Sonographic features of anterior neck masses in patients presenting at Moi Teaching and Referral Hospital-Eldoret, Kenya

Abstract

Background anterior neck masses are caused by a variety of conditions, some of which canbe life threatening. Due to the superficial nature of most anterior neck lumps, they are initially investigated by high frequency (7.5-15MHz) ultrasonography. Theultrasonographic features of the various neck lumps; with special emphasis on the thyroid gland; once characterized and documented shall assist in prompt diagnosis of the various pathologies thus improving treatment outcomes. Objective: This study sought to correlate the cytopathological diagnoses with the sonographic appearances of anterior neck masses in patients presenting at Moi Teaching and Referral Hospital (MTRH). Methods: This is a cross sectional study done at the ultrasound suite of MTRH between August 2014 and August 2015. The study population was persons over 18 years of age who presented with anterior neck masses. This was a census study where all (380) participants who met the inclusion criteria were studied. Non-consenting or participants who had undergone intervention; such as surgery or radiotherapy; were not included. Descriptive statistics such as frequencies, means and standard deviation were used to summarize the data. Results: Majority of the anterior neck masses arose from the thyroid gland with 269 (71%) cases, followed by lymph nodal masses at 102 (27%). Other anterior neck masses constituted 2% (n=9) of the lesions. Statistically significant findings of benignity in thyroid lesions were iso-echogenicity, well defined margins and peripheral flow on color Doppler interrogation. Malignant thyroid lesions on the other hand demonstrated micro-calcifications, marked hypoechogenicity and internal flow on color doppler. Statistically significant findings of neoplastic cervical lymphadenopathy were round shape, absence of central echogenic hilus and peripheral vascularity. Benign nodes on the other hand were mainly ovoid, with a central echogenic hilus and demonstrated hilar vascularity Conclusion: Differentiation of benign and malignant thyroid and lymph-nodal masses can be done by ultrasonography based on the grey scale and color Doppler appearances. Recommendation: Ultrasonographic workup should lay emphasis on differentiation of benign and malignant anterior neck masses. Those that appear sonographically neoplastic should warrant further work-up.