DOI QR코드

DOI QR Code

Comparison of Ultrasonographic Findings of Biopsy-Proven Tuberculous Lymphadenitis and Kikuchi Disease

  • Ryoo, Inseon (Department of Radiology, Guro Hospital, Korea University College of Medicine) ;
  • Suh, Sangil (Department of Radiology, Guro Hospital, Korea University College of Medicine) ;
  • Lee, Young Hen (Department of Radiology, Ansan Hospital, Korea University College of Medicine) ;
  • Seo, Hyung Suk (Department of Radiology, Ansan Hospital, Korea University College of Medicine) ;
  • Seol, Hae Young (Department of Radiology, Guro Hospital, Korea University College of Medicine)
  • Received : 2014.08.11
  • Accepted : 2015.03.24
  • Published : 2015.08.01

Abstract

Objective: Although tuberculous lymphadenitis and Kikuchi disease are common causes of cervical lymphadenopathy in Asians and exhibit similar clinical manifestations, their treatment strategies are totally different. The purpose of this study was to identify ultrasonographic features that distinguish these two diseases. Materials and Methods: This study was approved by the Institutional Review Board. The study included 77 patients with tuberculous lymphadenitis and 135 patients with Kikuchi disease. The sex and age distributions of the patients were analyzed. The size and shape of lymph nodes (LNs), presence of conglomeration, increased perinodal echogenicity, echogenic hilum, posterior neck involvement, internal calcification, patterns of internal necrosis, laterality of involved LNs, and hilar vascular patterns on ultrasonography were compared between the two groups. Multiple logistic regression analysis was conducted to identify independent findings to discriminate tuberculous lymphadenitis from Kikuchi disease. Finally, diagnostic accuracies were calculated using the independent findings. Results: The presence of an echogenic hilum, internal calcification, patterns of internal necrosis, and LN hilar vascular structures on power Doppler ultrasonography were independent findings that discriminated tuberculous lymphadenitis from Kikuchi disease. The diagnostic accuracy of each of these four factors was 84.9% (181/212), 76.9% (163/212), 84% (178/212), and 89.2% (189/212), respectively. A combination of internal calcification and hilar vascular structures showed the best accuracy of 89.6% (190/212) (sensitivity, 86.7% [117/135]; specificity, 94.8% [73/77]) for diagnosing Kikuchi disease. Conclusion: The presence of an echogenic hilum, internal calcification, pattern of internal necrosis, and LN hilar vascular structures are useful ultrasonographic findings to differentiate tuberculous lymphadenitis from Kikuchi disease.

Keywords

References

  1. Kwon SY, Kim TK, Kim YS, Lee KY, Lee NJ, Seol HY. CT findings in Kikuchi disease: analysis of 96 cases. AJNR Am J Neuroradiol 2004;25:1099-1102
  2. Na DG, Chung TS, Byun HS, Kim HD, Ko YH, Yoon JH. Kikuchi disease: CT and MR findings. AJNR Am J Neuroradiol 1997;18:1729-1732
  3. Onciu M, Medeiros LJ. Kikuchi-Fujimoto lymphadenitis. Adv Anat Pathol 2003;10:204-211 https://doi.org/10.1097/00125480-200307000-00003
  4. Song JY, Lee J, Park DW, Sohn JW, Suh SI, Kim IS, et al. Clinical outcome and predictive factors of recurrence among patients with Kikuchi's disease. Int J Infect Dis 2009;13:322-326 https://doi.org/10.1016/j.ijid.2008.06.022
  5. Youk JH, Kim EK, Ko KH, Kim MJ. Sonographic features of axillary lymphadenopathy caused by Kikuchi disease. J Ultrasound Med 2008;27:847-853 https://doi.org/10.7863/jum.2008.27.6.847
  6. Bosch X, Guilabert A, Miquel R, Campo E. Enigmatic Kikuchi-Fujimoto disease: a comprehensive review. Am J Clin Pathol 2004;122:141-152 https://doi.org/10.1309/YF081L4TKYWVYVPQ
  7. Han HJ, Lim GY, Yeo DM, Chung NG. Kikuchi's disease in children: clinical manifestations and imaging features. J Korean Med Sci 2009;24:1105-1109 https://doi.org/10.3346/jkms.2009.24.6.1105
  8. Fontanilla JM, Barnes A, von Reyn CF. Current diagnosis and management of peripheral tuberculous lymphadenitis. Clin Infect Dis 2011;53:555-562 https://doi.org/10.1093/cid/cir454
  9. Artenstein AW, Kim JH, Williams WJ, Chung RC. Isolated peripheral tuberculous lymphadenitis in adults: current clinical and diagnostic issues. Clin Infect Dis 1995;20:876-882 https://doi.org/10.1093/clinids/20.4.876
  10. Khan FY. Clinical pattern of tuberculous adenitis in Qatar: experience with 35 patients. Scand J Infect Dis 2009;41:128-134 https://doi.org/10.1080/00365540802578991
  11. Wei YF, Liaw YS, Ku SC, Chang YL, Yang PC. Clinical features and predictors of a complicated treatment course in peripheral tuberculous lymphadenitis. J Formos Med Assoc 2008;107:225-231 https://doi.org/10.1016/S0929-6646(08)60140-0
  12. Khanna R, Sharma AD, Khanna S, Kumar M, Shukla RC. Usefulness of ultrasonography for the evaluation of cervical lymphadenopathy. World J Surg Oncol 2011;9:29 https://doi.org/10.1186/1477-7819-9-29
  13. Tong TR, Chan OW, Lee KC. Diagnosing Kikuchi disease on fine needle aspiration biopsy: a retrospective study of 44 cases diagnosed by cytology and 8 by histopathology. Acta Cytol 2001;45:953-957 https://doi.org/10.1159/000328370
  14. Lin HC, Su CY, Huang CC, Hwang CF, Chien CY. Kikuchi's disease: a review and analysis of 61 cases. Otolaryngol Head Neck Surg 2003;128:650-653 https://doi.org/10.1016/S0194-5998(02)23291-X
  15. Poulose V, Chiam P, Poh WT. Kikuchi's disease: a Singapore case series. Singapore Med J 2005;46:229-232
  16. Lee S, Yoo JH, Lee SW. Kikuchi disease: differentiation from tuberculous lymphadenitis based on patterns of nodal necrosis on CT. AJNR Am J Neuroradiol 2012;33:135-140 https://doi.org/10.3174/ajnr.A2724
  17. Lo WC, Chang WC, Lin YC, Hsu YP, Liao LJ. Ultrasonographic differentiation between Kikuchi's disease and lymphoma in patients with cervical lymphadenopathy. Eur J Radiol 2012;81:1817-1820 https://doi.org/10.1016/j.ejrad.2011.04.030
  18. Ying M, Ahuja AT, Yuen HY. Grey-scale and power Doppler sonography of unusual cervical lymphadenopathy. Ultrasound Med Biol 2004;30:449-454 https://doi.org/10.1016/j.ultrasmedbio.2003.12.010
  19. Yoo JL, Suh SI, Lee YH, Seo HS, Kim KM, Shin BK, et al. Gray scale and power Doppler study of biopsy-proven Kikuchi disease. J Ultrasound Med 2011;30:957-963 https://doi.org/10.7863/jum.2011.30.7.957
  20. Ahuja A, Ying M, King A, Yuen HY. Lymph node hilus: gray scale and power Doppler sonography of cervical nodes. J Ultrasound Med 2001;20:987-992; quiz 994 https://doi.org/10.7863/jum.2001.20.9.987
  21. Ahuja AT, Ying M. Sonographic evaluation of cervical lymph nodes. AJR Am J Roentgenol 2005;184:1691-1699 https://doi.org/10.2214/ajr.184.5.01841691
  22. Harnsberger HR, Glastonbury CM, Michel MA, Koch BL, Branstetter BF, Davidson HC, et al. Diagnostic Imaging: Head and Neck, 2nd ed. Frisens, Altona, Manitoba, Canada: Amirsys, 2011
  23. Asai S, Miyachi H, Suzuki K, Shimamura K, Ando Y. Ultrasonographic differentiation between tuberculous lymphadenitis and malignant lymph nodes. J Ultrasound Med 2001;20:533-538 https://doi.org/10.7863/jum.2001.20.5.533
  24. Ying M, Ahuja A, Brook F. Accuracy of sonographic vascular features in differentiating different causes of cervical lymphadenopathy. Ultrasound Med Biol 2004;30:441-447 https://doi.org/10.1016/j.ultrasmedbio.2003.12.009
  25. Miller WT Jr, Perez-Jaffe LA. Cross-sectional imaging of Kikuchi disease. J Comput Assist Tomogr 1999;23:548-551 https://doi.org/10.1097/00004728-199907000-00011
  26. Pombo F, Rodriguez E, Mato J, Perez-Fontan J, Rivera E, Valvuena L. Patterns of contrast enhancement of tuberculous lymph nodes demonstrated by computed tomography. Clin Radiol 1992;46:13-17 https://doi.org/10.1016/S0009-9260(05)80026-1
  27. Fulcher AS. Cervical lymphadenopathy due to Kikuchi disease: US and CT appearance. J Comput Assist Tomogr 1993;17:131-133 https://doi.org/10.1097/00004728-199301000-00024
  28. Ogawa M, Ueda S, Ohto M, Fujita M, Kubosawa T. Ultrasonography of cervical lymphadenopathy in a patient with Kikuchi's disease. Acta Radiol 1991;32:260-261 https://doi.org/10.1177/028418519103200316
  29. De Backer AI, Mortele KJ, Van Den Heuvel E, Vanschoubroeck IJ, Kockx MM, Van de Vyvere M. Tuberculous adenitis: comparison of CT and MRI findings with histopathological features. Eur Radiol 2007;17:1111-1117 https://doi.org/10.1007/s00330-006-0412-1
  30. Lee Y, Park KS, Chung SY. Cervical tuberculous lymphadenitis: CT findings. J Comput Assist Tomogr 1994;18:370-375 https://doi.org/10.1097/00004728-199405000-00006
  31. Moon WK, Han MH, Chang KH, Im JG, Kim HJ, Sung KJ, et al. CT and MR imaging of head and neck tuberculosis. Radiographics 1997;17:391-402 https://doi.org/10.1148/radiographics.17.2.9084080
  32. Kuo TT, Lo SK. Significance of histological subtypes of Kikuchi's disease: comparative immunohistochemical and apoptotic studies. Pathol Int 2004;54:237-240 https://doi.org/10.1111/j.1440-1827.2004.01614.x
  33. Hutchinson CB, Wang E. Kikuchi-Fujimoto disease. Arch Pathol Lab Med 2010;134:289-293

Cited by

  1. Does the Reporting Quality of Diagnostic Test Accuracy Studies, as Defined by STARD 2015, Affect Citation? vol.17, pp.5, 2016, https://doi.org/10.3348/kjr.2016.17.5.706
  2. Selection and Reporting of Statistical Methods to Assess Reliability of a Diagnostic Test: Conformity to Recommended Methods in a Peer-Reviewed Journal vol.18, pp.6, 2017, https://doi.org/10.3348/kjr.2017.18.6.888
  3. CT pattern analysis of necrotizing and nonnecrotizing lymph nodes in Kikuchi disease vol.12, pp.7, 2015, https://doi.org/10.1371/journal.pone.0181169
  4. Acoustic radiation force impulse imaging of biopsy-proven Kikuchi disease: initial experiences for evaluating feasibility in pediatric patients vol.38, pp.1, 2019, https://doi.org/10.14366/usg.17067
  5. Cervical necrotic lymphadenopathy: a diagnostic tree analysis model based on CT and clinical findings vol.29, pp.10, 2015, https://doi.org/10.1007/s00330-019-06155-2
  6. A Case of Kikuchi-Fujimoto Disease in a 7-Year-Old African American Patient: A Case Report and Review of Literature vol.21, pp.None, 2015, https://doi.org/10.12659/ajcr.922784
  7. Cervical lymphadenopathy in children: a diagnostic tree analysis model based on ultrasonographic and clinical findings vol.30, pp.8, 2015, https://doi.org/10.1007/s00330-020-06794-w
  8. Kikuchi Cervical Lymphadenitis in Children : Ultrasound Differentiation From Common Infectious Lymphadenitis vol.40, pp.10, 2015, https://doi.org/10.1002/jum.15584
  9. Role of ultrasound in the diagnosis of cervical tuberculous lymphadenitis in children vol.17, pp.5, 2021, https://doi.org/10.1007/s12519-021-00453-w