Ultrasonographic Differentiation Between Kikuchi's Disease and Lymphoma in Patients With Cervical Lymphadenopathy

NCT ID: NCT01310933

Last Updated: 2012-02-02

Basic Information

• Recruitment Status: UNKNOWN
• Total Enrollment: 40 participants
• Study Classification: OBSERVATIONAL
• Study Start Date: 2010-12-31
• Study Completion Date: 2012-02-29

Brief Summary

The purpose of this study is to differentiate Kikuchi's disease and malignant lymphoma by soft tissue ultrasound.

Detailed Description

Introduction Kikuchi's disease (KD) is a histiocytic necrotizing lymphadenitis that was described for the first time in Japan in 1972 almost simultaneously by Kikuchi and Fujimoto1-2. KD is a self-limited necrotizing lymphadenitis and occurs predominantly in females between 20 and 30 years old. Its main presentation is cervical lymphadenopathy. The diagnosis of KD is based on clinical manifestation, fine-needle aspiration cytology or excision biopsy. The pathological characteristics include patchy paracortical lymphohistiocytic aggregates with variable karyorrhexis and absence of granulocytic infiltration. Antibiotics are not helpful symptoms remit within six months spontaneously.

As KD is a benign and self-limiting disease, proper diagnosis may help avoid unnecessary treatment. KD can be easily confused clinically, pathologically, and radiologically with malignant lymphadenopathy, especially lymphoma. Several reports have described the CT characteristics of KD3-4, including enlarged, multiple lymph nodes that are homogeneously enhanced without evidence of gross necrosis. The CT appearance of Kikuchi's disease may be variable, thus mimicking lymphoma4. In previous work, the ultrasound appearance of KD has not been well-described and has been compared to lymphoma. In this study, we compared the sonographic characteristic of Kikuchi's disease and malignant lymphoma.

Patients and methods From November 2007 to September 2009, sonograms of twelve case notes with pathological diagnoses of Kikuchi's disease and twelve patients with malignant lymphoma were studied.

The sonograms were performed by the same sinologist (L-J Liao) using an ATL HDI 5000 with a high-resolution 7.5- to 12-MHz real-time linear-array transducer (Philips Ultrasound, Bothell, WA, USA). Morphological US parameters were thoroughly evaluated and recorded on the Marosis PACS system (Marotech Inc., Seoul, South Korea). The lengths of short and long axes of enlarged lymph nodes were measured and recorded. The shape of the lymph node was determined by the short axis to long axis ratio (S/L ratio). The nodal border was assessed for sharpness. Echogenicity of the lymph nodes was compared with that of adjacent muscles. Swelling of the surrounding tissues that presented with hyperechoic rims was assessed. The nodes were considered matted when a number of lymph nodes were clustered together. The internal architecture of lymph nodes was examined for the presence of heterogeneous micronodular pattern or reticulation.

Fisher's exact test and X 2 test were used to calculate the significance of the difference in gray-scale features. Mann-Whitney U tests were used to calculate the significance of the difference in nodal size and short- to long-axis ratio.

Expected Results:

We suppose that basic ultrasonographic characteristics (size, shape, rims, matting, and micronodular echotexture) help in the differentiation of cervical lymph nodes in patients with Kikuchi's disease and lymphoma. A precise diagnosis of KD is possible avoiding unnecessary biopsies or aggressive treatment.

References:

1. Kikuchi M. Lymphadenitis showing focal reticulum cell hyperplasia with nuclear debris and phagocytosis. Nippon Ketsueki Kakkai Zasshi 1972;35:379-80.

2. Fujimoto Y, Kozima Y, Yamaguchi K. Cervical subacute necrotizing lymphadenitis. A new clinicological entity. Naika 1972;376:247-53.

3. Kwon S, Kim T, Kim Y, Lee K, Lee N, Seol H. CT findings in Kikuchi disease: analysis of 96 cases. American Journal of Neuroradiology 2004;25(6):1099.

4. Na D, Chung T, Byun H, Kim H, Ko Y, Yoon J. Kikuchi disease: CT and MR findings. American Journal of Neuroradiology 1997;18(9):1729.

Conditions

Lymphoma; Kikuchi's Disease

Study Design

• Study Time Perspective: RETROSPECTIVE

Study Groups

Kikuchi's disease

No interventions assigned to this group

Malignant lymphoma

No interventions assigned to this group

Eligibility Criteria

Inclusion Criteria

From November 2007 to September 20010, pathological diagnoses of Kikuchi's disease & malignant lymphoma were studied sonograms available

Exclusion Criteria

no pathology no sonograms

• Minimum Eligible Age: 3 Years
• Maximum Eligible Age: 80 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

Far Eastern Memorial Hospital

OTHER

Sponsor Role: lead

Responsible Party

Li-Jen Liao

Department of Otolaryngology

Responsibility Role: PRINCIPAL_INVESTIGATOR

Principal Investigators

Li-Jen Liao, MD

Role: STUDY_CHAIR

Department of Otolaryngology Far Eastern Memorial Hospital

Locations

Far Eastern Memorial Hospital, Taipei, Taiwan

Pan Chiao, Taipei, , Taiwan

Site Status: RECRUITING

Countries

Taiwan

Central Contacts

Li-Jen Liao, MD

Role: CONTACT

deniro@mail2000.com.tw

886-2-89667000 ext. 4201

Facility Contacts

Shih-Hong Huang, M.D., Ph.D.

Role: primary

irb@mail.femh.org.tw

886-8967-1592 ext. 1592

Other Identifiers

099086-E

Identifier Type: -

Identifier Source: org_study_id