Multimodal sonography with virtual touch IQ for entity differentiation between lymphoma and cervical lymph node metastasis: a case report

Introduction:

The correct differentiation of cervical lymph nodes is one of the main parts of the diagnosis in head and neck cancer. Important sonographic features for the detection of malignant lymph nodes (LN) are the size, shape and the so-called „hilus“ sign. Virtual Touch IQ (VTIQ) is a relatively new elastographic method that allows quantitative measurements of the mechanical stiffness of the tissue. An increase in stiffness in LN metastasis in squamous cell carcinoma (SCC) has been shown in previous studies.

Case presentation:

We present a 74-year-old patient with a histologically confirmed SCC of the left pinna cT2.

The following CT-scan showed increased pathological LN on both sides of the neck.

In addition to multiple cervical LN on both sides, a 21.5 × 9.6 × 13.5 mm oval, hypoechoic LN with hilus marking in level II on the left was also detected sonographically. The performed elastography showed homogeneous soft areas within the LN. In VTIQ, velocity from 1.9 m/s up to 3.1 m/s were measured throughout the whole area.

We performed a partial ablation of the left pinna and multiple punch biopsies of the left cervical LN in level II. Histopathological examination of the biopsies had revealed a chronic lymphocytic leukemia, so that the patient was further treated by haematooncology.

Conclusion:

Multimodal sonography with elastography and VTIQ can be helpful for further differentiation between lymphoma and LN metastasis in suspicious cervical masses and thus represents a promising diagnostic procedure.

Publication History

Publication Date:
18 April 2018 (online)