Efficacy of Ultrasound-Guided Core Needle Biopsy in Cervical Lymphadenopathy: A Retrospective Study of 6695 Cases

Abstract

To determine the diagnostic yield of ultrasound-guided core needle biopsy (US-CNB) in cervical lymphadenopathy and identify the factors influencing the diagnostic accuracy of US-CNB. We retrospectively reviewed the records of 6603 patients with cervical lymphadenopathy who underwent 6695 US-CNB procedures between 2004 and 2017. All the biopsies were performed under real-time US guidance by 1 to 6 passes with a 16 - 20G needle. The final diagnosis was based on histologic examination of excised specimens, clinical course, or laboratory results. Adequate specimens were obtained in 92.19% (6172/6695) of cases. Most lymph nodes (67.65%) were malignant (metastatic carcinoma, 4131; lymphoma, 398). The overall accuracy of US-CNB for differentiating benign from malignant lesions was 91.70% (6139/6695). Among biopsies in which adequate material was obtained, the sensitivity, specificity, and accuracy of US-CNB were 99.70%, 100%, and 99.46%, respectively. The success or failure of US-CNB for the diagnosis of lymphadenopathy was significantly correlated with node size, nature (malignant vs. benign), and location as well as penetration depth, but not with needle size (p = 0.665), number of core tissues obtained (p = 0.324), or history of malignancy (p = 0.060). There were no major procedure-related complications. US-CNB is a safe and effective method of diagnosing cervical lymphadenopathy, and our findings may help optimize the sampling procedure by maximizing its diagnostic accuracy and preserving its minimally invasive nature.