Reliable EGFR mutation testing in ultrasound-guided supraclavicular lymph node fine-needle aspirates: a cohort study with diagnostic performance analysis

Thoracic ultrasound in guiding management of respiratory disease

INTRODUCTION

Theuse of ultrasound in respiratory disease has evolved substantially over thepast two decades. From a test done to confirm the safe site of pleural fluiddrainage, thoracic ultrasound has become a point-of-care test that guides themanagement of patients on respiratory wards, in clinics and endoscopy.

AREASCOVERED

This review overviews of process ofultrasound examination in the chest. It then delves into specific disease areas(pleural disease, lung disease, diaphragm disease, and invasive procedures) tohighlight how thoracic ultrasound is being used to refine management. Thereview concludes with discussion on the training curricula and assessment toolsfor competency in thoracic ultrasound. Being a scoping review, literaturesearches were conducted on PubMed using relevant search terms.

EXPERT OPINION

Inaddition to its current uses, there are many avenues where thoracic ultrasound willsoon be beneficial. Recent studies show promising roles in areas such aspatient-tailored guidance of pleurodesis and non-invasively predicting lungre-expansion after pleural fluid drainage. In addition, auxiliary tools such ascontrast-enhanced ultrasound and elastography are proving useful in identifyingthe etiology and directing the successful sample of pleural and lung lesions. Studiesare also exploring the utility of sonographic biomarkers such as echogenicity andseptations to predict outcomes in pleural disease.

Routine neck ultrasound by respiratory physicians in the diagnosis and staging of patients with lung cancer and mediastinal lymphadenopathy: a prospective pilot study

Introduction

Cervical lymphadenopathy in lung cancer indicates advanced disease. The presence of mediastinal lymphadenopathy is commonly associated with involvement of neck lymph nodes and some studies suggest routine neck ultrasound (NUS) in this group of patients. We conducted a two-phase study looking at training a respiratory physician to perform ultrasound-guided neck lymph node aspiration in patients with suspected lung cancer.

Methods

In the first phase of the study, one of the authors underwent training in NUS according to predetermined criteria. The adequacy of sampling was prospectively recorded. In the second phase, consecutive patients with suspected lung cancer and mediastinal lymphadenopathy underwent NUS and sampling of abnormal lymph nodes. The outcomes were the adequacy of samples for pathological analysis and molecular analysis, prevalence of cervical lymphadenopathy, and change in stage.

Results

Following the period of training, 35 patients underwent neck node sampling with an overall adequacy of 88.6% (95% CI 78.1–99.1%). Cervical lymph node involvement was confirmed in 13 out of 30 patients with lung cancer (43.3%, 95% CI 25.5–62.6%). Further immunohistochemistry and molecular studies were possible in all patients when it was required (nine cases). NUS led to nodal upstaging in four out of 30 (13.3%) cases.

Conclusion

Training a respiratory physician to perform NUS and needle sampling to an acceptable level is feasible. Benefits of embedding this procedure in lung cancer diagnosis and pathway staging need to be explored in further studies.

It is feasible to train respiratory physicians to perform ultrasound-guided sampling of cervical lymph nodes. In lung cancer patients with mediastinal lymphadenopathy, 43% had cervical lymph node involvement with reduction in the number requiring EBUS.http://bit.ly/33LekBa

Ultrasound-Guided Cervical Lymph Node Sampling Performed by Respiratory Physicians

Background

A variety of disease processes investigated by respiratory physicians can lead to cervical lymphadenopathy. Ultrasound (US) has revolutionised respiratory investigations, and neck ultrasound (NUS) is increasingly recognised as an additional important skill for respiratory physicians.

Objectives

We aimed to assess the feasibility of NUS performed by respiratory physicians in the workup of patients with mediastinal lymphadenopathy.

Methods

This is a single-centre retrospective cohort study. All patients that underwent US-guided cervical lymph node sampling were included. The diagnostic yield is reported, and specimen adequacy is compared for respiratory physicians and radiologists.

Results

Over 5 years, 106 patients underwent NUS-guided lymph node sampling by respiratory physicians compared to 35 cases performed by radiologists. There was no significant difference in the adequacy of sampling between the two groups (respiratory physicians 91.5% [95% CI 84.5-96%] compared to 82.9% [95% CI 66.4-93.4%] for radiologists [p = 0.2]). In the respiratory physician group, a diagnosis was achieved based on lymph node sampling in 89 cases (84%). Neck lymph node sampling was the only procedure performed to obtain tissue in 48 cases (45.3%).

Conclusion

NUS and sampling performed by respiratory physicians are feasible and associated with an adequacy rate comparable to that of radiologists. It can reduce the number of invasive procedures performed in a selected group of patients. Guidelines for training and competency assessment are required.