Diagnostic Accuracy of Ultrasound to Differentiate Neoplastic and Non-Neoplastic causes of Cervical Lymphadenopathy taking Histopathology as the Gold Standard

Objective: To evaluate the efficacy of high-resolution ultrasound and colour Doppler in differentiating neoplastic and nonneoplastic causes of cervical lymphadenopathy compared to histopathological diagnosis. Study Design: Cross-Sectional study. Place and Duration of Study: Pakistan Institute of Medical Sciences, Islamabad Pakistan, from Jan to Jun 2019. Methodology: The study included 110 patients with palpable cervical lymph nodes undergoing neck ultrasound and Fine needle aspiration cytology/Biopsy. Certain important sonological features were considered to categorize them into nonneoplastic and neoplastic groups. Colour Doppler imaging was employed along with grey-scale imaging. The histopathology results were compared with sonographic findings to determine the diagnostic accuracy of ultrasound in differentiating neoplastic from non-neoplastic causes of enlarged cervical lymph nodes. Results: Our study revealed that High-resolution sonography has 94.4% sensitivity and 88.8% specificity, differentiating between neoplastic and non-neoplastic causes of cervical lymphadenopathy. At the same time, the overall accuracy of ultrasound is 90.9%. The most consistent grey-scale feature in the non-neoplastic nodal group was preserved central fatty hilum, while its loss was significantly associated with neoplastic etiologies.Conclusion: Due to high sensitivity and negative predictive value, high-resolution sonography can be deployed as a first-line investigating tool for enlarged lymph nodes, and invasive procedures like Fine needle aspiration cytology (FNAC) can be abandoned in non-neoplastic lymphadenopathies.