Nguyen Jolee, Patel Dharti, Lano Kinsey, Ansari Shehbaz, Wang Ethan, Yadav Megha, Gillison Maura, Lai Stephen, Fuller C D, Moreno Amy, Gule-Monroe Maria K, Johnson Jason M
From the Department of Diagnostic Radiology (J.N., D.P., K.L., E.W., M.K.G.), The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030, USA; Department of Diagnostic Radiology and Nuclear Medicine (S.A.), Rush University Medical Center, Chicago, IL 60612, USA; Department of Head & Neck Oncology (M.G., A.M.), The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030, USA; Department of Head & Neck Surgery (S.L.), The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030, USA; Department of Radiation Oncology (C.D.F.), The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030, USA; and Department of Radiology and Biomedical Imaging (M.Y., J.M.J.), Yale University, New Haven, CT 06520, USA.
AJNR Am J Neuroradiol. 2025 Aug 28. doi: 10.3174/ajnr.A8990.
Viable malignant disease is uncommon in patients with persistent adenopathy after definitive chemoradiotherapy (CRT) for head & neck squamous cell carcinoma (HNSCC). Preoperative ultrasound-guided fine needle aspiration (USFNA) can prevent unnecessary neck dissection. Post-radiation fibrosis can complicate the approach, resulting in an inadequate aspirate volume when using standard 20 or 22-gauge needles. We assessed the comparative 18 and 20-gauge diagnostic accuracy of USFNA in detecting persistent viable nodal malignancy in patients with HNSCC with nodal metastasis treated with CRT. We hypothesized that 18-gauge USFNA would outperform 20-gauge USFNA in diagnostic accuracy and efficiency.
We identified a 239-patient cohort (210 males, 60.4±9.8 y) presenting between 2002-2023 with HNSCC and biopsy-proven cervical nodal metastases. All patients were treated with CRT. After CRT, a suspicious nodal remnant underwent biopsy with an 18 or 20-gauge needle. 101 patients received a biopsy with a 20-gauge and 138 received a biopsy with an 18-gauge needle. Biopsy results were compared to either post-biopsy surgical pathology results when available or at least 3 months of computed tomography (CT) follow-up, referred to here as post-USFNA results.
FNA in 181/239 (75.7%) cases showed no evidence of viable metastatic disease on cytology evaluation. 20-gauge cases were performed with 1.36±0.52 passes. 18-gauge cases were performed with 1.26±0.51 passes (p=0.037). A neck dissection was performed within 90 days in 45 patients, while the other 194 patients had follow-up imaging. 40/58 cases were positive concordant (PC) between FNA and post-USFNA results. 177/181 cases were negative concordant (NC) between FNA and post-USFNA results. Overall, USFNA showed a sensitivity of 90.9%, specificity of 90.8%, accuracy of 90.8%, positive predictive value (PPV) of 69.0% and negative predictive value (NPV) of 97.8%. 20-gauge FNA showed PC of 26/39 and NC of 59/62 for a sensitivity of 89.7%, specificity of 81.9%, accuracy of 84.2%, PPV of 66.7% and NPV of 95.2%.18-gauge FNA showed a PC of 14/19 and NC of 118/119 for a sensitivity of 93.3%, specificity of 95.9%, accuracy of 95.7%, PPV of 73.7% and NPV of 99.2%.
Residual cervical lymph node USFNA after CRT is an accurate procedure with excellent PPV and NPV. 18-gauge USFNA is associated with statistically significant fewer biopsy passes and higher specificity compared to 20-gauge.
CRT＝chemoradiotherapy; FNA = fine needle aspiration; HNSCC＝ head & neck squamous cell carcinoma; HPV = human papillomavirus; NC = negative concordant; NPV = negative predictive value; PC = positive concordant; PPV = positive predictive value; SND = salvage neck dissection; USFNA = ultrasound-guided fine needle aspiration.
在头颈部鳞状细胞癌（HNSCC）接受确定性放化疗（CRT）后出现持续性淋巴结病的患者中，存在存活的恶性疾病并不常见。术前超声引导下细针穿刺抽吸（USFNA）可避免不必要的颈部清扫术。放疗后纤维化会使该方法变得复杂，导致使用标准20或22号针时抽吸量不足。我们评估了18号和20号USFNA在检测接受CRT治疗且有淋巴结转移的HNSCC患者中持续性存活淋巴结恶性肿瘤的诊断准确性。我们假设18号USFNA在诊断准确性和效率方面将优于20号USFNA。
我们确定了一个239例患者的队列（210例男性，年龄60.4±9.8岁），这些患者在2002年至2023年期间出现HNSCC且经活检证实有颈部淋巴结转移。所有患者均接受了CRT治疗。CRT后，对可疑的残留淋巴结用18号或20号针进行活检。101例患者接受了20号针活检，138例患者接受了18号针活检。将活检结果与活检后手术病理结果（若有）或至少3个月的计算机断层扫描（CT）随访结果（在此称为USFNA后结果）进行比较。
181/239例（75.7%）的细针穿刺抽吸（FNA）在细胞学评估中未显示有存活转移性疾病的证据。20号针活检平均进针1.36±0.52次。18号针活检平均进针1.26±0.51次（p = 0.037）。45例患者在90天内进行了颈部清扫术，而其他194例患者进行了随访影像学检查。FNA与USFNA后结果之间有40/58例呈阳性一致（PC）。FNA与USFNA后结果之间有177/181例呈阴性一致（NC）。总体而言，USFNA显示敏感性为90.9%，特异性为90.8%，准确性为90.8%，阳性预测值（PPV）为69.0%，阴性预测值（NPV）为97.8%。20号针FNA显示PC为26/39，NC为59/62，敏感性为89.7%，特异性为81.9%，准确性为84.2%，PPV为66.7%，NPV为95.2%。18号针FNA显示PC为14/19，NC为118/119，敏感性为93.3%，特异性为95.9%，准确性为95.7%，PPV为73.7%，NPV为99.2%。
CRT后残留颈部淋巴结的USFNA是一种准确的操作，具有出色的PPV和NPV。与20号针相比，18号针USFNA在统计学上具有显著更少的活检进针次数和更高的特异性。
CRT = 放化疗；FNA = 细针穿刺抽吸；HNSCC = 头颈部鳞状细胞癌；HPV = 人乳头瘤病毒；NC = 阴性一致；NPV = 阴性预测值；PC = 阳性一致；PPV = 阳性预测值；SND = 挽救性颈部清扫术；USFNA = 超声引导下细针穿刺抽吸
