Fleischman Gitanjali M, Thorp Brian D, Difurio Megan, Hackman Trevor G
Department of Otolaryngology-Head and Neck Surgery, School of Medicine, University of North Carolina, Chapel Hill.
Department of Pathology and Laboratory Medicine, School of Medicine, University of North Carolina, Chapel Hill.
JAMA Otolaryngol Head Neck Surg. 2016 Apr;142(4):377-82. doi: 10.1001/jamaoto.2015.3934.
Few patients with persistent adenopathy following chemoradiotherapy (CRT) for head and neck squamous cell carcinoma harbor viable disease. Improved selectivity for surgical salvage is needed to prevent unnecessary salvage neck dissection.
To determine whether ultrasonography-guided fine-needle aspiration (FNA) can be used to identify viable cancer cells in the lymph nodes of patients with persistent radiographic adenopathy following CRT.
DESIGN, SETTING, AND PARTICIPANTS: A pilot study included patients undergoing preoperative ultrasonography-guided FNA of lymph nodes considered suspicious on radiography prior to planned neck dissection at a quaternary care facility from February 28, 2011, to March 18, 2013. Data analysis was performed from April 28 to December 24, 2013. Patients treated for head and neck squamous cell carcinoma with CRT who were determined to have persistent neck disease on a 6-week posttreatment computed tomographic scan of the neck and scheduled for salvage neck dissection were considered candidates for this pilot study. All patients enrolled in the study underwent ultrasonography-guided FNA of the suspicious lymph nodes within 2 weeks of the planned neck dissection. The cytopathologist reading the samples was blinded to the patient's identity.
Fine-needle aspiration with a 23- to 25-gauge needle following CRT.
The accuracy of ultrasonography-guided FNA cytologic results was compared with the standard of surgical pathologic examination of neck dissection specimens.
Fourteen patients (11 [79%] men; mean [SD] age, 57.8 [11.2] years) were enrolled in this pilot study; data were collected on 17 lymph nodes. Among these 14 patients with incomplete radiographic clinical response, 17 lymph node aspirations were performed. Ultrasonography-guided FNA identified squamous cell carcinoma in the aspirates of 4 (80%) of the 5 nodes with squamous cell carcinoma identified on pathologic testing and confirmed the absence of disease in the remaining 12 (71%) lymph nodes. The statistical analysis of these results revealed a sensitivity of 80%; specificity, 100%; positive predictive value, 100%; and negative predictive value, 92.3%. The diagnostic accuracy of ultrasonography-guided FNA at detecting residual persistent cancer was 88%.
This pilot study suggests that ultrasonography-guided FNA may be a feasible ancillary diagnostic imaging tool to imaging to assess patients with radiographic persistent disease prior to consideration of salvage neck dissection.
接受放化疗（CRT）的头颈部鳞状细胞癌患者中，很少有持续性淋巴结病患者存在存活的疾病。需要提高手术挽救的选择性以防止不必要的挽救性颈部清扫术。
确定超声引导下细针穿刺抽吸术（FNA）是否可用于识别CRT后影像学检查显示持续性淋巴结病患者淋巴结中的存活癌细胞。
设计、地点和参与者：一项前瞻性研究纳入了2011年2月28日至2013年3月18日在一家四级医疗中心计划进行颈部清扫术前，接受术前超声引导下对影像学检查可疑淋巴结进行FNA的患者。数据分析于2013年4月28日至12月24日进行。接受CRT治疗的头颈部鳞状细胞癌患者，在治疗后6周的颈部计算机断层扫描中被确定有持续性颈部疾病并计划进行挽救性颈部清扫术，被视为该前瞻性研究的候选者。所有纳入研究的患者在计划颈部清扫术的2周内接受了超声引导下对可疑淋巴结的FNA。解读样本的细胞病理学家对患者身份不知情。
CRT后使用23至25号针进行细针穿刺抽吸。
将超声引导下FNA细胞学结果的准确性与颈部清扫标本手术病理检查的标准进行比较。
14名患者（11名[79%]男性；平均[标准差]年龄，57.8[11.2]岁）纳入了这项前瞻性研究；收集了17个淋巴结的数据。在这14名影像学临床反应不完全的患者中，进行了17次淋巴结抽吸。超声引导下FNA在病理检查中确定为鳞状细胞癌的5个淋巴结中的4个（80%）抽吸物中识别出鳞状细胞癌，并在其余12个（71%）淋巴结中证实无疾病。对这些结果的统计分析显示敏感性为80%；特异性为100%；阳性预测值为100%；阴性预测值为92.3%。超声引导下FNA检测残留持续性癌症的诊断准确性为88%。
这项前瞻性研究表明，超声引导下FNA可能是一种可行的辅助诊断成像工具，用于在考虑挽救性颈部清扫术前对影像学检查显示持续性疾病的患者进行评估。
