To Determine and Distinguish Enlarged Cervical Lymph Node Characteristics between Lymphoma and Nodal Metastasis by Using Computed Tomography

Abstract

Objective: To describe and distinguish the computed tomography (CT) characteristics of enlarged cervical lymph nodes in lymphoma and nodal metastasis.

Method: 40 patients from January 2010 to December 2011 who underwent the computed tomography of the neck due to enlarged cervical lymph nodes and were proved pathologically as lymphoma or nodal metastasis from biopsy were included. The data were retrospectively reviewed from medical records. The computed tomographic characteristics were reviewed from a radiologist in a blind fashion without knowledge of whether nature of diseases were.

Results: The statistically significant differences of CT characteristics of neck lymph nodes between lymphoma and nodal metastasis were observed, which were the presence of lymph node necrosis (20% versus 84%, p < 0.01), the heterogeneous density nodes (20% versus 88%, p < 0.01), the presence of lymph nodes in level V and posterior triangle (93.3% versus 40%, p < 0.01) and the difference of enhancement (p < 0.01). The sensitivity, specificity, positive predictive value and negative predictive value of the statistically significant differences of CT characteristics were calculated. No statistically significant differences of CT characteristics were seen in sex, age, size of lymph nodes in miminal diameter, margin, extracapsular fat infiltration, encasement, matted appearance, invasion and bone destruction.

Conclusion: Lymphoma is likely to be more homogeneous density, low enhancement and presents mostly at all zones particularly in level V and posterior triangle of neck which demonstrates the most favorable sensitivity and specificity CT characteristics. The nodal metastasis tends to have necrosis and heterogeneous density after intravenous contrast enhancement.