Performance of Ultrasound-Guided Core Biopsy Driven by FDG-avid Supraclavicular Lymph Nodes in Patients With Suspected Lung Cancer

Abstract

ObjectivesUltrasound-guided core biopsy (UGCB) for supraclavicular lymph nodes (SLNs) represents an attractive procedure to obtain tissues for lung cancer confirmation. The aim of the present study is to evaluate the performance of UGCB driven by FDG-avid SLNs, as performed by nuclear medicine physicians, in patients with suspected lung cancer.MethodsInstitutional database in our hospital was searched for eligible patients between September 2019 and March 2021. A 3-12 MHz linear probe was used to guide the biopsy process and to ensure that the needle tip was being directed at the metabolically active area that had been indicated by side-by-side PET/CT images. Diagnostic yield, malignancy rate, molecular testing results, and complications were reviewed.ResultsAmong the 54 patients included in this study, definite pathological diagnosis from UGCB specimens was achieved in 53 patients, reaching a diagnostic yield of 98.1% (53/54) and a malignancy rate of 96.2% (51/53). Among the 50 patients confirmed as lung cancer, thirty-eight were spared from further invasive procedures which had been planned. Molecular analyses were adequately performed on all the 38 specimens obtained from non-small cell lung cancer (NSCLS). The positive rate was 36.8% (14/38) for epidermal growth receptor (EGFR) mutation and 31.6% (12/38) for anaplastic lymphoma kinase (ALK) translocation. 28.9% (11/38) of the patients had a tumor proportion score (TPS) ≥ 50% for PD-L1 expression. No complication was observed and the average biopsy time was 15 min.ConclusionsNuclear medicine physicians-performed UGCB driven by FDG-avid SLNs in suspected lung cancer patients could produce a high performance in terms of diagnostic yield, malignancy rate, and molecular analysis, which may obliviate more invasive interventional procedures and lead to fast decisions on subsequent management.

Clinical Role of Upfront F-18 FDG PET/CT in Determining Biopsy Sites for Lung Cancer Diagnosis

“…Regarding PNB complications for lung target in patients with lung cancer, a metaanalysis revealed a total PNB complication rate of 17.3-38.8% and a very low rate of major complications (0.7-5.7%) [5]. PNB of the pleura, lymph nodes, and bone were associated with a low risk of minor complications (3.9-5.8%, 0-0.14%, and 0-2%, respectively), while no major complications were reported [4,[10][11][12]14,27,28]. In our cohort of patients, the most commonly observed complication was pneumothorax, with complication rates similar to those reported in previous studies.…”

“…PNB for the lung has limitations due to the potential risk of pneumothorax in approximately 15-38% of patients, with a subsequent requirement for chest tube insertion in approximately 5-10% of patients [3,5,7]. To avoid the risks of pneumothorax and chest tube placement, a histopathological diagnosis has been obtained through PNB for metastasis involving the pleura, lymph nodes, bones, and solid organs other than the lung [4,[8][9][10][11][12]. Detection of tumor viability through PET/CT improved the diagnostic yield of PNB for lung cancer diagnosis in patients who underwent a biopsy of the lung or other structures [12][13][14][15][16].…”

“…To avoid the risks of pneumothorax and chest tube placement, a histopathological diagnosis has been obtained through PNB for metastasis involving the pleura, lymph nodes, bones, and solid organs other than the lung [4,[8][9][10][11][12]. Detection of tumor viability through PET/CT improved the diagnostic yield of PNB for lung cancer diagnosis in patients who underwent a biopsy of the lung or other structures [12][13][14][15][16]. Prior studies that compared PNB with and without F-18 FDG PET/CT revealed that utilizing F-18 FDG PET/CT for guiding such biopsies enhanced the accuracy of diagnosis [16,17].…”

“…Prior studies that compared PNB with and without F-18 FDG PET/CT revealed that utilizing F-18 FDG PET/CT for guiding such biopsies enhanced the accuracy of diagnosis [16,17]. PNB guided by PET/CT findings exhibited a remarkable diagnostic success rate of 98.1% for lymph nodes and 96.1% for bones in the diagnosis of lung cancer [12,14].…”

Exosomes derived from M1 macrophages inhibit the proliferation of the A549 and H1299 lung cancer cell lines via the miRNA-let-7b-5p-GNG5 axis

“…In China, the situation of lung cancer is severe. Invasion and metastasis are the most important common causes of death in patients with advanced lung cancer ( Wang et al, 2021 ).…”