Background: The EUS appearance of lymph nodes in patients undergoing evaluation for malignancy was studied. Methods: In 378 patients EUS characteristics were assessed: size of tumor, largest lymph node size, number of lymph nodes, distance of lymph nodes from the tumor, and on a 5-point visual analogue scale (1 = least malignant to 5 = most malignant), roundness, homogeneity, and echogenicity. A morphology score (sum of roundness, homogeneity, and echogenicity) was calculated. Findings were compared with fine needle aspiration or surgical histopathology in 238 patients. Results: When using multivariate analysis, only lymph node size (1.4 ± 0.1 cm vs. 1.7 ± 0.1 cm, p = 0.001), distance from tumor (3.1 ± 0.4 cm vs. 1.6 ± 0.4 cm, p = 0.013), and morphology score (9.9 ± 0.3 vs. 11.9 ± 0.3, p = 0.001) for benign versus malignant lymph nodes (mean ± SEM) were significant. Lymph node size was significant for esophageal cancer (p = 0.006) and other mediastinal lymph nodes (p = 0.007) but not for pancreaticobiliary malignancies (p = 0.1) or celiac lymph nodes (p = 0.4). Distance from the tumor was significant for pancreaticobiliary (p = 0.01) but not esophageal cancers (p = 0.7). Morphology was significant for all sites. The presence of at least one lymph node of 1 cm or greater within 1 cm of the tumor and with a morphology score of 14 or greater had a positive predictive value of 81% (prevalence = 13%). A morphology score of 6 or less had a negative predictive value of 92% (prevalence = 12%). Conclusions: Patients with malignant adenopathy have lymph nodes that are larger, closer to the primary tumor, rounder, darker, and more homogeneous than those of patients without malignant adenopathy.
ASJC Scopus subject areas
- Radiology Nuclear Medicine and imaging