Prediction of The Yield of Percutaneous Ultrasound-Guided-Core-Biopsy from Cervical Lymph Nodes by Clinical and Sonographic Features
2Faculty of Social health and Welfare, Haifa University, Israel
Purpose: Cervical lymphadenopathy can represent various pathologies including both benign and malignant entities. Ultrasound-guided-core-biopsy is often used for achieving histopathologic diagnosis. The efficacy of this procedure is variable. The purpose of our study was to identify factors influencing the diagnostic yield of ultrasound-guided core needle biopsy in cervical lymphadenopathy, possibly contributing to appropriate patient referral to other diagnostic methods.
Methods: A retrospective study was conducted. We included patients that underwent ultrasound-guided-core-biopsy for histopathological diagnosis of cervical lymphadenopathy in a single institution. Imaging features were recorded, particularly characteristics that influence the complexity of the procedure, such as node proximity to blood vessels, depth of the lymph node in the neck and nodes` size. Data was collected by a single radiologist from the formal reports of the procedure and from the examinations themselves. Data were then correlated to histopathological reports.
Results: The study included 136 biopsies. Twenty-four biopsies were not diagnostic, and diagnosis was achieved with surgery, follow-up or repeated biopsies. Of the 136 patients, 17 had reactive lymph nodes, 102 were diagnosed with lymphoproliferative disease, and 17 with carcinoma. Out of 24 non-diagnostic core biopsies, 12 turned out to be reactive lymph nodes. Twelve showed lymphoproliferative disease. All carcinoma cases were diagnosed on initial biopsy.
Features correlated with good diagnostic yield included increased lymph node size: mean width was 2.6 cm for diagnostic versus 1.6 cm for non-diagnostic biopsies (P<0.0001). The presence of a fatty hilum was correlated with non-diagnostic biopsies (p=0.002). There was no correlation with needle gauge (p=0.13), proximity to large vessels (p=0.68), or the possibility for overshoot during the procedure (p=0.26).
Conclusion: The results of our study demonstrate that imaging features could influence the yield of ultrasound guided core biopsies. Patients that present smaller node size or a fatty hilum should be considered for other diagnostic approaches.