The linear echogenic hilus in cervical lymphadenopathy--a sign of benignity or malignancy?

The linear echogenic hilus seen within lymph nodes on ultrasound examination has been proposed as a sign of benignity. The echogenic line is thought to represent the converging sinuses within the medulla of the lymph node. Forty-six cases with a linear echogenic hilus within a cervical lymph node are presented, where a cytological or histological diagnosis was obtained. In 27 cases (58.7%) the diagnosis was malignancy, in seven cases (15.2%) tuberculosis and the remaining 12 cases (26%) were benign. In our experience the linear echogenic hilus should not be regarded as a sole criterion for benignity. A cytological diagnosis, preferably by an ultrasound-guided fine needle aspiration, should always be sought.