Efficacy and safety of ultrasound-guided core needle biopsies (US-CNBs) in cervical lymphadenopathy in patients with suspected head and neck cancer during the COVID-19 pandemic

Abstract

BACKGROUND: Cervical lymphadenopathy can be benign or malignant. Its accurate diagnosis is necessary to determine appropriate treatment. Ultrasound-guided core needle biopsies (US-CNBs) are frequently used as a percutaneous sampling approach. OBJECTIVES: Our aim was to identify the efficacy and safety of US-CNBs in 125 patients with cervical lymphadenopathy and clinically suspected head and neck cancer during the COVID-19 pandemic with limited surgical resources. METHODS: US-CNBs of pathological lymph nodes were performed in 146 lymph nodes on 125 patients. Biopsies were performed ultrasound-guided with a reusable gun core biopsy system and a 10-cm-long 16-G needle. Standard of reference for the histological findings were panendoscopy, clinical and sonographic follow-up, surgical biopsy or a repeat US-CNB. RESULTS: Adequate material for histologic diagnosis was obtained in 111 patients (89%), of these 83 patients (75%) were diagnosed as malignant, whereas benign lymphadenopathy accounted for 28 patients (25%). Therefore, US-CNB was able to identify malignant or benign lymphadenopathy with an overall accuracy of 88% and 90%, respectively. CONCLUSIONS: Percutaneous US-CNB is a safe and effective alternative to surgical biopsy in the management of cervical lymphadenopathy in patients with clinically suspected head and neck cancer in a setting with limited resources.

Retrospective audit of Ultrasound guided fine needle aspiration cytology and core biopsy in the assessment of head and neck lumps excluding thyroid nodules at South Warwickshire NHS Foundation Trust

“…The need for adjuncts such as immunohistochemistry in deciding treatment for the patients as in the case of lymphomas or for deciding the intensity of treatment and prognosis as in the case of p16 status in oropharyngeal carcinoma or to aid in finding the primary in nodal metastasis with occult primary would favour a core needle biopsy over FNAC 10,11 . Many studies have shown ultra sound guided core biopsy to be a safe and efficient investigation and has a very low risk of tumour seeding or damage to surrounding structures 12 . As FNAC yields only a very small sample, it is often inadequate for immunocytology which again is not as sensitive as immunohistochemistry and up to 37% patients would often need further FNAC or core biopsy following FNAC 5 .…”