Ultrasound-guided core biopsy for the diagnosis of lumps in the neck: results in 82 patients

Analysis of bleeding after ultrasound-guided needle biopsy of benign cervical lymph nodes

AIM

Summarized the incidence of bleeding after ultrasound-guided coarse needle biopsy (US-CNB) of benign cervical lymph nodes.

METHODS

We retrospectively examined the clinical and follow-up records of 590 patients with benign cervical lymph node disease who underwent US-CNB at our hospital during February 2015-July 2022 and were confirmed to have the disease by CNB and surgical pathology. The number of cases, types of diseases, and degree of bleeding of all patients with bleeding after US-CNB were statistically analyzed.

RESULTS

Of the 590 patients, bleeding was noted in 44 cases(7.46%), and the infectious lymph node bleeding rate was 9.48%. Infectious lymph nodes were more likely to bleed than noninfectious lymph nodes after CNB, ,x² = 8.771; P = 0.003, Lymph nodes with pus were more likely to bleed than solid lymph nodes after CNB, x² = 4.414; P = 0.036,.

CONCLUSION

The bleeding of all patients after CNB was minor bleeding. Infected lymph nodes bleed more frequently than noninfected lymph nodes. Lymph nodes with mobility and a large pus cavity, are more likely to bleed after CNB.

Ultrasound core biopsies of neck lumps: an experience from a tertiary head and neck cancer unit

BACKGROUND

Traditionally, fine needle aspiration cytology was the primary diagnostic investigation for head and neck lumps; however, ultrasound-guided core biopsy offers the advantage of preserving tissue architecture with increased tissue yield. This study reviews the diagnostic utility of ultrasound-guided core biopsy for investigating head and neck lumps.

METHODS

Overall, 287 ultrasound-guided core biopsies were reviewed between May 2017 and April 2019 at a single tertiary site for head and neck cancer.

RESULTS

On initial ultrasound-guided core biopsy, a diagnostic sample was obtained in 94.4 per cent of patients and in 83.7 per cent of patients with lymphoma. Where the initial ultrasound-guided core biopsy was non-diagnostic, 50 per cent of samples were diagnostic on repeat ultrasound-guided core biopsy. Overall, five complications were seen related to ultrasound-guided core biopsy, and all were managed conservatively. No cases of disease recurrence were identified at the biopsy site.

CONCLUSION

Ultrasound-guided core biopsy is a safe procedure with a high diagnostic yield when investigating head and neck lumps. Patients whose ultrasound-guided core biopsies were non-diagnostic should be considered for excisional biopsy over repeat ultrasound-guided core biopsy.

Role of contrast-enhanced ultrasound guidance in core-needle biopsy for diagnosis of cervical tuberculous lymphadenitis

OBJECTIVE

To investigate the diagnostic value of core-needle biopsy (CNB) guided by contrast-enhanced ultrasound (CEUS) in cervical tuberculous lymphadenitis (CTL).

METHODS

178 patients with pathological confirmation of CTL were retrospectively enrolled. All of them had undergone CNB prior to the final surgery. According to the different ways of puncture guidance, they were divided into two groups: conventional ultrasound (US) group (n = 81) and CEUS group (n = 97). The comparison of diagnostic efficacy between two groups was compared and analyzed.

RESULTS

Among the 178 patients, 146 were directly diagnosed as CTL by CNB, including 59 patients in CEUS group and 87 patients in US group. The diagnostic accuracy were 89.7% (87/97) and 72.8% (59/81), respectively (P < 0.01). For subgroup analyses, differences among diagnostic efficacy ascribed to the different guiding methods were significant in medium size group (>2.0 cm and ≤3.0 cm) and large size group (>3.0 cm), 91.7% for CEUS group vs. 69.0% for US group (P < 0.05) and 84.4% for CEUS group vs. 57.7% for US group (P < 0.05), respectively.

CONCLUSIONS

In the diagnosis of CTL, compared with the US-guided CNB, CEUS-guided CNB have certain advantages, especially for larger lymph nodes.

Core needle biopsy for diagnosing lymphoma in cervical lymphadenopathy: Meta-analysis

BACKGROUND

The diagnostic yield of core needle biopsies (CNB) in cervical lymphadenopathy for lymphoma diagnosis is controversial. The aim of this study was to calculate the accuracy of cervical CNB in diagnosing lymphoma.

METHODS

We conducted a meta-analysis of all studies on patients presenting with cervical lymphadenopathy and referred to CNB. Patients with a diagnosis other than lymphoma were excluded. All cases diagnosed with lymphoma sufficient to guide treatment based on CNB outcome were considered accurate (actionable) results. A separate meta-analysis was performed for various lymphoma subtypes.

RESULTS

Three prospective and 19 retrospective studies, comprising 1120 patients, met the inclusion criteria. The rate of actionable lymphoma diagnoses following CNB ranged from 30% to 96.3%, with a random-effects model of 82.45% (95% confidence interval [CI] =0.76-0.88) and a fixed-effects model of 78.3% (95% CI =0.75-0.80).

CONCLUSION

CNB for cervical lymphadenopathy in lymphoma cases is relatively accurate in guiding treatment.

Diagnosing Lymphoproliferative Disorders Using Core Needle Biopsy Versus Surgical Excisional Biopsy: Three-Year Experience of a Reference Center in Lebanon

BACKGROUND

Despite current guidelines, a significant increase in the use of core needle biopsy (CNB) has been noted. Our aims were to determine the profile of patients referred for image-guided biopsies, to assess the diagnostic yield of these biopsies, and to learn whether CNB is an effective alternative to surgical excisional biopsy (SEB).

PATIENTS AND METHODS

All lymph node biopsy samples evaluated in the Department of Pathology and Laboratory Medicine from 2014 to 2017 were included. Patients' demographics, biopsy type, and final diagnosis were recorded and classified as diagnostic or nondiagnostic. The reasons for the latter were evaluated and follow-up was obtained, where available.

RESULTS

A total of 373 cases, 210 CNB and 163 SEB, were collected. The diagnostic yield was 79% for CNB compared to 97% for SEB. The choice of CNB versus SEB was not dependent on patient's age, gender, or clinical suspicion of malignancy. Failure to reach a diagnosis was due to insufficient or suboptimal tissue in most nondiagnostic CNBs. Lymphoma was equally diagnosed among CNB and SEB. CNB was at an advantage in diagnosing large B-cell lymphomas.

CONCLUSION

When performed adequately, CNB is a good substitute for SEB. Strict and specific guidelines need to be updated and adopted to indicate how and when it can be used, including the recommendation of concomitant complementary diagnostic laboratory testing such as flow cytometry. The latter should be readily available in order to not compromise the quality and accuracy of the diagnoses.

Diagnostic utility of freehand core-needle biopsy in head and neck masses

OBJECTIVE

To review our experience with freehand core-needle biopsy in the assessment of unexplained head and neck masses.

METHODS

A total of 770 patients with head and neck masses (referred over a 22-month period) were evaluated. A retrospective chart review was performed on 53 of those patients who underwent core-needle biopsy for an unexplained mass.

RESULTS

Correct sampling of the target tissue was achieved in all 53 patients (100 per cent) using a freehand core-needle biopsy technique. The diagnostic accuracy for providing adequate tissue samples for histopathological diagnosis was 96 per cent; the test sensitivity was 92 per cent. Four patients (7 per cent) required open surgical biopsy prior to commencing definitive treatment.

CONCLUSION

Out-patient freehand core-needle biopsy can be carried out safely on select patients with head and neck masses, and provides high quality histopathology specimens with high diagnostic utility.

Ultrasound-guided core biopsy in the diagnosis of lymphoma of the head and neck. A 9 year experience

OBJECTIVES

This retrospective study aimed to evaluate the diagnostic utility of ultrasound-guided core biopsy (USCB) in lymphoma of the head and neck, in particular whether core biopsy can provide sufficient diagnostic information for definitive treatment.

METHODS

All lymphomas diagnosed in the head and neck at Eastbourne General Hospital between January 2000 and June 2009 were identified. Radiology and pathology reports were reviewed and the diagnostic techniques recorded. The type of biopsy (fine needle aspiration, needle core, surgical excision biopsy) used to establish a diagnosis sufficient to allow treatment, i.e. the "index" diagnostic technique, was identified. Previous inconclusive or inadequate biopsies were noted. Pathology reports based on USCB were graded 0-3 according to diagnostic completeness and ability to provide treatment information.

RESULTS

Of 691 overall cases of lymphoma diagnosed over the 9 year period, 171 different patients presented with lymphoma in the head and neck. Of these 171, 83 had USCB biopsy during diagnostic work up. 60 were regarded as grade 3 where a confident diagnosis of lymphoma was made. In seven patients, clinical management proceeded on the basis of a suggestive (grade 2) pathology report without surgical excision, and these were therefore also included as "index" biopsies. Overall therefore, 67/83 core biopsies (81%) provided adequate information to allow treatment. Surgical excision biopsy was the index modality in 104 cases.

CONCLUSION

In the majority of cases USCB is adequate for confident histopathological diagnosis avoiding the need for surgical excision biopsy in cases of suspected head and neck lymphoma.

Ultrasound guided Core Biopsy, Fine Needle Aspiration Cytology and Surgical Excision Biopsy in the diagnosis of metastatic squamous cell carcinoma in the head and neck: an eleven year experience

INTRODUCTION

This study aims to review our 11 year experience of diagnosing metastatic squamous cell carcinoma presenting as head and neck lumps. The techniques of Ultrasound guided Core Biopsy (USCB), Fine Needle Aspiration Cytology (FNAC) and Surgical Excision Biopsy (SEB) are compared.

MATERIALS AND METHODS

All patients with metastatic squamous cell carcinoma (SCC) involving the lymph nodes of the head and neck or parotid gland, diagnosed at Eastbourne District General Hospital between January 1998 and November 2009 were identified. The following data items were collated: biopsy location (e.g. cervical lymph node or parotid), any history of likely primary SCC and site, type of biopsy used to establish a conclusive diagnosis (index diagnostic technique), previous biopsies, the technique and their results, subsequent histology results.

RESULTS

A total of 90 patients were diagnosed with metastatic squamous cell carcinoma. The index diagnostic technique was USCB in 48 patients, FNAC in 29 and SEB in 13. In 72 (80%) patients the index biopsy was the sole tissue sample taken prior to surgery or other treatment. The remaining 18 patients underwent a total of 22 previous biopsies prior to the index biopsy. 95% (21/22) of these previous biopsies were non-definitive FNAC and 5% (1/22) was a non-definitive USCB. FNACs also demonstrated the highest non-diagnostic rate (42%). The accuracy of USCB and FNAC in correlating with final histopathology was 97% and 85% respectively.

CONCLUSIONS

USCB demonstrates excellent results in the diagnosis of metastatic SCC in the head and neck with higher accuracy and greater reliability than FNAC.

Imaging the major salivary glands

Advances in imaging have led to improved sensitivity in the diagnosis of diseases that involve the major salivary glands. Ultrasound (US), plain radiography and sialography, magnetic resonance imaging (MRI), computed tomography (CT), and nuclear scintigraphy/positron emission tomography (PET) all play a part, and imaging often assists in the planning of further management, operative or otherwise. We review the methods used for imaging the major salivary glands, and apply the indications for these methods to the principal pathological processes.

[Differential diagnosis and treatment of neck masses. A study based on observation in Otolaryngology Department of Miedzyleski Specialistic Hospital in Warsaw]

In otolaryngology practice we quite often encounter neck masses in all age group patients. The differential diagnosis is extensive and represents a variety of pathologic conditions of various origins, especially in relation to patient age. The authors present a retrospective analysis of patients with a neck mass treated in Otolaryngology Department of Miedzyleski Specialistic Hospital in Warsaw over the period of two years. Patients were divided into groups according to their age. Within each group the incidence of congenital, inflammatory and neoplastic disease was assessed. The most numerous was the group of adults older than 40 years of age with the highest incidence of malignant neoplasms. The location of metastatic lymph nodes in relation to primary site was described. Finally, methods of management for each tumour type were presented. Then we discuss a work-up of a neck mass with regard to literature data.

An update on the use of ultrasound imaging in oral and maxillofacial surgery

Ultrasound is a relatively inexpensive, non-invasive, and readily available technique that is well tolerated by patients. It is particularly useful in the examination of superficial structures where the use of a high frequency linear probe (7.5-12 MHz) produces high definition multi-planar images. The spatial resolution achieved is superior to other methods of cross-sectional imaging and, when combined with tissue biopsying techniques such as fine needle aspiration cytology (FNAC) or core biopsy samples, it is rendered a highly specific diagnostic tool. This article provides an overview of the use of ultrasound for common head and neck conditions, including its use in salivary gland disease, and for the assessment of cervical lymphadenopathy.

Primary thyroid lymphoma: role of ultrasound-guided needle biopsy

OBJECTIVE

The purpose of this study was to describe the sonographic findings of primary thyroid lymphoma and evaluate the role of ultrasound-guided biopsy in diagnosing thyroid lymphoma.

METHODS

This study included 6 patients (age range, 56-72 years; mean, 62.5 years). We searched the database of our institution and retrospectively collected data on the thyroid lymphomas that were confirmed pathologically. All of the sonograms and medical records were reviewed retrospectively.

RESULTS

All 6 patients had an enlarged neck mass and underwent ultrasound-guided fine-needle aspiration biopsy. The most notable sonographic feature of primary thyroid lymphoma was a marked hypoechoic mass compared with the residual thyroid tissue. Among the 6 patients with a diagnosis of thyroid lymphoma, 3 (50%) had a diagnosis of lymphoma by ultrasound-guided fine-needle aspiration biopsy. Final pathologic results were obtained by ultrasound-guided core needle biopsy (3/6 patients [50%]) or thyroidectomy (3/6 [50%]). Most patients with thyroid lymphoma (5/6 [83.3%]) were found to have diffuse large B-cell lymphoma and were treated with chemotherapy with or without radiotherapy. In 1 patient with follicular lymphoma, diagnosis and treatment were accomplished by total thyroidectomy.

CONCLUSIONS

Our results show that ultrasound-guided core needle biopsy can be a safe and accurate method for diagnosing thyroid lymphoma and may be a suitable replacement for diagnostic thyroid surgery.

Ultrasound-guided core-needle biopsy in the diagnosis of head and neck masses: Indications, technique, and results

BACKGROUND

Unclear cervicofacial masses are common presentations that often require tissue sampling to guide therapy. While open biopsy is invasive, fine-needle aspiration cytology includes a high rate of nondiagnostic samples.

METHODS

A retrospective analysis on 181 core-needle biopsies in 88 patients was performed to determine the diagnostic efficacy of ultrasound-guided core-needle biopsies in the head and neck.

RESULTS

We experienced 100% success in obtaining high-quality histopathologic specimens. The target tissue was correctly sampled in 80 of 88 patients. In these patients the sensitivity, specificity, and accuracy rate of core-needle biopsies in differentiating benign from malignant cervicofacial lesions was 98.1%, 100%, and 98.8%, respectively.

CONCLUSIONS

Ultrasound-guided core-needle biopsies can be recommended as a safe and reliable technique in the diagnosis of cervicofacial masses with a high diagnostic yield. It obtains tissue samples of high quality and represents a sufficient alternative to open biopsy even in the diagnosis of lymphoma.

A study to evaluate the efficacy of image-guided core biopsy in the diagnosis and management of lymphoma--results in 103 biopsies

The reason for this study was to evaluate the ability of image-guided core biopsy to replace surgical excision by providing sufficient diagnostic and treatment information. All consecutive image-guided core biopsies in patients with a final diagnosis of lymphoma over a 6-year period at our institution were collected retrospectively. Case notes and pathology reports were reviewed and the diagnostic techniques used were recorded. Pathology reports were graded according to their diagnostic completeness and their ability to provide treatment information. Out of a total of 328 instances of lymphoma, 103 image-guided core biopsies were performed in 96 patients. In 78% of these, the diagnostic information obtained from the biopsy provided a fully graded and subtyped diagnosis of lymphoma with sufficient information to initiate therapy. In the head and neck 67% of core biopsies were fully diagnostic for treatment purposes compared to 91% in the thorax, abdomen and pelvis. Image-guided core biopsy has a number of cost and safety advantages over surgical excision biopsy and in suitable cases it can obviate the need for surgery in cases of suspected lymphoma. This is especially relevant for elderly patients and those with poor performance status.

Value of ultrasound-guided core biopsy in the diagnosis of malignant lymphoma

PURPOSE

Ultrasound-guided core needle biopsy for the diagnosis and management of malignant lymphomas is controversial and has not been accepted as an alternative to surgical biopsy. We investigate the clinical usefulness of this procedure in a large series of patients.

METHODS

Over a 5-year period (2000-2004), ultrasound-guided core needle biopsies were performed in 102 malignant lymphomas. Five diagnostic categories were considered: large B-cell lymphomas (LBCL), small B-cell lymphomas (SBCL), Hodgkin's disease (HD), T cell lymphomas, and miscellaneous. Surgical excisional biopsy of the node was performed in 47 cases (46.1%) for diagnostic confirmation.

RESULTS

The overall diagnostic accuracy of ultrasound-guided core needle biopsy was 88.2% (90/102). SBCL (39), LBCL (36), HD (15), T cell lymphomas (5), and miscellaneous (7) [including T cell-rich B cell (2), natural killer cell (1), Burkitt's lymphoma (1), and non-Hodgkin's lymphoma of the B cell type, NOS (3)] were correctly diagnosed. Three HDs, 1 natural killer cell lymphoma, 1 follicular lymphoma, and 1 LBCL were not correctly diagnosed. The core needle biopsy did not yield tumor tissue in 6 cases.

CONCLUSIONS

Ultrasound-guided core needle biopsy is effective in the diagnosis of malignant lymphomas and can be used as the first diagnostic approach in selected clinical situations.

Sonographically guided core needle biopsy of cervical lymphadenopathy in patients without known malignancy

OBJECTIVE

The purpose of this study was to retrospectively evaluate the efficacy of sonographically guided core needle biopsy (core biopsy) for diagnosing the causes of cervical lymphadenopathy in patients without known malignancy.

METHODS

One hundred fifty-five sonographically guided core biopsies performed in 155 patients with cervical lymphadenopathy were retrospectively evaluated. None of the 155 patients had any known primary malignancy. Final diagnoses were determined by the histologic examination from excision biopsy when performed or by the clinical and sonographic follow-up for more than 12 months. When a lymph node diagnosed as benign by sonographically guided core biopsy regressed spontaneously or by subsequent management, the diagnosis made by the sonographically guided core biopsy was considered correct. When a lymph node diagnosed as benign by sonographically guided core biopsy was unchanged or increased in size with subsequent management, excision biopsy was performed. Diagnostic yield, sensitivity, specificity, accuracy, and complications of core biopsy were evaluated.

RESULTS

Histologic diagnosis could be made by sonographically guided core biopsy in 146 (94%) of the 155 patients. The histologic diagnoses were reactive hyperplasia in 44 patients, tuberculosis in 37, Kikuchi disease in 25, metastasis in 16, lymphoma in 16, normal in 7, and toxoplasmosis in 1. Sensitivity, specificity, and accuracy of sonographically guided core biopsy were 97.9%, 99.1%, and 97.9%, respectively. There were no procedure-related complications.

CONCLUSIONS

Sonographically guided core biopsy is a safe and efficient tool for diagnosing the cause of cervical lymphadenopathy in patients without known malignancy and may obviate unnecessary excisional biopsy.

Usefulness of cutting needle biopsy in recurrent and advanced staged head and neck malignancies in a palliative setting

GOAL OF WORK

Advanced staged and recurrent head and neck malignancies require histological confirmation before planning further treatment. The purpose of this article is to focus on the clinical usefulness of cutting needle biopsies in the head and neck as a minimal invasive procedure to establish a tissue diagnosis in a palliative setting.

MATERIALS AND METHODS

A retrospective analysis on 74 core needle biopsies in 32 patients with recurrent and advanced staged head and neck malignancies was performed to determine the advantages of ultrasound-guided cutting needle biopsies compared to open biopsy and fine-needle aspiration cytology in palliative cancer treatment.

MAIN RESULTS

We experienced 100% success in obtaining high-quality histopathologic specimens. In 93.8% of the patients, a tissue core of the target organ was successfully obtained. All of the patients tolerated the procedure well without any minor or major complications.

CONCLUSIONS

Cutting needle biopsy in the head and neck is a safe and minimal-invasive procedure that can be performed in local anaesthesia on an outpatient basis. In a palliative setting, it can be recommended as an attractive alternative to both fine needle aspiration and open biopsy. It represents a simple and fast device for obtaining a tissue diagnosis with high diagnostic yield and accuracy and low morbidity.

"One-stop" clinics in the investigation and diagnosis of head and neck lumps

This article considers the issues raised by the NICE guidelines "Improving outcomes in head and neck cancers" (2004) with particular emphasis on the guidelines regarding the creation of "one-stop" neck lump assessment clinics. Tissue sampling is an essential function of the clinics and the relative merits of fine needle aspiration cytology (FNAC) and ultrasound-guided core biopsy (US-CB) in the context of a one-stop model are discussed. All cancer service providers in the UK have a duty to implement the NICE guidelines, with the intention of improving cancer services to our patients. The measures against which head and neck cancer teams are to be accredited through the process of peer review will specify such a clinic to be in place. Teams should implement the guidance in such a way that there is a genuine benefit to patients. In many centres this may require clinicians to learn new skills and adopt different ways of working.