Table 1.

Sonographic features of benign and malignant neck nodes

Sonographic features	Benign nodes	Malignant nodes
Size	Persistent or slight changes in serial examinations	Increase in serial examinations
Shape	Elliptical (S/L <0.5)	Round (S/L >0.5)
Nodal border	Unsharp	Sharp. Proven malignant nodes with unsharp borders indicate extracapsular spread
Echogenic hilus	Present	Absent
Echogenicity	Hypoechoic	Hyperechoic in metastatic nodes from papillary thyroid carcinoma. Other malignant nodes tend to be hypoechoic
Intranodal reticulation	Absent	Common in lymphomatous nodes
Intranodal calcification	Absent	Punctate and peripherally located calcification is common in metastatic nodes from papillary thyroid carcinoma
Intranodal cystic necrosis	Common in tuberculous nodes	Common in metastatic nodes from papillary thyroid carcinoma and squamous cell carcinoma
Matting	Common in tuberculous nodes	May be found in patients with previous neck radiation therapy
Adjacent soft tissue oedema	Common in tuberculous nodes	May be found in patients with previous neck radiation therapy. May be found in malignant nodes with extracapsular spread
Intranodal vascular pattern	Hilar vascularity or apparently avascular	Peripheral or mixed vascularity
Stiffness	Soft	Hard