Differences in ultrasonographic features and diagnostic value of biopsy between tuberculous lymphadenitis and reactive lymphadenopathy

This study aimed to investigate the differences in ultrasonographic features between tuberculous lymphadenitis (TBL) and reactive lymphadenopathy and evaluate the diagnostic value of biopsy techniques. A retrospective analysis was conducted on 225 cases of superficial lymph node lesions confirmed by pathology or microbiology between February 2022 and February 2024, including 128 cases of TBL and 97 cases of reactive lymphadenopathy. Ultrasonographic characteristics were compared between the 2 groups, and diagnostic performance was evaluated using pathological results as the gold standard. A multivariate logistic regression model was used to establish an ultrasound scoring system, and receiver operating characteristic curve performance was analyzed. The diagnostic accuracy and safety of fine-needle aspiration biopsy (FNAB) and core needle biopsy (CNB) were compared, and the benefits of biopsy were assessed based on ultrasound risk stratification. TBL cases more frequently exhibited round lymph nodes (S/L ≥ 0.5), liquefactive necrosis, loss of the hilum, calcification, and peripheral/mixed blood flow patterns (all P < .01). Liquefactive necrosis had the highest odds ratio (odds ratio = 14.47). Multivariate analysis identified these features as independent predictors. A 6-point ultrasound scoring system (≥3 points defined as high risk) achieved an area under the curve of 0.901, sensitivity of 82.0%, and specificity of 86.6%. CNB showed higher specimen adequacy and diagnostic accuracy compared to FNAB ( P < .01), with no significant difference in complication rates. The positive biopsy rate was significantly higher in the high-risk group than in the low-risk group (95.9% vs 85.7%). Liquefactive necrosis, loss of the lymphatic hilum, and calcification are characteristic ultrasonographic features of tuberculous lymphadenitis. The ultrasound scoring system effectively improves the diagnostic accuracy of TBL. CNB offers advantages over FNAB in terms of sample adequacy and diagnostic efficiency. Ultrasound-based risk stratification can guide biopsy decisions and enhance overall diagnostic value. Different biopsy techniques may be appropriate under different clinical scenarios, and ultrasound-based risk stratification may help optimize individualized biopsy decision-making.