Leon Jonathan Menezes BMBCH, Presenter: Nothing to Disclose

Thomas Witcher MBBS, Abstract Co-Author: Nothing to Disclose

Daniel J. Bell MBCHB, Abstract Co-Author: Nothing to Disclose

Keith Ramesar, Abstract Co-Author: Nothing to Disclose

Michael D Williams MD, Abstract Co-Author: Nothing to Disclose

David C. Howlett MBBS, Abstract Co-Author: Nothing to Disclose

To report the accuracy of ultrasound guided core needle biopsy (USCB) compared to final surgical pathological histology, in obtaining a diagnosis in patients presenting with symptomatic cervical lymphadenopathy.

82 consecutive patients with symptomatic cervical lymphadenopathy were prospectively enrolled into this study over 4 years. The age of the patients ranged from 24 to 93 years. 46 were male and 36 were female. A single operator performed a diagnostic ultrasound and USCB under local anaesthetic, using 18 or 20 gauge needles and a spring loaded biopsy gun with a mean of 2 passes per lesion. Outcome measures were the sensitivity, specificity and predictive values of USCB compared with the surgical pathological diagnosis as the gold standard. Final diagnosis was made on the basis of adequate histology, surgical specimen, and clinical follow up.

81/82 (99%) core biopsies yielded adequate material for histological interpretation. In 76/81 (94%) cases the histological diagnosis at USCB was unequivocal, and 5/81 (6%) resulted in equivocal diagnoses. 6/82 (7%) patients went on to have surgical biopsy for diagnosis. 25/76 (33%) patients underwent lymph node resection for therapeutic purposes, after a definitive diagnosis was made at USCB. 51/82 (62%) patients avoided surgery as a result of USCB. 51/82 (62%) had malignant lesions and 31/82 (38%) benign. Compared with the surgical pathological diagnosis, in differentiating benign from malignant lesions, USCB had a sensitivity of 71%, and a specificity of 100%. USCB had a positive predictive value of 100% and a negative predictive value of 63% in diagnosing malignancy. There were no complications of USCB.

USCB in patients presenting with cervical lymphadenopathy is a procedure that has a high diagnostic yield and accuracy. It can be safely performed under local anaesthetic as an outpatient. It frequently reduces the need for further surgical biopsy, a potential advanatge over fine needle aspiration, as the larger tissue sample allows the use of histological and immunohistochemical stains that can more precisely classify carcinomas and lymphomas.

Menezes, L, Witcher, T, Bell, D, Ramesar, K, Williams, M, Howlett, D, Diagnosis of Symptomatic Cervical Lymphadenopathy with Ultrasound-guided Core Needle Biopsy: Results in a Series of 82 Patients.  Radiological Society of North America 2005 Scientific Assembly and Annual Meeting, November 27 - December 2, 2005 ,Chicago IL. http://archive.rsna.org/2005/4406665.html