The Value of Ultrasound-guided Biopsy of Fluorodeoxy-glucose Positron Emission Tomography (FDG-PET)-positive Supraclavicular Lymph Nodes in Patients with Suspected Lung Cancer

Overview

Journal BMC Med Imaging

Publisher Biomed Central

Specialty Radiology

Date 2017 Jul 12

PMID 28693444

Citations 4

Authors

Lennart Werner

Franziska Aebersold Keller

Ujwal Bhure

Justus Egidius Roos

Katharina Tornquist

Maria Del Sol Perez-Lago

Oliver Gautschi

Klaus Strobel

Affiliations

Soon will be listed here.

Abstract

Background: Accurate lymph node staging is essential for adequate prognostication and therapy planning in patients with non-small cell lung cancer (NSCLC). FDG-PET/CT is a sensitive tool for the detection of metastases, including non-palpable supraclavicular lymph node (SCLN) metastases. Histological proof of metastatic spread and mutation analysis is crucial for optimal staging and therapy. The aim of this study was to investigate the value of ultrasound-guided fine needle aspiration cytology (FNAC) and core biopsy (CB) of FDG active, non-palpable SCLN's in patients with suspicion for lung cancer.

Methods: Twelve consecutive patients with suspected lung cancer and FDG-positive SCLN underwent FNAC (n = 11) and/or CB (n = 10) and were included and evaluated retrospectively in this study. Cytologic and/or histologic evaluation was performed to confirm initially suspected diagnosis (lung cancer), to confirm N3 stage, and to screen for driver mutations in lung adenocarcinoma.

Results: FNAC alone showed diagnostic success in 11/11 cases (100%), CB alone in 9/10 patients (90%), and the combination of both procedures was successful in 12/12 cases (100%). Lymph node metastases from NSCLC (7 adenocarcinoma, 2 squamous cell carcinoma) could be confirmed in 9 patients. Other diagnoses were small cell lung cancer (SCLC), breast cancer and sarcoidosis. There was enough material for immunhistochemistry in all patients. For molecular testing, material from this lymph node biopsies and lung biopsy was used. In two patients with adenocarcinoma of the lung driver mutations were detected (EGFR Exon 19 deletion and ALK rearrangement) out of the lymph node metastasis.

Conclusions: US-guided combined FNAC and CB of FDG positive supraclavicular lymph nodes in patients with suspected lung cancer is a safe and effective procedure to confirm N3-stage and to obtain representative material for molecular testing.

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Performance of Ultrasound-Guided Core Biopsy Driven by FDG-avid Supraclavicular Lymph Nodes in Patients With Suspected Lung Cancer.

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References

Kumaran M, Benamore R, Vaidhyanath R, Muller S, Richards C, Peake M . Ultrasound guided cytological aspiration of supraclavicular lymph nodes in patients with suspected lung cancer. Thorax. 2005; 60(3):229-33. PMC: 1747328. DOI: 10.1136/thx.2004.029223. View

Lardinois D, Weder W, Hany T, Kamel E, Korom S, Seifert B . Staging of non-small-cell lung cancer with integrated positron-emission tomography and computed tomography. N Engl J Med. 2003; 348(25):2500-7. DOI: 10.1056/NEJMoa022136. View

van Overhagen H, Lameris J, Zonderland H, Tilanus H, van Pel R, SCHUTTE H . Ultrasound and ultrasound-guided fine needle aspiration biopsy of supraclavicular lymph nodes in patients with esophageal carcinoma. Cancer. 1991; 67(3):585-7. DOI: 10.1002/1097-0142(19910201)67:3<585::aid-cncr2820670310>3.0.co;2-q. View

Kendirlinan R, Ozkan G, Bayram M, Bakan N, Tutar M, Gur A . Ultrasound guided fine-needle aspiration biopsy of metastases in nonpalpable supraclavicular lymph nodes in lung cancer patients. Multidiscip Respir Med. 2012; 6(4):220-5. PMC: 3463075. DOI: 10.1186/2049-6958-6-4-220. View

Moreira A, Thornton R . Personalized medicine for non-small-cell lung cancer: implications of recent advances in tissue acquisition for molecular and histologic testing. Clin Lung Cancer. 2012; 13(5):334-9. DOI: 10.1016/j.cllc.2012.01.004. View

Shaw A, Ou S, Bang Y, Camidge D, Solomon B, Salgia R . Crizotinib in ROS1-rearranged non-small-cell lung cancer. N Engl J Med. 2014; 371(21):1963-71. PMC: 4264527. DOI: 10.1056/NEJMoa1406766. View

Prosch H, Strasser G, Sonka C, Oschatz E, Mashaal S, Mohn-Staudner A . Cervical ultrasound (US) and US-guided lymph node biopsy as a routine procedure for staging of lung cancer. Ultraschall Med. 2007; 28(6):598-603. DOI: 10.1055/s-2007-963215. View

Ahn D, Roh J, Kim J . Ultrasound-Guided Core Needle Biopsy for Head and Neck Mass Lesions in Patients Undergoing Antiplatelet or Anticoagulation Therapy: A Preliminary Report. J Ultrasound Med. 2017; 36(7):1339-1346. DOI: 10.7863/ultra.16.05045. View

Anastasilakis A, Polyzos S, Nikolopoulos P . Subendothelial carotid hematoma after fine-needle aspiration biopsy of a solitary thyroid nodule. J Ultrasound Med. 2008; 27(10):1517-20. DOI: 10.7863/jum.2008.27.10.1517. View

10.

Sihoe A, Lee T, Ahuja A, Yim A . Should cervical ultrasonography be a routine staging investigation for lung cancer patients with impalpable cervical lymph nodes?. Eur J Cardiothorac Surg. 2004; 25(4):486-91. DOI: 10.1016/j.ejcts.2003.12.026. View

11.

Shaw A, Engelman J . Ceritinib in ALK-rearranged non-small-cell lung cancer. N Engl J Med. 2014; 370(26):2537-9. DOI: 10.1056/NEJMc1404894. View

12.

Goerres G, von Schulthess G, Steinert H . Why most PET of lung and head-and-neck cancer will be PET/CT. J Nucl Med. 2004; 45 Suppl 1:66S-71S. View

13.

Gupta R, Naran S, Lallu S, Fauck R . The diagnostic value of fine needle aspiration cytology (FNAC) in the assessment of palpable supraclavicular lymph nodes: a study of 218 cases. Cytopathology. 2003; 14(4):201-7. DOI: 10.1046/j.1365-2303.2003.00057.x. View

14.

Donatini G, Masoni T, Ricci V, DElia M, Guadagni A, Baldetti G . Acute respiratory distress following fine needle aspiration of thyroid nodule: case report and review of the literature. G Chir. 2010; 31(8-9):387-9. View

15.

Pao W, Girard N . New driver mutations in non-small-cell lung cancer. Lancet Oncol. 2011; 12(2):175-80. DOI: 10.1016/S1470-2045(10)70087-5. View

16.

Steinert H . PET and PET-CT of lung cancer. Methods Mol Biol. 2011; 727:33-51. DOI: 10.1007/978-1-61779-062-1_3. View