Abstract
ObjectivesUltrasound-guided core biopsy (UGCB) for supraclavicular lymph nodes (SLNs) represents an attractive procedure to obtain tissues for lung cancer confirmation. The aim of the present study is to evaluate the performance of UGCB driven by FDG-avid SLNs, as performed by nuclear medicine physicians, in patients with suspected lung cancer.MethodsInstitutional database in our hospital was searched for eligible patients between September 2019 and March 2021. A 3-12 MHz linear probe was used to guide the biopsy process and to ensure that the needle tip was being directed at the metabolically active area that had been indicated by side-by-side PET/CT images. Diagnostic yield, malignancy rate, molecular testing results, and complications were reviewed.ResultsAmong the 54 patients included in this study, definite pathological diagnosis from UGCB specimens was achieved in 53 patients, reaching a diagnostic yield of 98.1% (53/54) and a malignancy rate of 96.2% (51/53). Among the 50 patients confirmed as lung cancer, thirty-eight were spared from further invasive procedures which had been planned. Molecular analyses were adequately performed on all the 38 specimens obtained from non-small cell lung cancer (NSCLS). The positive rate was 36.8% (14/38) for epidermal growth receptor (EGFR) mutation and 31.6% (12/38) for anaplastic lymphoma kinase (ALK) translocation. 28.9% (11/38) of the patients had a tumor proportion score (TPS) ≥ 50% for PD-L1 expression. No complication was observed and the average biopsy time was 15 min.ConclusionsNuclear medicine physicians-performed UGCB driven by FDG-avid SLNs in suspected lung cancer patients could produce a high performance in terms of diagnostic yield, malignancy rate, and molecular analysis, which may obliviate more invasive interventional procedures and lead to fast decisions on subsequent management.
Highlights
Ultrasound-guided core biopsy (UGCB) for supraclavicular lymph nodes (SLNs) represents an attractive technique to obtain tissues for lung cancer confirmation [1–3]
Lung cancer confirmation through SLN tissues could directly upstage the patients into stage IIIB disease which would exclude surgical therapeutic options according to guidelines [4, 5]
A total of 54 suspected lung cancer patients who have underwent UGCB driven by FDG-positive SLNs and were included in this retrospective study
Summary
Ultrasound-guided core biopsy (UGCB) for supraclavicular lymph nodes (SLNs) represents an attractive technique to obtain tissues for lung cancer confirmation [1–3]. It is a simple, rapid and minimally invasive choice that could avoid the risk of complications from more costly procedures such as bronchoscopy, CT-guided lung biopsy and diagnostic surgery. The PET/CT findings may help to optimize UGCB for SLNs from several aspects It could reveal more suspicious SLNs as compared to initial examinations such as CT [9]. The PET scan could provide wholebody information of tumor involvement including easy-to-access superficial distant metastases, which may obliviate the need for sampling SLNs. but most importantly, biopsy driven by FDG-avid lesions have demonstrated a high diagnostic yield in various type of changes including thoracic, abdominal, bone, muscle, and breast lesions [10, 11]. Because FDG avidness in malignant lesions represents the existence of metabolically active tumor cells, sampling of FDG-avid lesions will be more likely to yield representative material for molecular analysis [12, 13]
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