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Reliable EGFR mutation testing in ultrasound-guided supraclavicular lymph node fine-needle aspirates: a cohort study with diagnostic performance analysis.

Awwad A, Tiwari S, Sovani V, Baldwin DR, Kumaran M - BMJ Open Respir Res (2015)

Bottom Line: Ultrasound (US)-guided fine-needle aspiration (FNA) cytology is regarded as an effective diagnostic tool in small size lymph nodes (LNs) and impalpable positron emission tomography detected nodes.The remaining 57 patients had further investigations; 45 reconfirmed the US-guided FNA diagnosis.No complications were recorded.

View Article: PubMed Central - PubMed

Affiliation: Radiology Department , Nottingham University Hospitals NHS Trust, Queen's Medical Centre , Nottingham, Nottinghamshire , UK.

ABSTRACT

Introduction: 15-30% of patients with lung cancer will have supraclavicular and cervical lymphadenopathy (SCLN). Ultrasound (US)-guided fine-needle aspiration (FNA) cytology is regarded as an effective diagnostic tool in small size lymph nodes (LNs) and impalpable positron emission tomography detected nodes. We evaluated our diagnostic service performance in relation to the adequacy of samples for epidermal growth factor receptor (EGFR) mutation.

Methods: Retrospective data analysis from electronic records, searching for all suspected lung cancer referrals that underwent US of the neck±FNA, over a continuous period of 4 years.

Results: Of 306 cases with suspected lung cancer referred to our department for US FNA of SCLN, 228 patients underwent the procedure. Of the remaining 78 patients, LNs were not detected in 52 cases and appeared benign in 26. Cytological diagnosis was established in 171 patients (75%) for treatment decisions without further investigations. The remaining 57 patients had further investigations; 45 reconfirmed the US-guided FNA diagnosis. The average LN size was 12.9 mm, and positive cytology was obtained in LNs ranging from 3 to 45 mm. Of 57 adenocarcinoma cases, 34 were tested for EGFR confirming 4 positive, 25 negative and 5 insufficient samples. No complications were recorded.

Conclusions: US-guided FNA of SCLN remains an important diagnostic tool in lung cancer. Adequate tissue can be obtained for reliable diagnosis from LNs and for EGFR mutational analysis, without the need for more invasive and expensive investigations in more than 80% of cases.

No MeSH data available.


Related in: MedlinePlus

(A) Cross-sectional (axial) sonographic image showing a 21-gauge fine-needle aspiration cytology needle introduced in a 12 mm supraclavicular lymph node (white arrow). (B) Adapted version of the updated 2011 diagnostic pathway published by the National Collaboration Centre for Cancer (NICE Clinical Guidelines, CG121 April 2011) emphasising on the sole role of neck nodes in reaching a diagnosis decision leading to treatment (curative or palliation). All rights reserved.5
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BMJRESP2014000075F1: (A) Cross-sectional (axial) sonographic image showing a 21-gauge fine-needle aspiration cytology needle introduced in a 12 mm supraclavicular lymph node (white arrow). (B) Adapted version of the updated 2011 diagnostic pathway published by the National Collaboration Centre for Cancer (NICE Clinical Guidelines, CG121 April 2011) emphasising on the sole role of neck nodes in reaching a diagnosis decision leading to treatment (curative or palliation). All rights reserved.5

Mentions: Fifteen to 30 per cent of patients with lung cancer will have supraclavicular lymphadenopathy (SCLN) and anterior cervical lymph nodes (LNs).12 Ultrasound (US)-guided fine-needle aspiration (FNA) cytology (FNAC) is known to be an effective diagnostic tool in small size supraclavicular or neck LNs as well as in impalpable positron emission tomography (PET)-detected nodes.34 The latest algorithm of the National Institute for Health and Care Excellence (NICE) guidance published in April 2011 incorporates the use of US of the neck to obtain cytology (figure 1B). It clearly indicates that clinicians should offer US of the neck with an intention to sample any visibly abnormal LNs or non-US-guided transbronchial needle aspiration (TBNA) to patients with a high probability of mediastinal malignancy (LNs >20 mm maximum short axis on CT.5 It also states that US of the neck should be offered with biopsy of visible LNs to patients who have neck nodes detected by initial CT. If CT is negative, non-US-guided TBNA or endobronchial US (EBUS)-guided TBNA or endoscopic US-guided FNA is recommended.5


Reliable EGFR mutation testing in ultrasound-guided supraclavicular lymph node fine-needle aspirates: a cohort study with diagnostic performance analysis.

Awwad A, Tiwari S, Sovani V, Baldwin DR, Kumaran M - BMJ Open Respir Res (2015)

(A) Cross-sectional (axial) sonographic image showing a 21-gauge fine-needle aspiration cytology needle introduced in a 12 mm supraclavicular lymph node (white arrow). (B) Adapted version of the updated 2011 diagnostic pathway published by the National Collaboration Centre for Cancer (NICE Clinical Guidelines, CG121 April 2011) emphasising on the sole role of neck nodes in reaching a diagnosis decision leading to treatment (curative or palliation). All rights reserved.5
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4488608&req=5

BMJRESP2014000075F1: (A) Cross-sectional (axial) sonographic image showing a 21-gauge fine-needle aspiration cytology needle introduced in a 12 mm supraclavicular lymph node (white arrow). (B) Adapted version of the updated 2011 diagnostic pathway published by the National Collaboration Centre for Cancer (NICE Clinical Guidelines, CG121 April 2011) emphasising on the sole role of neck nodes in reaching a diagnosis decision leading to treatment (curative or palliation). All rights reserved.5
Mentions: Fifteen to 30 per cent of patients with lung cancer will have supraclavicular lymphadenopathy (SCLN) and anterior cervical lymph nodes (LNs).12 Ultrasound (US)-guided fine-needle aspiration (FNA) cytology (FNAC) is known to be an effective diagnostic tool in small size supraclavicular or neck LNs as well as in impalpable positron emission tomography (PET)-detected nodes.34 The latest algorithm of the National Institute for Health and Care Excellence (NICE) guidance published in April 2011 incorporates the use of US of the neck to obtain cytology (figure 1B). It clearly indicates that clinicians should offer US of the neck with an intention to sample any visibly abnormal LNs or non-US-guided transbronchial needle aspiration (TBNA) to patients with a high probability of mediastinal malignancy (LNs >20 mm maximum short axis on CT.5 It also states that US of the neck should be offered with biopsy of visible LNs to patients who have neck nodes detected by initial CT. If CT is negative, non-US-guided TBNA or endobronchial US (EBUS)-guided TBNA or endoscopic US-guided FNA is recommended.5

Bottom Line: Ultrasound (US)-guided fine-needle aspiration (FNA) cytology is regarded as an effective diagnostic tool in small size lymph nodes (LNs) and impalpable positron emission tomography detected nodes.The remaining 57 patients had further investigations; 45 reconfirmed the US-guided FNA diagnosis.No complications were recorded.

View Article: PubMed Central - PubMed

Affiliation: Radiology Department , Nottingham University Hospitals NHS Trust, Queen's Medical Centre , Nottingham, Nottinghamshire , UK.

ABSTRACT

Introduction: 15-30% of patients with lung cancer will have supraclavicular and cervical lymphadenopathy (SCLN). Ultrasound (US)-guided fine-needle aspiration (FNA) cytology is regarded as an effective diagnostic tool in small size lymph nodes (LNs) and impalpable positron emission tomography detected nodes. We evaluated our diagnostic service performance in relation to the adequacy of samples for epidermal growth factor receptor (EGFR) mutation.

Methods: Retrospective data analysis from electronic records, searching for all suspected lung cancer referrals that underwent US of the neck±FNA, over a continuous period of 4 years.

Results: Of 306 cases with suspected lung cancer referred to our department for US FNA of SCLN, 228 patients underwent the procedure. Of the remaining 78 patients, LNs were not detected in 52 cases and appeared benign in 26. Cytological diagnosis was established in 171 patients (75%) for treatment decisions without further investigations. The remaining 57 patients had further investigations; 45 reconfirmed the US-guided FNA diagnosis. The average LN size was 12.9 mm, and positive cytology was obtained in LNs ranging from 3 to 45 mm. Of 57 adenocarcinoma cases, 34 were tested for EGFR confirming 4 positive, 25 negative and 5 insufficient samples. No complications were recorded.

Conclusions: US-guided FNA of SCLN remains an important diagnostic tool in lung cancer. Adequate tissue can be obtained for reliable diagnosis from LNs and for EGFR mutational analysis, without the need for more invasive and expensive investigations in more than 80% of cases.

No MeSH data available.


Related in: MedlinePlus