Werner Lennart, Keller Franziska Aebersold, Bhure Ujwal, Roos Justus Egidius, Tornquist Katharina, Del Sol Pèrez-Lago Maria, Gautschi Oliver, Strobel Klaus
Department of Radiology and Nuclear Medicine, Cantonal Hospital, Spitalstrasse 13, 6000, Lucerne, Switzerland.
Department of Pathology, Cantonal Hospital, Lucerne, Switzerland.
BMC Med Imaging. 2017 Jul 11;17(1):41. doi: 10.1186/s12880-017-0214-8.
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.
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.
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.
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.
准确的淋巴结分期对于非小细胞肺癌（NSCLC）患者的充分预后评估和治疗计划至关重要。氟代脱氧葡萄糖正电子发射断层扫描/计算机断层扫描（FDG-PET/CT）是检测转移灶的敏感工具，包括不可触及的锁骨上淋巴结（SCLN）转移。转移扩散的组织学证据和突变分析对于最佳分期和治疗至关重要。本研究的目的是探讨超声引导下对疑似肺癌患者的FDG活性、不可触及的SCLN进行细针穿刺抽吸细胞学检查（FNAC）和粗针活检（CB）的价值。
连续12例疑似肺癌且FDG阳性SCLN的患者接受了FNAC（n = 11）和/或CB（n = 10），并在本研究中进行回顾性纳入和评估。进行了细胞学和/或组织学评估，以确认最初疑似的诊断（肺癌）、确认N3期，并筛查肺腺癌中的驱动基因突变。
单独FNAC在11/11例（100%）中显示诊断成功，单独CB在9/10例患者（90%）中成功，两种方法联合在12/12例（100%）中成功。9例患者中证实有NSCLC的淋巴结转移（7例腺癌，2例鳞状细胞癌）。其他诊断为小细胞肺癌（SCLC）、乳腺癌和结节病。所有患者都有足够的材料进行免疫组织化学检查。对于分子检测，使用了来自该淋巴结活检和肺活检的材料。在2例肺腺癌患者的淋巴结转移灶中检测到驱动基因突变（EGFR外显子19缺失和ALK重排）。
对于疑似肺癌患者，超声引导下对FDG阳性锁骨上淋巴结进行联合FNAC和CB是确认N3期并获得用于分子检测的代表性材料的安全有效方法。
