Fine-needle aspiration biopsy of cervical lymph nodes: factors in predicting malignant diagnosis

Abstract

The objective of the study was to determine the predicting factors in malignant diagnosis in ultrasonography guided fine-needle aspiration biopsy of cervical lymph nodes. Design is retrospective follow-up study. Ultrasonography guided fine-needle aspiration biopsies of cervical lymph nodes were performed in 290 patients. The mean age was 45.5 ± 14.4 years (range; 15-85). 207 (71.4%) and 83 (28.6%) were women and men, respectively. Cytopathologist was not present in any biopsy procedure. Factors in predicting malignancy were age, gender, presence of primary malignancy, localization (Level 1-6), hypoechogenicity with loss of echogenic hilum, microcalcification, cystic feature, minimum and maximum sizes, and index value (minimum size/maximum size). Factors were analyzed by univariate and multivariable tests. The mean minimum size and index value of the lymph nodes were 10.4 ± 5.5 mm and 0.58 ± 0.18, respectively. Age, gender, microcalcification, cystic feature, minimum size, and index value were poor predictors in malignancy. Predictors were presence of primary malignancy (p-< 0.001), the level of localization (p=0.001), and hypoechogenicity (p-< 0.001)- in malignancy. Microcalcification and cystic parts were specific US findings of metastasis of thyroid carcinoma; nevertheless cystic parts were seen more specific finding in the other malignancies. Malignant lymph nodes were often found in the presence of primary malignancy, mid neck and lower neck localizations as Level 3-6, and markedly hypoechoic lymph nodes. In 131 patients with a primary thyroid carcinoma, the predictors for malignancy were localization where the most often regions were Level 3, 4, and 6 and hypoechogenicity. Malignancy rate was relatively low in patients with thyroid malignancy than those with non thyroid malignancies in Level 5. Level 6 was the most difficult area for biopsy due to postoperative changes. Microcalcification was specific only in thyroid carcinoma, whereas cystic parts were more specific in the other malignancies

A real‐time prediction model for post‐irradiation malignant cervical lymph nodes

“…It is reported that the nondiagnostic rate of FNA is higher at level VI than at lateral compartment in patients who had received surgery of the central neck. 28,29 In this scenario, it is suggested to repeat biopsy of the central nodes until an unequivocal diagnosis is made. 28,29 Certain limitations of this study should be noted.…”

“…28,29 In this scenario, it is suggested to repeat biopsy of the central nodes until an unequivocal diagnosis is made. 28,29 Certain limitations of this study should be noted. First, it may be subjected to selection bias because only those patients who had received US and USgFNA were included.…”

“…Furthermore, other clinical examinations should also be referred before deciding not to perform an aspiration to the node. It is reported that the nondiagnostic rate of FNA is higher at level VI than at lateral compartment in patients who had received surgery of the central neck . In this scenario, it is suggested to repeat biopsy of the central nodes until an unequivocal diagnosis is made …”

NONHSAT076754 aids ultrasonography in predicting lymph node metastasis and promotes migration and invasion of papillary thyroid cancer cells

“…When combined with the detection of NONHSAT076754, the diagnostic value of ultrasonography was also greatly increased for the differentiation of PTC with LNM from PTC without LNM. Ultrasonography is a useful tool for the identification and location of metastasis in the neck; however, for lymph nodes without typical signs of metastasis (e.g., microcalcification, cystic changes) [32], it is difficult to make a decision regarding surgery through ultrasonography alone. NONHSAT076754 is of great value for the indication of the existence of LNM in PTC.…”

US‐guided core‐needle biopsy versus US‐guided fine‐needle aspiration of suspicious cervical lymph nodes for staging workup of non‐head and neck malignancies: A propensity score matching study

“…US‐guided fine‐needle aspiration (USFNA) is an easy, safe, and cost‐effective technique for diagnosing malignant lymph nodes in the head and neck with a variable range of diagnostic accuracy from 79% to 94.5% . Studies comparing USFNA and US‐guided core‐needle biopsy (USCNB) have reported that the diagnostic performance of USCNB is superior or comparable to that of USFNA in different regions in the body .…”