Lymph Nodes: Evaluating Normal vs. Malignant Conditions

Q: Lymph Nodes: Evaluating Normal vs. Malignant Conditions

Hello： Both ultrasound and biopsy can provide clinical physicians with reference information, but neither can definitively determine whether a lesion is benign or malignant. <br>If the clinical physician initially assesses it as benign, regular follow-up is recommended as the bes

Right submandibular lymph nodes?

Hello Doctor, last December I experienced pain in my right lower jaw and felt a lymph node.
I first visited a general clinic where the doctor prescribed anti-inflammatory medication.
After taking it for a day, the pain subsided significantly, but it did not completely disappear.
Later, I went to a large hospital's ENT department for further examination.
The doctor stated that he could not feel anything, but I could still feel the lymph node! Feeling uneasy, I visited a second hospital at the end of February this year.
I also had a neck ultrasound, and the doctor mentioned that based on the location of the lymph node in the right lower jaw, it did not appear to be metastatic.
The ultrasound showed the lymph node was about one centimeter in size.
I asked if a biopsy could be performed, but he said it was not necessary at that size and that the ultrasound appeared to show a normal lymph node.
Additionally, during a routine health check in early March, I had a chest X-ray, which showed no abnormalities.

I would like to ask the doctor if it is possible to determine whether a lymph node is normal or malignant based solely on ultrasound findings.
I have seen online that there are differences in the shape and characteristics of malignant versus normal lymph nodes on ultrasound.
I previously requested a biopsy, but the doctor was confident it was a normal lymph node and believed that observation was sufficient.
Therefore, I am curious about the accuracy rate of ultrasound in distinguishing between malignant and normal lymph nodes.
Should I follow up with the ENT department in two to three months? Thank you, Doctor.

Chuang, 20~29 year old female. Ask Date: 2017/03/18

Dr. Zheng Jueyi reply Otolaryngology

Hello: Both ultrasound and biopsy can provide clinical physicians with reference information, but neither can definitively determine whether a lesion is benign or malignant.
If the clinical physician initially assesses it as benign, regular follow-up is recommended as the best approach.
Wishing you safety and health.
Sincerely, Dr.
Jue-Yi Cheng, Director of the Department of Otolaryngology, Taoyuan Hospital, Ministry of Health and Welfare.

Reply Date: 2017/03/18

More Info

When evaluating lymph nodes, distinguishing between normal and malignant conditions is crucial for patient management and treatment planning. Your experience with the lymph node in your neck raises several important points regarding the assessment of lymph nodes through ultrasound and the decision-making process regarding further intervention, such as fine needle aspiration (FNA).

Ultrasound is a valuable tool in the evaluation of lymph nodes. It provides information about the size, shape, echogenicity (the ability to reflect ultrasound waves), and vascularity of the lymph nodes. Typically, benign lymph nodes tend to be oval in shape, have a well-defined margin, and exhibit a central echogenic hilum. In contrast, malignant lymph nodes may appear irregularly shaped, have indistinct margins, and may lack a central echogenic hilum. However, these characteristics are not definitive, and overlap can occur between benign and malignant nodes.

In your case, the ultrasound indicated that the lymph node was approximately 1 cm in size and was described as normal in appearance. The fact that the doctor did not feel it necessary to perform an FNA suggests that the ultrasound findings did not raise significant concern for malignancy. Generally, lymph nodes that are less than 1 cm in size, particularly if they are mobile and have a normal appearance, are often considered benign. However, the subjective nature of palpation can lead to discrepancies between what a patient feels and what a physician can detect.

Regarding the accuracy of ultrasound in differentiating between benign and malignant lymph nodes, studies have shown that while ultrasound can provide useful information, it is not infallible. The sensitivity and specificity of ultrasound in detecting malignancy in lymph nodes can vary widely depending on the criteria used and the experience of the operator. Some studies suggest that ultrasound can have a sensitivity of around 70-90% and specificity of about 80-90% for detecting malignant lymph nodes, but these figures can fluctuate based on the population studied and the characteristics of the lymph nodes being evaluated.

Given your situation, it is reasonable to follow up with your ENT specialist in a few months, as suggested. Regular monitoring of the lymph node can help ensure that any changes in size or characteristics are promptly addressed. If the lymph node increases in size or if you develop new symptoms, further evaluation, including an FNA, may be warranted.

In summary, while ultrasound is a helpful tool in assessing lymph nodes, it is important to consider the entire clinical picture, including patient history, physical examination findings, and imaging results. If there are persistent concerns or if the lymph node changes, further investigation may be necessary. Always feel empowered to discuss your concerns with your healthcare provider and seek clarification on any aspects of your care. Regular follow-up is key to ensuring that any potential issues are caught early.

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