RESUMEN
PURPOSE: Cervical lymph nodes with cystic changes are an important finding seen with several pathologies including papillary thyroid carcinoma (PTC), tuberculosis (TB) and HPV-positive oropharyngeal squamous cell carcinoma (HPVâ¯+â¯OPSCC). In the absence of known primary tumor or conclusive medical history, differentiating among these nodes is difficult. We compared the pathologic nodes of PTC, TB and HPVâ¯+â¯OPSCC to identify imaging features useful for their differentiation. MATERIALS AND METHODS: Fifty-five PTC, 58 TB and 51 HPVâ¯+â¯OPSCC nodes were selected based on surgical pathology records and suspicious morphological features. These nodes were compared for morphological features: long axis length, nodal shape, nodal location, presence of cystic change, area of cystic change:area of entire node ratio, Hounsfield unit of the cystic component, degree of enhancement, enhancement pattern, presence of calcification, presence of perinodal infiltration, and presence of surrounding inflammatory changes. RESULTS: PTC nodes formed calcifications more frequently and demonstrated greater enhancement (Pâ¯<â¯0.01). TB nodes were characterized by their irregular shape (Pâ¯<â¯0.05), irregular enhancement surrounding the cystic change (Pâ¯<â¯0.01), greater frequencies of perinodal infiltration (Pâ¯<â¯0.01) and surrounding inflammatory changes (Pâ¯<â¯0.01). While no unique features were seen with HPV+OPSCC, they were characterized by the absence of those features that distinguished the other groups: these nodes tended to have smooth, circumscribed margins with no hyperenhancement, calcifications or inflammatory changes. PTC and TB nodes were more frequently identified in the lower neck, while HPV+OPSCC nodes were localized to the upper neck (Pâ¯<â¯0.01). CONCLUSIONS: PTC, TB and HPVâ¯+â¯OPSCC lymph nodes can be differentiated based on their morphologies and locations.
