Ultrasound-Guided Cervical Lymph Node Sampling Performed by Respiratory Physicians

Abstract

Background: A variety of disease processes investigated by respiratory physicians can lead to cervical lymphadenopathy. Ultrasound (US) has revolutionised respiratory investigations, and neck ultrasound (NUS) is increasingly recognised as an additional important skill for respiratory physicians. Objectives: We aimed to assess the feasibility of NUS performed by respiratory physicians in the workup of patients with mediastinal lymphadenopathy. Methods: This is a single-centre retrospective cohort study. All patients that underwent US-guided cervical lymph node sampling were included. The diagnostic yield is reported, and specimen adequacy is compared for respiratory physicians and radiologists. Results: Over 5 years, 106 patients underwent NUS-guided lymph node sampling by respiratory physicians compared to 35 cases performed by radiologists. There was no significant difference in the adequacy of sampling between the two groups (respiratory physicians 91.5% [95% CI 84.5–96%] compared to 82.9% [95% CI 66.4–93.4%] for radiologists [p = 0.2]). In the respiratory physician group, a diagnosis was achieved based on lymph node sampling in 89 cases (84%). Neck lymph node sampling was the only procedure performed to obtain tissue in 48 cases (45.3%). Conclusion: NUS and sampling performed by respiratory physicians are feasible and associated with an adequacy rate comparable to that of radiologists. It can reduce the number of invasive procedures performed in a selected group of patients. Guidelines for training and competency assessment are required.

European Respiratory Society statement on thoracic ultrasound

“…Focused ultrasound performed by pulmonologists of structures related to the chest (e.g. neck) and subsequent ultrasound-guided biopsy has been described and potentially provides a rapid, less invasive method for obtaining a diagnosis and staging patients with suspected thoracic malignancy [250][251][252][253]. In addition, a potential role has been described in other diseases with extrapulmonary involvement (e.g.…”

Bedside physician led US-guided supra-clavicular lymph node biopsy and ROSE (rapid on-site evaluation): SVC obstruction swift management in lung cancer

“…Furthermore, carrying out an US-guided biopsy before giving systemic treatments can improve the quality of the biopsy specimen as high-dose steroids and radiotherapy can degrade the specimen [ 17 , 18 ].…”

Focused Neck Ultrasound and Lymph Node Sampling by Respiratory Physicians in Suspected Lung Cancer

“…Neck LN sampling by respiratory physicians attending lung cancer fast-track clinic is feasible and safe – adding to an increasing body of evidence [10, 12]. Rapid diagnosis with a median time from referral to pathological confirmation of malignancy of 7 days means treatment decisions can be made with the current aspirational national targets (ref rapid pathway – 9 days) [3].…”

“…The Royal College of Radiology (RCR) guidelines for thoracic ultrasound performed by physicians lists NUS and biopsy as part of the competencies required to attain level 2 proficiency [11]. It has been shown that respiratory physicians are able to perform neck nodal sampling efficiently and safely after appropriate training [12]. In the setting of fast-track clinics, the availability of appropriately trained respiratory physicians, who typically see patients upon referral to the cancer pathway, allows examinations and sampling to be performed immediately, streamlining the diagnostic pathway and reducing waiting times for diagnosis.…”