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Background The differentiation between the causes of cervical lymphadenopathy is of paramount importance as these have different modalities of treatment with varying prognosis. The aim of this study was to evaluate the efficacy of B Mode and colour Doppler ultrasound (CDUS) to differentiate between benign and metastatic lymph nodes. Methods 100 patients of clinically palpable lymph nodes were evaluated with B Mode and CDUS. B Mode assessment included short-long (S:L) axis ratio, hilum, nodal border, echogenicity, intranodal necrosis and ancillary features. CDUS assessment included distribution of vascularity, resistive index (RI) and pulsatility index (PI). Statistical analysis was carried out with histopathological or cytological diagnosis as gold standard. Results B-Mode US correctly diagnosed 22/25 (88%) of the reactive lymph nodes giving it a sensitivity of 88% and specificity of 97.3%. Colour Doppler US diagnosed 23/25 (92%) reactive lymph nodes with a sensitivity of 92% and specificity of 97.3%. B-Mode underdiagnosed one case each of granulomatous disease and metastasis as reactive node while CDUS missed out two cases of granulomatous disease as reactive lymph node. Conclusion Individual parameters of B Mode when used alone were not found to be very effective in differentiating benign and malignant lymph nodes. However features of B-Mode combined together as well as color Doppler ultrasound, help in the detection of reactive lymph nodes and can be used as a diagnostic tool with good accuracy. However, they cannot be used as a diagnostic method for metastatic or tubercular nodes and cytopathology/histopathology remains the gold standard in such situations. [ABSTRACT FROM AUTHOR]

Background Type 2 Diabetes: Type 2 diabetes mellitus (T2DM) is a strong risk factor for peripheral artery disease (PAD) and PAD diagnosis in T2DM may indicate coexisting coronary artery disease as well. Postexercise ankle brachial index (ABI) and transcutaneous partial pressure of oxygen (TcPO 2 ) have not been evaluated for PAD diagnosis among Indian T2DM patients. This study aimed to evaluate the performance of resting + postexercise(R + PE) ABI and R + PE-TcPO 2 for PAD diagnosis among T2DM patients at increased PAD risk, using colour duplex ultrasound (CDU) as reference standard., Methods: This prospectively conducted diagnostic accuracy study involved T2DM patients at increased PAD risk. R-ABI≤0.9 or PE-ABI decline >20% from resting value in those with R-ABI between 0.91 and 1.4, R-TcPO 2 <30 mm Hg or PE decline of TcPO 2 to <30 mm Hg in those with R-TcPO 2 ≥30 mm Hg, CDU showing >50% stenosis or complete occlusion of lower extremity arteries constituted PAD., Results: Among 168 patients enrolled, R + PE-ABI diagnosed PAD in 19(11.3%), R + PE-TcPO 2 in 61 (36.3%) and 17 (≈10%) had PAD finally confirmed by CDU. Sensitivity, specificity, PPV and NPV of R + PE-ABI for PAD diagnosis were 82.3%, 96.7%, 73.7% and 98% and that of R + PE-TcPO 2 were 76.5%, 68.2%, 21.3% and 96.2%, respectively. PE-ABI increased the sensitivity of ABI by ≈ 18% and had 100% PPV for PAD. When both ABI and TcPO 2 (R + PE tests) were normal, PAD could be safely excluded in 88% of patients., Conclusion: PE-ABI should be routinely employed and TcPO 2 (R/PE) is unreliable as a stand-alone test for PAD detection among moderate to high risk T2DM patients., Competing Interests: The authors have none to declare., (© 2021 Director General, Armed Forces Medical Services. Published by Elsevier, a division of RELX India Pvt. Ltd.)