Duguay Sean, Wagner Jason M, Zheng Wei, Ling Johnny, Zhao Lichao C, Allen Karen S, North Justin C, Deb Subrato J
Departments of *Radiological Sciences, †Pathology, ‡College of Medicine, Departments of §Pulmonary, Critical Care, and Sleep Medicine, and ∥Surgery, Oklahoma University, Norman, OK.
Ultrasound Q. 2017 Jun;33(2):133-138. doi: 10.1097/RUQ.0000000000000270.
The purpose of this study is to determine the ability of ultrasound guided needle biopsy of a neck lymph node to provide adequate tissue for complete pathologic evaluation of suspected metastatic lung cancer, including molecular testing for epidermal growth factor receptor gene mutations by pyrosequencing and anaplastic lymphoma kinase gene rearrangement by fluorescence in situ hybridization.
Institutional review board approval was obtained and the requirement for informed consent was waived. All ultrasound guided neck biopsies performed July 1, 2011, to June 30, 2015, were retrospectively reviewed, and all biopsies performed for suspected lung cancer metastatic to supraclavicular and cervical lymph nodes were included.
Forty patients with suspected lung cancer underwent ultrasound-guided needle biopsy of an abnormal appearing neck lymph node identified on preprocedure computed tomography or positron emission tomography/computed tomography. Thirty-seven patients were subsequently diagnosed with lung cancer and 3 were diagnosed with lymphoma. A definitive pathologic diagnosis was rendered in 95% of neck node biopsies (38/40; 95% confidence interval, 84%-99%). Of the 36 specimens diagnostic for lung cancer, 16 were considered for further molecular testing and the specimen was adequate for molecular testing in 15 (94%; 73%-100%) cases. Therefore, the neck node biopsy specimens were adequate for complete pathologic workup in 93% (37/40; 81%-98%). No complications related to the biopsies were observed.
In patients presenting with suspected lung cancer and suspicious neck lymph nodes, ultrasound-guided needle biopsy frequently provides adequate tissue for complete pathologic evaluation and eliminates the need for more invasive procedures.
本研究的目的是确定超声引导下颈部淋巴结穿刺活检能否提供足够的组织，以对疑似转移性肺癌进行全面的病理评估，包括通过焦磷酸测序对表皮生长因子受体基因突变进行分子检测，以及通过荧光原位杂交对间变性淋巴瘤激酶基因重排进行检测。
获得机构审查委员会的批准，并免除了知情同意的要求。对2011年7月1日至2015年6月30日期间进行的所有超声引导下颈部活检进行回顾性分析，纳入所有因疑似肺癌转移至锁骨上和颈部淋巴结而进行的活检。
40例疑似肺癌患者接受了超声引导下对术前计算机断层扫描或正电子发射断层扫描/计算机断层扫描中发现的异常颈部淋巴结进行穿刺活检。随后37例患者被诊断为肺癌，3例被诊断为淋巴瘤。95%的颈部淋巴结活检（38/40；95%置信区间，84%-99%）做出了明确的病理诊断。在36例诊断为肺癌的标本中，16例被考虑进行进一步分子检测，其中15例（94%；73%-100%）标本适合进行分子检测。因此，93%（37/40；81%-98%）的颈部淋巴结活检标本足以进行全面的病理检查。未观察到与活检相关的并发症。
对于疑似肺癌且颈部淋巴结可疑的患者，超声引导下穿刺活检通常能提供足够的组织进行全面的病理评估，无需进行更具侵入性的检查。
