Ultrasound-Guided Core Needle Biopsy for Head and Neck Mass Lesions in Patients Undergoing Antiplatelet or Anticoagulation Therapy: A Preliminary Report

Diagnostic use of fine-needle aspiration cytology and core-needle biopsy in head and neck sarcomas

The diagnostic role of fine-needle aspiration cytology (FNAC) and core-needle biopsy (CNB) has not been comprehensively assessed in head and neck sarcomas. A systematic review of published cases (1990-2020) was conducted. Diagnostic performance of both FNAC/CNB to determine tumor dignity and histopathological diagnosis was calculated. One hundred and sixty-eight cases were included for which FNAC (n = 156), CNB (n = 8), or both (n = 4) were used. Predominant histologies were skeletal muscle, chondrogenic and vascular sarcomas. FNAC correctly assessed dignity in 76.3% and histology in 45% of cases. Dignity was significantly better for vascular tumors, metastatic and recurrent specimens, and worse for chondrogenic sarcomas. CNB showed a 92% accuracy to identify dignity and 83% for histopathology. FNAC and CNB are useful methods for the diagnosis of head and neck sarcomas, particularly well-suited in the context of recurrent or metastatic disease. The role of CNB remains largely unexplored for this indication.

[Ultrasound-guided minimally invasive diagnostics and treatment in the head and neck area]

Tumoral lesions in the head and neck region represent a diagnostic and therapeutic challenge in otorhinolaryngologic routine. High-resolution ultrasound is usually able to guide diagnosis. Nevertheless, a definite differentiation between benign and malignant lesions can only be achieved by tissue biopsy. The various options for obtaining samples for histopathological or cytological examination-from minimally invasive ultrasound-guided fine-needle biopsy to punch biopsy and open surgical biopsy-will be discussed in the first part along with the associated advantages and disadvantages. In the second part of this CME article, minimally invasive ultrasound-guided therapeutic options in the head and neck region which can be performed on an outpatient basis are depicted.

The effectiveness of high-resolution ultrasound in the assessment of the carotid intima-media thickness for postirradiated neck

OBJECTIVE

The carotid intimal-medial thickness (CIMT) is a strong predictor of future cardiovascular events. We assessed the mean CIMT and evaluated associated factors in head and neck cancer (HNC) patients.

MATERIALS AND METHODS

Between January 2016 and March 2018, 70 volunteers underwent automatic ultrasound measurement of the common carotid artery CIMT. A mean CIMT ≥ 1.0 mm was regarded as an elevated risk for cardiovascular disease (CVD). We aimed to investigate the risk factors for an increased mean CIMT.

RESULTS

We recruited 20 HNC survivors and 50 noncancer control individuals. Multiple linear regression analysis showed that old age (β = 0.006, 95% confidence interval, CI 0.004-0.008), increased weight (β = 0.003, 95% CI 0.001-0.005), hypertension (β = 0.10, 95% CI 0.03-0.17), and prior irradiation (β = 0.13, 95% CI 0.08-0.19) were positively correlated with the mean CIMT. From logistic regression analysis, it was shown that patients who underwent radiotherapy (OR 13.5, 95% CI 1.48-122.8) and who had higher bodyweight (OR 1.09, 95% CI 1.01-1.18) had a significantly higher risk of developing CVD.

CONCLUSION

Measurement of the mean CIMT using ultrasound could be useful for assessing CVD risk in HNC survivors after neck irradiation.

The value of ultrasound-guided biopsy of fluorodeoxy-glucose positron emission tomography (FDG-PET)-positive supraclavicular lymph nodes in patients with suspected lung cancer

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.