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Original Investigation |

Accuracy of Ultrasonography-Guided Fine-Needle Aspiration in Detecting Persistent Nodal Disease After Chemoradiotherapy

Gitanjali M. Fleischman, MD1; Brian D. Thorp, MD1; Megan Difurio, MD2; Trevor G. Hackman, MD1
[+] Author Affiliations
1Department of Otolaryngology–Head and Neck Surgery, School of Medicine, University of North Carolina, Chapel Hill
2Department of Pathology and Laboratory Medicine, School of Medicine, University of North Carolina, Chapel Hill
JAMA Otolaryngol Head Neck Surg. 2016;142(4):377-382. doi:10.1001/jamaoto.2015.3934.
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Importance  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.

Objective  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.

Exposures  Fine-needle aspiration with a 23- to 25-gauge needle following CRT.

Main Outcomes and Measures  The accuracy of ultrasonography-guided FNA cytologic results was compared with the standard of surgical pathologic examination of neck dissection specimens.

Results  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%.

Conclusions and Relevance  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.

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Figure.
Comparison of Permanent Histopathologic and Ultrasonography-Guided Fine-Needle Aspiration (FNA) Cytologic Testing

CT indicates computed tomography; SCC, squamous cell carcinoma.

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