röfo 1990; 153: 575-579
- 3 Ahuja AT, Ying M, Ho SY et al. Ultrasound of malignant cervical lymph nodes. Cancer Imaging 2008; 8: 48-56
- 4 Ying M, Ahuja A, Brook F. Sonographic appearances of cervical lymph nodes: variations by age and sex. J Clin Ultrasound 2002; 30: 1-11
- 5 Rettenbacher T. Sonography of peripheral lymph nodes part 1: normal findings and B-image criteria. Ultraschall Med 2010; 31: 344-362
- 6 Toma P, Granata C, Rossi A et al. Multimodality imaging of Hodgkin disease and non-Hodgkin lymphomas in children. Radiographics 2007; 27: 1335-1354
- 7 Engert A, Eichenauer DA, Dreyling M. Hodgkin's lymphoma: ESMO clinical recommendations for diagnosis, treatment and follow-up. Ann Oncol 2009; 20 (Suppl. 04) 108-109
- 8 Moehler M, Al BatranSE, Andus T et al. German S3-guideline "Diagnosis and treatment of esophagogastric cancer". Z Gastroenterol 2011; 49: 461-531
- 9 Jenssen C, Dietrich CF, Burmester E. Malignant neoplasias of the gastrointestinal tract--endosonographic staging revisited. Z Gastroenterol 2011; 49: 357-368
- 10 Schmiegel W, Pox C, Adler G et al. S3-guideline conference "Colorectal Cancer" 2004. Dtsch Med Wochenschr 2005; 130 (Suppl. 01) S5-53
- 11 Fischerova D. Ultrasound scanning of the pelvis and abdomen for staging of gynecological tumors: a review. Ultrasound Obstet Gynecol 2011; 38: 246-266
- 12 Vassallo P, Wernecke K, Roos N et al. Differentiation of benign from malignant superficial lymphadenopathy: the role of high-resolution US. Radiology 1992; 183: 215-220
- 13 Ahuja AT, Ying M. Sonographic evaluation of cervical lymph nodes. Am J Roentgenol Am J Roentgenol 2005; 184: 1691-1699
- 14 Hocke M, Schulze E, Gottschalk P et al. Contrast-enhanced endoscopic ultrasound in discrimination between focal pancreatitis and pancreatic cancer. World J Gastroenterol 2006; 12: 246-250
- 15 Ying M, Ahuja A. Sonography of neck lymph nodes. Part I: normal lymph nodes. Clin Radiol 2003; 58: 351-358
- 16 Hocke M, Menges M, Topalidis T et al. Contrast-enhanced endoscopic ultrasound in discrimination between benign and malignant mediastinal and abdominal lymph nodes. J Cancer Res Clin Oncol 2008; 134: 473-480
- 17 Rouviere H. Anatomie des lymphatiques de l'homme. Paris: Masson; 1932
- 18 Qatarneh SM, Kiricuta IC, Brahme A et al. Three-dimensional atlas of lymph node topography based on the visible human data set. Anat Rec B New Anat 2006; 289: 98-111
- 19 Kaldjian EP, Gretz JE, Anderson AO et al. Spatial and molecular organization of lymph node T cell cortex: a labyrinthine cavity bounded by an epithelium-like monolayer of fibroblastic reticular cells anchored to basement membrane-like extracellular matrix. Int Immunol 2001; 13: 1243-1253
- 20 Katakai T, Hara T, Lee JH et al. A novel reticular stromal structure in lymph node cortex: an immuno-platform for interactions among dendritic cells, T cells and B cells. Int Immunol 2004; 16: 1133-1142
- 21 Cui XW, Ignee A, Bachmann NM et al. Contrast enhanced ultrasound of sentinel lymph nodes. J Ultrason 2013; 13: 73-81
- 22 van den Brekel MW, Stel HV, Castelijns JA et al. Cervical lymph node metastasis: assessment of radiologic criteria. Radiology 1990; 177: 379-384
- 23 Solbiati L, Rizatto G, Bellotti E et al. High resolution sonography of cervical lymph nodes in head and neck cancer: criteria for differentiation of reactive versus malignant nodes. Radiology 1988; 169: 113
- 24 Schroder W, Baldus SE, Monig SP et al. Lymph node staging of esophageal squamous cell carcinoma in patients with and without neoadjuvant radiochemotherapy: histomorphologic analysis. World J Surg 2002; 26: 584-587
- 25 Monig SP, Zirbes TK, Schroder W et al. Staging of gastric cancer: correlation of lymph node size and metastatic infiltration. Am J Roentgenol Am J Roentgenol 1999; 173: 365-367
- 26 Monig SP, Baldus SE, Zirbes TK et al. Lymph node size and metastatic infiltration in colon cancer. Ann Surg Oncol 1999; 6: 579-581
- 27 Jurgensen C, Dietrich CF. Role of endoscopic ultrasound (EUS) in the staging of rectal cancer. Z Gastroenterol 2008; 46: 580-589
- 28 Dietrich CF, Schneider JG, Ignee A. Schilddrüsensonografie: Eine Übersicht. Endoskopie Heute 2007; 20: 17-27
- 29 van Overhagen H, Lameris JS, Berger MY et al. Supraclavicular lymph node metastases in carcinoma of the esophagus and gastroesophageal junction: assessment with CT, US, and US-guided fine-needle aspiration biopsy. Radiology 1991; 179: 155-158
- 30 Bruneton JN, Balu-Maestro C, Marcy PY et al. Very high frequency (13 MHz) ultrasonographic examination of the normal neck: detection of normal lymph nodes and thyroid nodules. J Ultrasound Med 1994; 13: 87-90
- 31 Ying M, Ahuja A, Brook F et al. Sonographic appearance and distribution of normal cervical lymph nodes in a Chinese population. J Ultrasound Med 1996; 15: 431-436
- 32 Ying M, Ahuja A, Brook F et al. Nodal shape (S/L) and its combination with size for assessment of cervical lymphadenopathy: which cut-off should be used?. Ultrasound Med Biol 1999; 25: 1169-1175
- 33 Steinkamp HJ, Teske C, Knobber E et al. Sonography in tumor after-care of head-neck tumor patients. Value of sonomorphologic criteria and sonographic M/Q quotients. Ultraschall Med 1994; 15: 81-88
- 34 Gritzmann N, Hollerweger A, Macheiner P et al. Sonography of soft tissue masses of the neck. J Clin Ultrasound 2002; 30: 356-373
- 35 Tregnaghi A, De Candia A, Calderone M et al. Ultrasonographic evaluation of superficial lymph node metastases in melanoma. Eur J Radiol 1997; 24: 216-221
- 36 Esen G, Gurses B, Yilmaz MH et al. Gray scale and power Doppler US in the preoperative evaluation of axillary metastases in breast cancer patients with no palpable lymph nodes. Eur Radiol 2005; 15: 1215-1223
- 37 Moore A, Hester M, Nam MW et al. Distinct lymph nodal sonographic characteristics in breast cancer patients at high risk for axillary metastases correlate with the final axillary stage. Br J Radiol 2008; 81: 630-636
- 38 Barreiros AP, Braden B, Schieferstein-Knauer C et al. Characteristics of intestinal tuberculosis in ultrasonographic techniques. Scand J Gastroenterol 2008; 43: 1224-1231
- 39 Steinkamp HJ, Beck A, Werk M et al. Extracapsular spread of cervical lymph node metastases: diagnostic relevance of ultrasound examinations. Ultraschall Med 2003; 24: 323-330
- 40 Shozushima M, Suzuki M, Nakasima T et al. Ultrasound diagnosis of lymph node metastasis in head and neck cancer. Dentomaxillofac Radiol 1990; 19: 165-170
- 41 Johnson JT. A surgeon looks at cervical lymph nodes. Radiology 1990; 175: 607-610
- 42 Som PM. Lymph nodes of the neck. Radiology 1987; 165: 593-600
- 43 Ahuja A, Ying M, King A et al. Lymph node hilus: gray scale and power Doppler sonography of cervical nodes. J Ultrasound Med 2001; 20: 987-992
- 44 Gritzmann N. Sonography of the neck: current potentials and limitations. Ultraschall Med 2005; 26: 185-196
- 45 Esen G. Ultrasound of superficial lymph nodes. Eur J Radiol 2006; 58: 345-359
- 46 Piscaglia F, Nolsoe C, Dietrich CF et al. The EFSUMB guidelines and recommendations on the clinical practice of contrast enhanced ultrasound (CEUS): update 2011 on non-hepatic applications. Ultraschall Med 2012; 33: 33-59
- 47 Na DG, Lim HK, Byun HS et al. Differential diagnosis of cervical lymphadenopathy: usefulness of color Doppler sonography. Am J Roentgenol Am J Roentgenol 1997; 168: 1311-1316
- 48 Steinkamp HJ, Wissgott C, Rademaker J et al. Current status of power Doppler and color Doppler sonography in the differential diagnosis of lymph node lesions. Eur Radiol 2002; 12: 1785-1793
- 49 Tzankov A, Heiss S, Ebner S et al. Angiogenesis in nodal B cell lymphomas: a high throughput study. J Clin Pathol 2007; 60: 476-482
- 50 Farinha P, Kyle AH, Minchinton AI et al. Vascularization predicts overall survival and risk of transformation in follicular lymphoma. Haematologica 2010; 95: 2157-2160
- 51 Cardesa-Salzmann TM, Colomo L, Gutierrez G et al. High microvessel density determines a poor outcome in patients with diffuse large B-cell lymphoma treated with rituximab plus chemotherapy. Haematologica 2011; 96: 996-1001
- 52 Dietrich CF, Jedrzejczyk M, Ignee A. Sonographic assessment of splanchnic arteries and the bowel wall. Eur J Radiol 2007; 64: 202-212
- 53 Ignee A, Jedrejczyk M, Schuessler G et al. Quantitative contrast enhanced ultrasound of the liver for time intensity curves – Reliability and potential sources of errors. Eur J Radiol 2010; 73: 153-158
- 54 Dietrich CF, Ignee A, Hocke M et al. Pitfalls and artefacts using contrast enhanced ultrasound. Z Gastroenterol 2011; 49: 350-356
- 55 Ignee A, Gebel M, Caspary WF et al. Doppler imaging of hepatic vessels – review. Z Gastroenterol 2002; 40: 21-32
- 56 Dietrich CF. Endoscopic ultrasound, an introductory manual and atlas. 2nd edition. Stuttgart: Thieme Verlag; 2011
- 57 Dietrich CF. Ultraschall-Kurs. 6. Aufl. Deutscher Ärzteverlag; 2012
- 58 Schmid-Wendtner MH, Partscht K, Korting HC et al. Improved differentiation of benign and malignant lymphadenopathy in patients with cutaneous melanoma by contrast-enhanced color Doppler sonography. Arch Dermatol 2002; 138: 491-497
- 59 Steinkamp HJ, Teichgraber UK, Mueffelmann M et al. Differential diagnosis of lymph node lesions. A semiquantitative approach with power Doppler sonography. Invest Radiol 1999; 34: 509-515
- 60 Wu CH, Chang YL, Hsu WC et al. Usefulness of Doppler spectral analysis and power Doppler sonography in the differentiation of cervical lymphadenopathies. Am J Roentgenol Am J Roentgenol 1998; 171: 503-509
- 61 Wu CH, Shih JC, Chang YL et al. Two-dimensional and three-dimensional power Doppler sonographic classification of vascular patterns in cervical lymphadenopathies. J Ultrasound Med 1998; 17: 459-464
- 62 Wu CH, Hsu MM, Chang YL et al. Vascular pathology of malignant cervical lymphadenopathy: qualitative and quantitative assessment with power Doppler ultrasound. Cancer 1998; 83: 1189-1196
- 63 Tschammler A, Wirkner H, Ott G et al. Vascular patterns in reactive and malignant lymphadenopathy. Eur Radiol 1996; 6: 473-480
- 64 Tschammler A, Hahn D. Multivariate analysis of the adjustment of the colour duplex unit for the differential diagnosis of lymph node alterations. Eur Radiol 1999; 9: 1445-1450
- 65 Dietrich CF. Endoscopic ultrasound. An introductory manual and atlas. Stuttgart: Thieme Verlag; 2008
- 66 Ho SS, Metreweli C, Ahuja AT. Does anybody know how we should measure Doppler parameters in lymph nodes?. Clin Radiol 2001; 56: 124-126
- 67 Ahuja A, Ying M, Yuen YH et al. Power Doppler sonography to differentiate tuberculous cervical lymphadenopathy from nasopharyngeal carcinoma. AJNR Am J Neuroradiol 2001; 22: 735-740
- 68 Ying M, Ahuja A, Brook F. Repeatability of power Doppler sonography of cervical lymph nodes. Ultrasound Med Biol 2002; 28: 737-744
- 69 Chang DB, Yuan A, Yu CJ et al. Differentiation of benign and malignant cervical lymph nodes with color Doppler sonography. Am J Roentgenol Am J Roentgenol 1994; 162: 965-968
- 70 Goldberg BB, Merton DA, Liu JB et al. Contrast-enhanced ultrasound imaging of sentinel lymph nodes after peritumoral administration of Sonazoid in a melanoma tumor animal model. J Ultrasound Med 2011; 30: 441-453
- 71 Hocke M, Ignee A, Topalidis T et al. Contrast-enhanced endosonographic Doppler spectrum analysis is helpful in discrimination between focal chronic pancreatitis and pancreatic cancer. Pancreas 2007; 35: 286-288
- 72 Dietrich CF, Cui XW, Barreiros AP et al. EFSUMB guidelines 2011: comment on emergent indications and visions. Ultraschall Med 2012; 33 (Suppl. 01) S39-S47
- 73 Dietrich CF, Schreiber-Dietrich D, Hocke M. Comments on the EFSUMB non-liver Guidelines 2011. Praxis (Bern 1994) 2012; 101: 1175-1181
- 74 EFSUMB. European Course Book. London: European Federation of Societies for Ultrasound in Medicine and Biology; 2012
- 75 Dietrich CF. Editorial "Challenges for the German Health Care System". Z Gastroenterol 2012; 50: 555-556
- 76 Dietrich CF, Riemer-Hommel P. Challenges for the German Health Care System. Z Gastroenterol 2012; 50: 557-572
- 77 Dietrich CF, Ponnudurai R, Bachmann NM. Is there a need for new imaging methods for lymph node evaluation?. Ultraschall Med 2012; 33: 411-414
- 78 Schreiber-Dietrich D, Dietrich CF. Contrast enhanced ultrasound (CEUS) and off-label use (in children). Ultraschall Med 2012; 33: 295-296
- 79 Cui XW, Jenssen C, Saftoiu A et al. New ultrasound techniques for lymph node evaluation. World J Gastroenterol 2013; 19: 4850-4860
- 80 Dietrich CF, Hocke M, Jenssen C. Ultrasound for abdominal lymphadenopathy. Dtsch Med Wochenschr 2013; 138: 1001-1018
- 81 Claudon M, Dietrich CF, Choi BI et al. Guidelines and good clinical practice recommendations for contrast enhanced ultrasound (CEUS) in the liver – update 2012: A WFUMB-EFSUMB initiative in cooperation with representatives of AFSUMB, AIUM, ASUM, FLAUS and ICUS. Ultrasound Med Biol 2013; 39: 187-210
- 82 Claudon M, Dietrich CF, Choi BI et al. Guidelines and good clinical practice recommendations for contrast enhanced ultrasound (CEUS) in the liver – update 2012: a WFUMB-EFSUMB initiative in cooperation with representatives of AFSUMB, AIUM, ASUM, FLAUS and ICUS. Ultraschall Med 2013; 34: 11-29
- 83 Dietrich CF, Sharma M, Hocke M. Contrast enhanced endoscopic ultrasound. Endoscopic Ultrasound 2013; 1: 130-136
- 84 Dietrich CF, Jenssen C. Evidence based endoscopic ultrasound. Z Gastroenterol 2011; 49: 599-621
- 85 Dietrich CF. Interventional endosonography. Ultraschall Med 2011; 32: 8-22
- 86 Bamber J, Cosgrove D, Dietrich CF et al. EFSUMB Guidelines and recommendations on the clinical use of ultrasound elastography. Part 1: basic principles and technology. Ultraschall Med 2013; 34: 169-184
- 87 Dietrich CF. Echtzeit-Gewebeelastografie. Anwendungsmöglichkeiten nicht nur im Gastrointestinaltrakt. Endoskopie Heute 2010; 23: 177-212
- 88 Dietrich CF, Cantisani V. Current status and perspectives of elastography. Eur J Radiol 2013; Mar 26. [Epub ahead of print]
- 89 Dietrich CF, Rudd L. The EFSUMB website, a guide for better understanding. Med Ultrason 2013; 15: 215-223
- 90 Obwegeser R, Lorenz K, Hohlagschwandtner M et al. Axillary lymph nodes in breast cancer: is size related to metastatic involvement?. World J Surg 2000; 24: 546-550
- 91 Dietrich CF, Liesen M, Buhl R et al. Detection of normal mediastinal lymph nodes by ultrasonography. Acta Radiol 1997; 38: 965-969
- 92 Dietrich CF, Lee JH, Herrmann G et al. Enlargement of perihepatic lymph nodes in relation to liver histology and viremia in patients with chronic hepatitis C. Hepatology 1997; 26: 467-472
- 93 Dietrich CF, Zeuzem S, Caspary WF et al. Ultrasound lymph node imaging in the abdomen and retroperitoneum of healthy probands. Ultraschall Med 1998; 19: 265-269