Diagnostic utility of immunohistochemical analysis and Epstein–Barr virus‐encoded small RNAs in situ hybridisation of cell block sections obtained using fine‐needle aspiration in nasopharyngeal carcinoma with lymph node metastasis

Abstract

Objective This study aimed to investigate the diagnostic utility of immunohistochemistry (IHC) analysis (FNA) and Epstein–Barr virus‐ (EBV) encoded small RNAs (EBERs) in situ hybridisation analyses of cell block (CB) sections obtained using fine needle aspiration in nasopharyngeal carcinoma (NPC) with lymph node metastasis. Methods A total of 38 FNA biopsies were collected using a Youyi aspirator. The cytomorphology, CB‐based histomorphology, IHC, and EBERs in situ hybridisation were observed and the sensitivity/final diagnostic rates were compared with those of simple smears and a combination of smears and CBs. Results The 38 cases of metastatic lymph nodes from NPC displayed the morphological characteristics of non‐keratinising carcinoma in cell smears and CB sections. The tumour cells showed high expression of CK5/6, P63, Ki‐67, and EBERs (94.7%, 36/38 cases) in the CB sections. The sensitivity and the final diagnostic rates were lowest with the simple cell smears (86.8%, 33/38 and 71.1%, 27/38 cases), moderate with the smears combined with CB sections (92.1%, 35/38 cases and 81.6%, 31/38 cases), and the highest with IHC and EBERs in situ hybridisation (94.7%, 36/38 and 94.7%, 36/38 cases). Conclusions FNA has great value in the diagnosis of NPC with lymph node metastases, and using cell smears combined with IHC and EBERs in situ hybridisation of CB sections could help clinical doctors promptly identify the primary lesions.

Diagnosis and Therapy of Nasopharyngeal Carcinoma

“…Cervical lymph node biopsy by fine-needle aspiration should only be used when the pathological finding in primary tumor biopsy is negative but remains highly suspicious of NPC. Combining with EBV encoded small RNAs (EBERs) in situ hybridization examination could help clinical doctors promptly identify the primary lesions [29]. To further assess the tumor size and location, a series of radiologic tests, including computed tomography (CT) scans and magnetic resonance imaging (MRI) of the head and neck are required.…”

Metastatic Squamous Cell Carcinoma to the Cervical Lymph Nodes From an Unknown Primary Cancer: Management in the HPV Era

“…When fine needle aspiration fails to produce a diagnosis and cancer is strongly suspected, obtaining a positive core biopsy may provide the cancer diagnosis early, making it practically easier to justify the expense of a PET-CT before panendoscopy. This approach is supported by several large series showing that the incidence of clinically significant hematoma, infection, or seeding of the soft tissues with cancer from core biopsy is low (35)(36)(37)(38)(39)(48)(49)(50)(51)(52)(53)(54)(55)(56)(57)(58). At this point, National Cancer Center Network (NCCN) guidelines in the United States leave core biopsy as an option to confirm cancer before taking the patient to the operating room.…”

“…The possibility of applying additional cytopathological and molecular techniques to the cytologic aspirate, to provide an estimate regarding the risk of malignancy relative to a benign branchial cleft cyst, is an area that is open for further study. If a few non-diagnostic cells are encountered, IHC or in-situ hybridization (ISH for HPV ( 36 – 38 ) Epstein Barr Virus (EBV), ( 39 ) P53 mutations ( 40 ), cytokeratin and other markers ( 41 ) can be performed, depending on the viral prevalence in the region and level of suspicion.…”