Ultrasound-Guided Fine Needle Aspiration Cytology in the Assessment of Cervical Metastasis in Patients Undergoing Elective Neck Dissection

Dabirmoghaddam, Payman; Sharifkashani, Shervin; Mashali, Leila

doi:10.5812/iranjradiol.7928

Cited by 6 publications

(5 citation statements)

References 17 publications

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“…Similar concerns are noted for accurate detection of cervical metastatic disease in human oncology, with palpation, diagnostic imaging, and cytologic evaluation failing to replace elective neck dissection (END) for patients with the clinically negative (cN0) neck. The cN0 neck is defined as having no identified metastatic nodal disease with clinical staging utilizing palpation, diagnostic imaging, and/or cytologic sampling (18)(19)(20).…”

Section: Introductionmentioning

confidence: 99%

Variability in Recommendations for Cervical Lymph Node Pathology for Staging of Canine Oral Neoplasia: A Survey Study

2020

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There is no clear guideline regarding the indication for routine lymph node extirpation and pathologic evaluation during staging of canine oral tumors, despite a relatively high reported nodal metastatic rate for select tumor types. It is particularly unclear if clinicians recommend removal of lymph nodes only when there is confirmation of metastasis, defined as the N+ neck, or if elective neck dissection (END) is routinely recommended to confirm the true pathologic metastatic status of lymph nodes in the clinical N0 neck (no evidence of metastasis on clinical staging with diagnostic imaging or cytology). When clinicians are recommending END as a staging tool to confirm nodal status, there is also ambiguity regarding the surgical extent for subsequent histopathologic evaluation. The objective of this cross-sectional survey study was to determine the current recommendations given by practicing specialists regarding lymph node removal for dogs with oral tumors. Overall, 87 responses were obtained from 49 private practices (56%) and 38 academic institutions (44%). Respondents identified as oncologists (44%, N = 38), soft tissue surgeons (40%, N = 35), and dentists (16%, N = 14). Regardless of tumor type and stage, extirpation and histopathology were most commonly recommended in the clinical N+ neck only. The recommendation to routinely perform END in the N0 neck was significantly associated with tumor type. Bilateral removal of the mandibular and retropharyngeal lymph nodes was recommended more often for oral malignant melanoma (OMM) than for oral squamous cell carcinoma (OSCC; p ≤ 0.0039) or for oral fibrosarcoma (OFSA; p ≤ 0.0007). The likelihood of recommending END increased with increasing tumor size. Academic clinicians were significantly ( p < 0.01) more likely to recommend END compared to private practitioners for canine T1–T3 OMM, T3 OSCC, T2 OFSA, and MCT. This study highlights the variability in recommendations for lymph node pathology for dogs with oral tumors. While tumor type and size influenced the decision to pursue END, it was not routinely recommended, even for tumor types with a known propensity for metastasis. Prospective studies are warranted to determine the potential diagnostic and therapeutic value of END in the N0 neck in veterinary patients such that a consensus approach can be made.

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Section: Introductionmentioning

confidence: 99%

Variability in Recommendations for Cervical Lymph Node Pathology for Staging of Canine Oral Neoplasia: A Survey Study

2020

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“…When FNAB is combined with ultrasound guidance, FNAB demonstrates a diagnostic accuracy between 95% and 100% 2,4,6,7,9‐12 . While overall diagnostic accuracy is well documented, less is known about node characteristics impacting the technique's sensitivity for identification of metastatic disease.…”

Section: Discussionmentioning

confidence: 99%

“…The technique is less successful in the specific diagnosis of lymphadenopathy due to primary lymphoproliferative processes 14 . When combined with ultrasound guidance FNAB demonstrates a diagnostic accuracy between 95% and 100% 1,2,4,5,7‐10 . Diagnostic accuracy varies somewhat with site of the lymph node undergoing FNAB but regardless of site when ultrasound guidance is utilized diagnostic sensitivity and specificity remain high 1,2,4‐10 .…”

Section: Introductionmentioning

confidence: 99%

“…When combined with ultrasound guidance FNAB demonstrates a diagnostic accuracy between 95% and 100% 1,2,4,5,7‐10 . Diagnostic accuracy varies somewhat with site of the lymph node undergoing FNAB but regardless of site when ultrasound guidance is utilized diagnostic sensitivity and specificity remain high 1,2,4‐10 . While overall diagnostic accuracy is well documented for ultrasound‐guided FNAB, less is known about lymph node characteristics impacting the techniques sensitivity for metastatic disease.…”

Section: Introductionmentioning

confidence: 99%

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Axillary lymph node metastasis: Fine‐needle aspiration biopsy sensitivity as a function of node size, percent replacement of lymph node by tumor and tumor deposit size

Layfield

Zhang

Esebua

et al. 2020

Diagnostic Cytopathology

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BackgroundFine‐needle aspiration (FNA) is commonly used to investigate lymphadenopathy of suspected metastatic origin. While diagnostic accuracy of FNA for lymph node disease is well described, the relationship between node size, percent tumor replacement, and size of metastatic deposit with diagnostic accuracy is less well documented.MethodsAll axillary lymph nodes undergoing ultrasound‐guided FNA for suspected breast metastases were correlated with subsequent surgical excision specimens. FNAs were judged as positive or negative for malignancy and the percent of false negative FNAs was correlated with node size, percent tumor replacement and size of metastatic depositResultsSensitivities were calculated for nodes greater than 15 mm (92%), nodes 11 to 14.9 mm (83%), nodes 7 to 10.9 mm (61%), and for nodes less than 7 mm (60%). Sensitivity increases with increasing node size (P = .001). Percent tumor replacement correlated with sensitivity: 90% or greater replacement (85%) 60% to 89.9% replacement (75%), 40% to 59.9% replacement (75%) and less than 39.9% replacement (64%)(P < .001). Metastases size correlated with sensitivity: metastases greater than 10 mm (94%), 6 to 9.9 mm (70%), 4 to 5.9 mm (54%), and less than 4 mm (72%).ConclusionsPercentage of false negative FNAs associate with investigation of metastatic disease correlates with node size, size of metastatic deposit and percentage of nodes replaced by tumor. Lymph nodes smaller than 7 mm, deposit diameter less than 6 mm and percentage replacement of less than 40% have the highest percentage of false negative results.

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“…Lymphadenopathy can be identified by observing cell morphological abnormalities such as the nuclear membrane, nucleolus and nuclear-cytoplasm ratio (4,9,13,14). Most existing studies of lymph nodes with short diameters ≤1 cm have indicated that FNA can be performed in cases with absent lymphatic portals, local cortical thickening and changes in the blood supply pattern in the primary lymph node drainage area (15,16). However, Plukker et al believe that the results of FNA are limited due to the limited number of cells obtained by FNA (2).…”

Section: Discussionmentioning

confidence: 99%

The value of sonographically guided fine-needle aspiration in the diagnosis of small lymph

2020

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Background:To analyze the diagnostic value of ultrasound-guided fine-needle aspiration (FNA) biopsy for lymph nodes with short-axis diameters ≤1 cm and to investigate whether the short-axis diameter influences the results of FNA biopsy. Methods:The cytological results of ultrasound-guided FNA lymph node biopsies in 1,242 cases treated at our hospital between December 2015 and June 2017 were retrospectively analyzed. The results were compared with the final diagnostic results of the cases (988 cases had core-needle biopsies, and 254 cases were followed-up for more than six months) to explore the diagnostic value of ultrasound-guided FNA for small lymph nodes.Results: The sensitivities, specificities and accuracies of ultrasound-guided FNA were 99.6%, 99.5% and 99.5% for small lymph nodes with short-axis diameters ≤1 cm and 97.2%, 94.4% and 96.4% for lymph nodes with short-axis diameters >1 cm, respectively. No significant differences were detected between the two groups (P>0.05). Lymph nodes with short-axis diameters ≤1 cm were divided into three groups according to the following diameters: 0.7 cm ≤ short-axis diameter ≤1 cm, 0.5 cm ≤ short-axis diameter <0.7 cm, and short-axis diameter <0.5 cm. The sensitivities of ultrasound-guided FNA for these three groups were 99.6%, 99.5% and 98.0% respectively; the specificities were 99.5%, 99.0% and 98.0%, respectively; and the accuracies were 99.8%, 99.3% and 99.0%, respectively. The differences in accuracy between the three groups were significant (P<0.05), while the differences in sensitivity and specificity were not significant (P>0.05). Conclusions:The diagnostic results of ultrasound-guided FNA for small lymph nodes are not affected by the short-axis diameter. For lymph nodes with short-axis diameters ≤1 cm, the accuracy decreases as the short-axis diameter decreases, but FNA still has a high diagnostic accuracy for these small lymph nodes.

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Ultrasound-Guided Fine Needle Aspiration Cytology in the Assessment of Cervical Metastasis in Patients Undergoing Elective Neck Dissection

Cited by 6 publications

References 17 publications

Variability in Recommendations for Cervical Lymph Node Pathology for Staging of Canine Oral Neoplasia: A Survey Study

Variability in Recommendations for Cervical Lymph Node Pathology for Staging of Canine Oral Neoplasia: A Survey Study

Axillary lymph node metastasis: Fine‐needle aspiration biopsy sensitivity as a function of node size, percent replacement of lymph node by tumor and tumor deposit size

The value of sonographically guided fine-needle aspiration in the diagnosis of small lymph

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