Ultrasound‐guided fine needle aspiration of retropharyngeal lymph nodes after radiotherapy for nasopharyngeal carcinoma: a novel technique for accurate diagnosis

Abstract

BackgroundEnlarged retropharyngeal lymph nodes (RLNs) are very common in patients with nasopharyngeal carcinoma (NPC) undergoing radiotherapy. The most suitable treatment option for enlarged RLNs depends on the pathological results. However, RLN sampling is difficult and imminent in the clinic setting. We recently developed a novel minimally invasive technique termed endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) for sampling RLN tissues sufficient for pathological or cytological diagnosis.MethodsWe enrolled 30 post-radiotherapy patients with NPC with suspected RLN metastasis detected via magnetic resonance imaging (MRI). The EUS probe was introduced into the nasopharynx via the nostrils, and EUS was then used to scan the retropharyngeal space and locate the RLN in the anterior carotid sheath. EUS-FNA was subsequently performed. The safety and efficacy of using EUS-FNA to sample the RLN tissues were assessed.ResultsStrips of tissue were successfully sampled from all patients using EUS-FNA. Of the 30 patients, 23 were confirmed to have cancer cells in the biopsied tissues via pathology or cytology examinations with 1 EUS-FNA biopsy session. The seven cases without confirmed cancer cells were subsequently reanalyzed by using another EUS-FNA biopsy session, and two more cases were confirmed possessing cancer cells. The other five patients without confirmed cancer cells were closely followed with MRI every month for 3 months. After follow-up for 3 months, three patients were still considered cancer-free due to the presence of RLNs with stable or shrinking diameters. The rest two patients who showed progressive disease underwent a third EUS-FNA biopsy procedure and were further confirmed to be cancer cell-positive. In the whole cohort reported here, the EUS-FNA procedure was not associated with any severe complications.ConclusionEUS-FNA is a safe and effective diagnostic approach for sampling tissues from the RLNs in patients with suspected recurrent NPC.Electronic supplementary materialThe online version of this article (10.1186/s40880-018-0286-z) contains supplementary material, which is available to authorized users.

Verification of the Efficacy of New Diagnostic Criteria for Retropharyngeal Nodes in a Cohort of Nasopharyngeal Carcinoma Patients

“…The limitations of this study included the lack of radiologic-histopathologic correlation data. The feasibility of histological confirmation before ongoing chemotherapy or RT for LRPNs in newly diagnosed NPC is still lacking, although several biopsy methods had been reported; still, several procedures could be safe [31][32][33][34][35]. However, these procedures are only applied to the recurrent LRPNs and not for new cases before RT.…”

The diagnostic and prognostic values of plasma Epstein‐Barr virus DNA for residual cervical lymphadenopathy in nasopharyngeal carcinoma patients: a retrospective study

“…This group of patients faces a clinical dilemma. Because lymphadenopathy may harbor disease or merely appear as post-treatment necrosis or hyaline fibrosis without viable tumor cells [14–16, 19], it may be difficult to define the nature of the cervical masses due to post-irradiation changes in neck soft tissues [15, 18, 19]. Furthermore, since most studies have focused on the efficacy and safety of neck dissection in this group of patients, there is no commonly accepted method for post-treatment determination of malignancy.…”

High-Frequency Ultrasound to Assess Activity in Connective Tissue Panniculitis

“…Studies comparing HFUS findings with histology found a high intra-observer correlation [14]. When a biopsy is needed to confirm the diagnosis, HFUS can aid the choice of the most inflamed sites for sample collection, as is performed in other organs, such as the liver, breast, or lymph nodes [26,27]. The main weakness of HFUS is that it is operatordependent, and expertise requires previous training [19,28].…”