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      Ultrasound evaluation of the morphometric patterns of lymph nodes of the head and neck in young and middle-aged individuals* Translated title: Padrão ultrassonográfico dos linfonodos da cabeça e pescoço em indivíduos jovens e de meia-idade

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          Abstract

          Objective

          To show the morphometric patterns of lymph nodes of the head and neck, evaluating their number, shape, dimensions, hilum, and cortex, through the use of ultrasound examination of the neck.

          Materials and Methods

          We analyzed 400 right and left lymph nodes in a group of 20 healthy young and middle-aged individuals of both genders.

          Results

          In the ultrasound examination, we observed the following lymph nodes: mastoid; parotid (superficial, extraglandular, and intraglandular); submandibular (preglandular, retroglandular, and intracapsular); submental; and cervical (anterior and posterior). Although some individuals had up to seven lymph nodes in the same region, most had only two to three per region. The smallest lymph node diameter observed was 0.4 cm, and the largest was 2.7 cm. Most lymph nodes showed an elongated or oval shape. Most of the lymph node hila were echogenic, although a few were hyperechoic. However, the cortex was clearly hypoechoic in all of the lymph nodes evaluated.

          Conclusion

          Ultrasound examination of healthy individuals allowed the characteristics of the lymph nodes of the head and neck to be observed clearly, which could provide a basis for the analysis of patients with diseases of these lymph nodes.

          Translated abstract

          Objetivo

          Fornecer padrão morfoquantitativo ultrassonográfico dos linfonodos da cabeça e pescoço, mediante avaliação do seu número, forma, dimensões, hilo e córtex, como base para diagnóstico de alterações nestes parâmetros.

          Materiais e Métodos

          Foram analisados 400 linfonodos dos lados direito e esquerdo de 20 indivíduos, homens e mulheres, jovens e de meia-idade.

          Resultados

          Os linfonodos observados no exame ultrassonográfico foram: mastóideos, parotídeos superficiais, parotídeos extraglandulares, parotídeos intraglandulares, submandibulares pré-glandulares, retroglandulares e intracapsulares, submentuais, cervicais anteriores e posteriores. Quanto ao número de linfonodos, alguns indivíduos apresentaram até sete em uma mesma região, mas a maioria apresentou de dois a três linfonodos por região. O menor diâmetro dos linfonodos foi 0,4 cm e o maior foi 2,7 cm. A maioria dos linfonodos apresentou forma alongada ou ovalada. O hilo dos linfonodos apresentou-se geralmente ecogênico e poucas vezes hiperecogênico. De modo geral, o córtex dos linfonodos mostrou-se muito pouco ecogênico.

          Conclusão

          A ultrassonografia de indivíduos sadios permitiu uma clara observação das características dos linfonodos da região da cabeça e pescoço, que podem ser importantes para análise de pacientes portadores de afecções desses linfonodos.

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          Most cited references21

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          Differentiation of benign from malignant superficial lymphadenopathy: the role of high-resolution US.

          Ultrasonography has proved a valuable tool for the detection of enlarged lymph nodes; however, differentiation between benign and malignant nodal disease remains a problem. High-frequency probes with improved spatial and contrast resolution display superficial nodes to advantage and also show the internal structure of the nodes. Ninety-four superficial nodes in patients with suspected nodal disease were examined by using 7.5-MHz probes to evaluate longitudinal-transverse diameter ratio (L/T), the central hilus, cortical widening, and size. Histologic diagnosis was obtained after sonographic examination in 73 nodes (five reactive nodes, 35 primary nodal malignancies, and 33 nodal metastases). The remaining 21 nodes regressed after either antibiotic or no therapy. Marked differences were observed among the proportions of benign and malignant nodes in terms of L/T, hilus, and cortex; the latter two structures, however, must be interpreted together. Eccentric cortical widening was seen in only malignant nodes. The distribution of nodal size was not significantly (P greater than .1) different for benign and malignant nodes. No differences were observed between primary and secondary nodal malignancies. The sonographic criteria evaluated in this study assist in the differentiation of benign from malignant superficial lymph nodes.
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            Imaging-based nodal classification for evaluation of neck metastatic adenopathy.

            This study was undertaken to create an imaging-based classification for the lymph nodes of the neck that will be readily accepted by clinicians, result in consistent nodal classification, and be easily used by radiologists. Over an 18-month period, the necks of 50 patients with cervical lymphadenopathy were scanned with CT, MR imaging, or both. Imaging anatomic landmarks were sought that would create a nodal classification of these necks similar to the clinically based nodal classifications of the American Joint Committee on Cancer and the American Academy of Otolaryngology-Head and Neck Surgery. Each nodal level was defined to ensure consistent nodal classification and eliminate areas of confusion existing in the clinically based classifications. Necks were classified using the imaging-based classification and then compared with the classification of the same necks using the most common clinically based classifications. The imaging-based nodal classifications of the superficial nodes were the same as the clinically based classifications; however, the deep nodes of eight patients were found only by imaging. The anatomic precision and the level definition afforded by sectional imaging allowed the radiologists to use the imaging-based classification in a consistent manner. This imaging-based classification has been endorsed by clinicians who specialize in head and neck cancer. The boundaries of the nodal levels were easily discerned by radiologists and yielded consistent nodal classifications. The reproducibility of this classification will allow it to become an essential component of future classifications of metastatic neck disease.
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              Sonographic evaluation of cervical lymphadenopathy: is power Doppler sonography routinely indicated?

              Routine sonographic examination of neck nodes now includes both grey-scale and Doppler sonography. Although the addition of Doppler sonography to the well-established practice of grey-scale sonography increases the amount of information obtained by sonography, it also increases the examination time, particularly if spectral Doppler and estimation of vascular resistance is performed. This study was, therefore, undertaken to evaluate whether Doppler sonography is routinely indicated in every case or its use should be limited to those cases where grey-scale sonography is equivocal. We evaluated the grey-scale and power Doppler sonograms of 101 fine-needle aspiration cytology (FNAC)-proven metastatic nodes and 72 FNAC-proven nonmetastatic nodes. All lymph nodes were evaluated with grey-scale and power Doppler sonography. The shape, echogenicity, internal architecture, vascular distribution and vascular resistance of the lymph nodes were evaluated. Grey-scale sonographic features evaluated in this study had a high sensitivity (95%) and specificity (83%) in classifying metastatic and nonmetastatic nodes. Metastatic and nonmetastatic lymph nodes that could not be classified by grey-scale sonography demonstrated Doppler features that helped in their correct identification. Power Doppler sonography is not necessary for every case in routine clinical practice, but is essential and useful in patients where grey-scale sonography is equivocal. In this study, power Doppler sonography aided in the diagnosis in 5% and 17% of patients with metastatic and nonmetastatic nodes, respectively.
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                Author and article information

                Journal
                Radiol Bras
                Radiol Bras
                rb
                Radiologia Brasileira
                Colégio Brasileiro de Radiologia e Diagnóstico por Imagem
                0100-3984
                1678-7099
                Jul-Aug 2016
                Jul-Aug 2016
                : 49
                : 4
                : 225-228
                Affiliations
                [1 ]Intern at the Hospital do Servidor Público Estadual de São Paulo and at the Faculdade de Medicina da Universidade Cidade de São Paulo (Unicid), São Paulo, SP, Brazil.
                [2 ]MD, Sonographer at the Clínica Tucunduva, Jundiaí, SP, Brazil.
                [3 ]Tenured Professor of the Graduate School at the Universidade São Judas Tadeu (USJT), São Paulo, SP, Brazil.
                [4 ]Tenured Professor in the Faculdade de Medicina da Universidade Cidade de São Paulo (Unicid), São Paulo, SP, Brazil.
                Author notes
                Mailing address: Dra. Beatriz Ogassavara. Universidade Cidade de São Paulo. Rua Cesário Galero, 448/475, Tatuapé, São Paulo, SP, Brazil, 03071-000. E-mail: beatriz_ogassavara@ 123456hotmail.com .
                Article
                10.1590/0100-3984.2015.0002
                5073388
                27777475
                ba480cfb-f501-4d56-bfd4-073a3dfba642
                © Colégio Brasileiro de Radiologia e Diagnóstico por Imagem

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 01 January 2015
                : 14 July 2015
                Categories
                Original Articles

                lymph nodes/anatomy & histology,radiology,diagnostic imaging

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