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Incorporation of ultrasound-guided core biopsy with flow cytometry to assist the diagnosis of cervical lymphoma. Eur Arch Otorhinolaryngol 2023; 280:1437-1446. [PMID: 36322178 DOI: 10.1007/s00405-022-07705-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 10/12/2022] [Indexed: 02/07/2023]
Abstract
PURPOSE The main purpose of surgery for cervical lymphoma is only for tissue sampling. To establish a patient-friendly diagnostic approach, we investigated the feasibility of ultrasound-guided core biopsy with flow cytometry in the patients with suspected cervical lymphoma. METHODS We prospectively recruited patients with suspected cervical lymphoma from Nov 2017 till Jan 2021 in a referral medical center and performed retrospective interpretation of the prospectively acquired data. Ultrasound-guided core biopsy as the tissue sampling approach for the targeted lesions was performed in all patients. The ultrasound-guided core biopsy samples were analyzed by immunohistochemical stains and flow cytometry. The sample quality and the rate of definite and decisive diagnosis obtained by ultrasound-guided core biopsy alone and ultrasound-guided core biopsy with flow cytometry were evaluated. RESULTS Total 81 consecutive patients were recruited for analysis. All ultrasound-guided core biopsy samples were qualified for analysis of pathology and flow cytometry. Pathologically, the diagnoses were definite and compatible with their flow cytometry results in 70 patients (86.42%). Either newly-diagnosed or recurrent cervical lymphoma/lymphoproliferative disorders with histologic transformation could be diagnosed by ultrasound-guided core biopsy with flow cytometry. Nine of the 11 patients with pathologically indefinite diagnosis became clinically decisive when flow cytometry was incorporated into the process, which improved the rate of decisive diagnosis to 98.77% (Odds ratio [95% CI]: 6.21 [1.28, 58.96]). CONCLUSION Ultrasound-guided core biopsy combined with flow cytometry is suggested to serve as the first-line and patient-friendly diagnostic approach for the patients with suspected cervical lymphoma.
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Liao LJ, Wen MH, Yang TL. Point-of-care ultrasound in otolaryngology and head and neck surgery: A prospective survey study. J Formos Med Assoc 2021; 120:1547-1553. [PMID: 33775533 DOI: 10.1016/j.jfma.2021.02.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 02/18/2021] [Accepted: 02/25/2021] [Indexed: 10/21/2022] Open
Abstract
PURPOSE The ultrasound applications, examination facilities and methods used by otolaryngology and head and neck surgeons may vary and be different. This study was conducted to assess the methods used for head-and-neck point-of-care ultrasound (POCUS). METHODS This prospective survey study was conducted from 1 July 2018 to 31 December 2019. The surgeons of otolaryngology and head neck surgery who used POCUS in their daily practice were recruited for analyses. RESULTS In total, 30 male and 14 female surgeons who used neck POCUS were recruited. Thirty-nine (89%) surgeons placed patients in a supine position with the head toward the operator. Forty (91%) surgeons performed US-guided fine needle aspiration (FNA), and 35 (80%) surgeons did not use local anesthesia during US-FNA. Thirty-nine (88%) surgeons used the long-axis method to harvest the specimen, and forty-one (93%) used a free-hand method. Most surgeons (25, 57%) used 22G needles for US-FNA, and 29 (66%) used 18G for US-guided core-needle biopsy (CNB). For the cost analysis, reimbursements for US-related procedures were relatively cheaper than those for computer tomography (CT) and magnetic resonance imaging (MRI). CONCLUSION POCUS can be performed by otolaryngology and head and neck specialists with a wide scope of applications and in a cost-effective manner.
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Affiliation(s)
- Li-Jen Liao
- Department of Otolaryngology Head and Neck Surgery, Far Eastern Memorial Hospital, New Taipei, Taiwan; Department of Electrical Engineering, Yuan Ze University, Taoyuan, Taiwan; Biomedical Engineering Office, Far Eastern Memorial Hospital, New Taipei, Taiwan
| | - Ming-Hsun Wen
- Department of Otolaryngology Head and Neck Surgery, Far Eastern Memorial Hospital, New Taipei, Taiwan
| | - Tsung-Lin Yang
- Department of Otolaryngology, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, 10002, Taiwan; Research Center for Developmental Biology and Regenerative Medicine, National Taiwan University, Taipei, Taiwan.
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Wei T, Lu M, Wang L, Jiang Z, Wu M, Li J, Hu Z, Cheng X, Li T, Zhang Z, Wu X, Tan B, Liao J. Contrast-Enhanced Ultrasound Guided Transoral Core Needle Biopsy: A Novel, Safe and Well-Tolerated Procedure for Obtaining High-Quality Tissue in Patients with Oral Cancer. ULTRASOUND IN MEDICINE & BIOLOGY 2020; 46:3210-3217. [PMID: 32988670 DOI: 10.1016/j.ultrasmedbio.2020.09.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 08/28/2020] [Accepted: 09/01/2020] [Indexed: 06/11/2023]
Abstract
The aim of the prospective study described here was to compare the tolerability, safety and diagnostic value of contrast-enhanced ultrasound-guided transoral core needle biopsy (CEUS-CNB) with that of conventional US-guided transoral CNB (US-CNB) and standard incisional biopsy in patients with oral masses. Between June 2017 and November 2019, consecutive patients with oral masses referred for biopsy were randomly assigned to undergo incisional biopsy, US-CNB or CEUS-CNB. Procedure time, intra‑operative blood loss volume, diagnostic performance and pain level before and after the procedure assessed by visual analogue score (VAS) were recorded and compared among the three procedures. Finally, 238 patients with pathology confirmation were analyzed: 80 patients underwent incisional biopsy, 78 patients US-CNB and 80 patients CEUS-CNB. In this study, no significant difference was found in biopsy time between CEUS-CNB, US-CNB and incisional biopsy (75 ± 11 s vs. 73.6 ± 12 s vs. 77 ± 13 s, p = 0.24). CEUS-CNB achieved the highest sensitivity (CEUS-CNB: 100%, US-CNB: 88.5%, incisional biopsy: 84.3%), negative predictive value (CEUS-CNB: 100%, US-CNB: 81.3%, incisional biopsy: 78.4%) and accuracy (CEUS-CNB: 100%, US-CNB: 92.3%, incisional biopsy: 90%). The VAS score for incision biopsy was higher (p = 0.01) and the amount of bleeding was larger (p < 0.001), yet there was no significant difference between CEUS-CNB and US-CNB. Our results indicate CEUS-guided transoral CNB is an efficient, safe and well-tolerated procedure, with biopsy time comparable to and diagnostic performance better than those of conventional US-guided transoral CNB and incisional biopsy.
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Affiliation(s)
- Ting Wei
- Department of Ultrasound Medical Center, Sichuan Cancer Hospital Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Man Lu
- Department of Ultrasound Medical Center, Sichuan Cancer Hospital Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China.
| | - Lu Wang
- Department of Ultrasound Medical Center, Sichuan Cancer Hospital Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Zirui Jiang
- Electrical and Computer Engineering, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Minggang Wu
- Department of Ultrasound Medical Center, Sichuan Cancer Hospital Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Juan Li
- Department of Ultrasound Medical Center, Sichuan Cancer Hospital Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Ziyue Hu
- Department of Ultrasound Medical Center, Sichuan Cancer Hospital Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Xueqing Cheng
- Department of Ultrasound Medical Center, Sichuan Cancer Hospital Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Tingting Li
- Department of Ultrasound Medical Center, Sichuan Cancer Hospital Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Zhenqi Zhang
- Department of Ultrasound Medical Center, Sichuan Cancer Hospital Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Xiaobo Wu
- Department of Ultrasound Medical Center, Sichuan Cancer Hospital Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Bo Tan
- Department of Ultrasound Medical Center, Sichuan Cancer Hospital Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Jifen Liao
- Department of Ultrasound Medical Center, Sichuan Cancer Hospital Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China; North Sichuan Medical College, Nanchong, China
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Smith A, Grady A, Vieira F, Sebelik M. Ultrasound-Guided Needle Biopsy for Diagnosis of Advanced-Stage Malignancies of the Upper Aerodigestive Tract. OTO Open 2017; 1:2473974X17690132. [PMID: 30480173 PMCID: PMC6239046 DOI: 10.1177/2473974x17690132] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Revised: 12/22/2016] [Accepted: 01/03/2017] [Indexed: 11/17/2022] Open
Abstract
Objective Traditionally, direct laryngoscopy confirms stage and tissue diagnosis prior to treatment planning. Patients who are frail or have tenuous airway anatomy may incur risks while undergoing anesthesia. Further, direct laryngoscopy is scheduled after initial examination, introducing diagnosis delay. This study investigates the impact of ultrasound examination with guided needle biopsy compared with traditional operative biopsy. Study Design Case series. Setting Tertiary head and neck clinic. Subjects and Methods The records of patients at the Veterans Affairs Medical Center Memphis and Regional One Health who had supraglottic, oropharyngeal, and hypopharyngeal cancer that was diagnosed by ultrasound needle biopsy were reviewed from 2011 to 2016. Demographics, stage, biopsy results, and treatment were abstracted. Results Seventeen patients who underwent ultrasound-guided needle biopsy of the primary site were included. Average age was 63 years old, and 65% of patients were stage T4 (11/17). Needle biopsy yielded malignant cells in 76% (13/17). Eleven patients were included in subsequent analysis because 6 patients underwent needle biopsy only. Fisher exact test showed no difference between the 2 methods (P = .27). Sensitivity was 86% and specificity was 100%. Seven patients had a median potential delay in diagnosis of 10 days. Conclusions Ultrasound can be used effectively to obtain a tissue diagnosis, circumventing an operative biopsy. Moreover, ultrasound may provide additional imaging details to support accurate staging. This strategy may prove worthwhile to cut costs and reduce delay to staging, reduce risk for those with contraindications to anesthesia, and increase staging accuracy via enhanced imaging details.
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Affiliation(s)
- Aaron Smith
- Department of Otolaryngology, Head & Neck Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Anthony Grady
- Department of Otolaryngology, Head & Neck Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Francisco Vieira
- Department of Otolaryngology, Head & Neck Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Merry Sebelik
- Department of Otolaryngology, Head & Neck Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
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Ho UC, Chen CN, Lin CY, Hsu YC, Chi FH, Chou CH, Chen TC, Wang CP, Lou PJ, Ko JY, Hsiao TY, Yang TL. Application of ultrasound-guided core biopsy to minimize the non-diagnostic results and the requirement of diagnostic surgery in extrapulmonary tuberculosis of the head and neck. Eur Radiol 2016; 26:2999-3005. [DOI: 10.1007/s00330-015-4159-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Revised: 09/05/2015] [Accepted: 12/07/2015] [Indexed: 12/18/2022]
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Chen CN, Lin CY, Ko JY, Lou PJ, Wang CP, Chen TC, Hsiao TY, Yang TL. Application of ultrasound-guided core biopsy as a novel diagnostic tool for base of tongue cancer: Our experiences with ten patients. Clin Otolaryngol 2016; 41:86-90. [DOI: 10.1111/coa.12458] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2015] [Indexed: 12/16/2022]
Affiliation(s)
- C.-N. Chen
- Department of Otolaryngology; National Taiwan University Hospital and National Taiwan University College of Medicine; Taipei Taiwan
- Department of Otolaryngology; National Taiwan University Hospital Hsin-Chu Branch; Hsin-Chu Taiwan
- Graduate Institute of Clinical Medicine; National Taiwan University College of Medicine; Taipei Taiwan
| | - C.-Y. Lin
- Department of Otolaryngology; National Taiwan University Hospital and National Taiwan University College of Medicine; Taipei Taiwan
- Department of Otolaryngology; National Taiwan University Hospital Yun-Lin Branch; Yun-Lin Taiwan
| | - J.-Y. Ko
- Department of Otolaryngology; National Taiwan University Hospital and National Taiwan University College of Medicine; Taipei Taiwan
| | - P.-J. Lou
- Department of Otolaryngology; National Taiwan University Hospital and National Taiwan University College of Medicine; Taipei Taiwan
| | - C.-P. Wang
- Department of Otolaryngology; National Taiwan University Hospital and National Taiwan University College of Medicine; Taipei Taiwan
| | - T.-C. Chen
- Department of Otolaryngology; National Taiwan University Hospital and National Taiwan University College of Medicine; Taipei Taiwan
| | - T.-Y. Hsiao
- Department of Otolaryngology; National Taiwan University Hospital and National Taiwan University College of Medicine; Taipei Taiwan
| | - T.-L. Yang
- Department of Otolaryngology; National Taiwan University Hospital and National Taiwan University College of Medicine; Taipei Taiwan
- Research Center for Developmental Biology and Regenerative Medicine; National Taiwan University; Taipei Taiwan
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Learned KO, Lev-Toaff AS, Brake BJ, Wu RI, Langer JE, Loevner LA. US-guided Biopsy of Neck Lesions: The Head and Neck Neuroradiologist’s Perspective. Radiographics 2016; 36:226-43. [DOI: 10.1148/rg.2016150087] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Chen CN, Lin CY, Chi FH, Chou CH, Hsu YC, Kuo YL, Lin CF, Chen TC, Wang CP, Lou PJ, Ko JY, Hsiao TY, Yang TL. Application of Ultrasound-Guided Core Biopsy to Minimal-Invasively Diagnose Supraclavicular Fossa Tumors and Minimize the Requirement of Invasive Diagnostic Surgery. Medicine (Baltimore) 2016; 95:e2172. [PMID: 26825877 PMCID: PMC5291547 DOI: 10.1097/md.0000000000002172] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Tumors of the supraclavicular fossa (SC) is clinically challenging because of anatomical complexity and tumor pathological diversity. Because of varied diseases entities and treatment choices of SC tumors, making the accurate decision among numerous differential diagnoses is imperative. Sampling by open biopsy (OB) remains the standard procedure for pathological confirmation. However, complicated anatomical structures of SC always render surgical intervention difficult to perform. Ultrasound-guided core biopsy (USCB) is a minimally invasive and office-based procedure for tissue sampling widely applied in many diseases of head and neck. This study aims to evaluate the clinical efficacy and utility of using USCB as the sampling method of SC tumors. From 2009 to 2014, consecutive patients who presented clinical symptoms and signs of supraclavicular tumors and were scheduled to receive sampling procedures for diagnostic confirmation were recruited. The patients received USCB or OB respectively in the initial tissue sampling. The accurate diagnostic rate based on pathological results was 90.2% for USCB, and 93.6% for OB. No significant difference was noted between USCB and OB groups in terms of diagnostic accuracy and the percentage of inadequate specimens. All cases in the USCB group had the sampling procedure completed within 10 minutes, but not in the OB group. No scars larger than 1 cm were found in USCB. Only patients in the OB groups had the need to receive general anesthesia and hospitalization and had scars postoperatively. Accordingly, USCB can serve as the first-line sampling tool for SC tumors with high diagnostic accuracy, minimal invasiveness, and low medical cost.
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Affiliation(s)
- Chun-Nan Chen
- From the Department of Otolaryngology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan (CN-C, CY-L, CH-C, YC-H, YL-K, CH-L, TC-C, CP-W, PJ-L, JY-K, TY-H, TL-Y); Department of Otolaryngology, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan (CN-C, YC-H, YL-K); Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan (CN-C, CY-L); Department of Otolaryngology, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin, Taiwan (CY-L, FH-C, CH-C); and Research Center for Developmental Biology and Regenerative Medicine, National Taiwan University, Taipei, Taiwan (TL-Y)
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Yu SC, Chen CN, Huang HI, Chen TC, Wang CP, Lou PJ, Ko JY, Hsiao TY, Yang TL. Diagnosis of Kikuchi-Fujimoto disease: a comparison between open biopsy and minimally invasive ultrasound-guided core biopsy. PLoS One 2014; 9:e95886. [PMID: 24787483 PMCID: PMC4008434 DOI: 10.1371/journal.pone.0095886] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2013] [Accepted: 04/01/2014] [Indexed: 12/19/2022] Open
Abstract
Kikuchi-Fujimoto disease (KFD) is a self-limited disease without any need of surgical treatments. Sampling of tissue is the only invasive procedure during the clinical course. However, the standard sampling procedure with accuracy, minimal invasiveness, and esthetic maintenance has not been established yet. In this study, a retrospective review of clinical utility and pathological presentations of the ultrasound-guided core biopsy (USCB) and the open biopsy (OB) in consecutive KFD patients. From 2010 to 2012, 34 consecutive patients were enrolled. USCB was performed in 11 patients, and OB was done in 26 patients. KFD was confirmed in 82% cases by USCB. Similar pathological presentations were found both in the specimens of USCB and OB. In the three patients who had received both USCB and OB, KFD was confirmed by USCB in one case, while two by OB. Sampling errors were found both in USCB and OB. For diagnosing KFD, USCB can serve as the first-line diagnostic tool. OB can be applied only in the failed cases of USCB.
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Affiliation(s)
- Shan-Chi Yu
- Department of Pathology, National Taiwan University Hospital, Taiwan
| | - Chun-Nan Chen
- Department of Otolaryngology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
- Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Hsin-I Huang
- Department of Pathology, National Taiwan University Hospital, Taiwan
| | - Tseng-Cheng Chen
- Department of Otolaryngology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Cheng-Ping Wang
- Department of Otolaryngology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Pei-Jen Lou
- Department of Otolaryngology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Jenq-Yuh Ko
- Department of Otolaryngology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Tzu-Yu Hsiao
- Department of Otolaryngology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Tsung-Lin Yang
- Department of Otolaryngology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
- Research Center for Developmental Biology and Regenerative Medicine, National Taiwan University, Taipei, Taiwan
- * E-mail:
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