Published online Aug 14, 2013. doi: 10.3748/wjg.v19.i30.4850
Revised: April 4, 2013
Accepted: May 7, 2013
Published online: August 14, 2013
Conventional ultrasound (US) is the recommended imaging method for lymph node (LN) diseases with the advantages of high resolution, real time evaluation and relative low costs. Current indications of transcutaneous ultrasound and endoscopic ultrasound include the detection and characterization of lymph nodes and the guidance for LN biopsy. Recent advances in US technology, such as contrast enhanced ultrasound (CEUS), contrast enhanced endoscopic ultrasound (CE-EUS), and real time elastography show potential to improve the accuracy of US for the differential diagnosis of benign and malignant lymph nodes. In addition, CEUS and CE-EUS have been also used for the guidance of fine needle aspiration and assessment of treatment response. Complementary to size criteria, CEUS could also be used to evaluate response of tumor angiogenesis to anti-angiogenic therapies. In this paper we review current literature regarding evaluation of lymphadenopathy by new and innovative US techniques.
Core tip: The differentiation of malignant from benign lymph nodes by ultrasound, computed tomography and magnetic resonance imaging traditionally relies mainly on size measurements and topographic distribution. However, sensitivity and specificity in the differentiation of benign and malignant lymph nodes are disappointing using only size parameters. The presented paper is intended to discuss, comment and illustrate the clinical important work-up of lymphadenopathy with respect of recently introduced imaging techniques including contrast enhanced ultrasound and elastography.