Diagnostic Correlation of Ultrasonographic Findings With Fine-Needle Aspiration Cytology and Histopathology in Patients With Cervical Lymphadenopathy

Abstract

Background: Cervical lymphadenopathy is a common clinical condition encountered across all age groups and may arise from infectious, inflammatory, or malignant etiologies. Accurate differentiation between benign and malignant cervical lymph nodes is essential because treatment strategies and prognosis vary considerably. High-resolution ultrasonography (USG), combined with color Doppler imaging, provides a rapid, non-invasive, and cost-effective method for evaluating cervical lymph nodes. Histopathological examination (HPE) and Fine Needle Aspiration Cytology (FNAC) remain the reference standards for definitive diagnosis.

Objective: To evaluate the diagnostic performance of high-resolution ultrasonography in differentiating neoplastic from non-neoplastic cervical lymphadenopathy and to correlate ultrasonographic findings with FNAC/histopathological diagnosis.

Materials and Methods: This prospective observational study included 76 patients presenting with cervical lymphadenopathy. The study was conducted in the Department of Radiodiagnosis, VMKV Medical College Hospital & Research Centre, Salem, Tamil Nadu, India.

All patients underwent high-resolution ultrasonography using 7–15 MHz linear array transducers. Gray-scale and color Doppler sonographic parameters evaluated included:

Nodal level, Laterality, Size, Shape, Short-axis/Long-axis (S/L) ratio, Margins, Echogenic hilum, Echotexture, Intranodal necrosis, Intranodal reticulation, Calcification, Matting, Adjacent soft tissue edema, Vascularity pattern.

Ultrasonographic diagnosis was subsequently correlated with FNAC and histopathological examination.

Results : Among the 76 patients, ultrasonography classified

• 58 patients (76.3%) as non-neoplastic
• 18 patients (23.7%) as malignant.

Among non-neoplastic lesions,

• Tuberculous lymphadenitis constituted 51.3%
• Reactive lymphadenitis constituted 25.0%

Malignant lymphadenopathy accounted for 23.7% of cases.

Reactive lymph nodes predominantly demonstrated

• Oval configuration
• S/L ratio <0.7
• Preserved echogenic hilum
• Hypoechoic echotexture
• Hilar vascularity

Tuberculous lymph nodes commonly showed

• Matting
• Adjacent soft tissue edema
• Intranodal necrosis

Malignant lymph nodes were significantly associated with

• Round shape
• S/L ratio >0.7
• Absent fatty hilum
• Hyperechoic echotexture
• Ill-defined borders
• Intranodal necrosis
• Calcification
• Reticulation
• Peripheral or mixed vascularity

Ultrasonography demonstrated

• Sensitivity: 94.7%
• Specificity: 100%

for differentiating malignant from benign cervical lymphadenopathy.

Conclusion: High-resolution ultrasonography combined with color Doppler is an excellent first-line imaging modality for evaluating cervical lymphadenopathy. Multiple sonographic parameters interpreted together provide excellent diagnostic accuracy in differentiating benign from malignant lymph nodes. Correlation with FNAC/histopathology further improves diagnostic confidence and facilitates appropriate clinical management.