Abstract
Early detection of neck lymph node (LN) recurrence is paramount in improving the prognosis of treated head and neck cancer patients. Ultrasound (US) with US-guided fine needle aspiration (FNA) and core needle biopsy (CNB) have been shown to have great accuracy for LN diagnoses in the untreated neck. However, in the treated neck with fibrosis, their roles are not clarified. Here, we retrospectively review 153 treated head and neck cancer patients who had received US and US-guided FNA/CNB. In multivariate logistic regression analyses, size (short-axis diameter >0.8 cm) (odds ratio (OR) 4.19, P = 0.007), round shape (short/long axis ratio >0.5) (OR 3.44, P = 0.03), heterogeneous internal echo (OR 3.92, P = 0.009) and irregular margin (OR 7.32, P < 0.001) are effective US features in predicting recurrent LNs in the treated neck. However, hypoechogenicity (OR 2.38, P = 0.289) and chaotic/absent vascular pattern (OR 3.04, P = 0.33) are ineffective. US-guided FNA (sensitivity/specificity: 95.24%/97.92%) is effective in the treated neck, though with high non-diagnostic rate (29.69%). US-guided CNB (sensitivity/specificity: 84.62%/100%) is also effective, though with low negative predictive value (62.5%). Overall, US with US-guided FNA/CNB are still effective diagnostic tools for neck nodal recurrence surveillance.
Highlights
Among all recurrent head and neck cancers, recurrences in the lymph nodes (LNs) of the neck are the most common, with an incidence of approximately 31–42%1
In routine practice, we frequently rely on several types of image examinations, such as neck ultrasound (US), computed tomography (CT), magnetic resonance imaging (MRI) and positron emission tomography (PET) to detect possible LN recurrence in the treated neck
After excluding the patients who did not receive fine needle aspiration (FNA) or core needle biopsy (CNB) and the patients who did not have complete medical and image records, a total of 153 eligible patients were enrolled in this study, including 134 male and 19 female patients
Summary
Among all recurrent head and neck cancers, recurrences in the lymph nodes (LNs) of the neck are the most common, with an incidence of approximately 31–42%1. Most previous treatments will increase the difficulties in detecting LN recurrence in the treated neck of patients with head and neck cancers. The tissue repair process after surgery leads to fibrotic tissue changes and scar formation All of these changes will increase the difficulties in detecting LN recurrence in the treated neck. Most importantly, when there are suspicions of recurrent cancer in the LNs during the examination, the clinician can perform ancillary tissue sampling using US-guided fine needle aspiration (FNA) or core needle biopsy (CNB). For the treated neck, which has more scar tissue and anatomic changes after previous surgery or radiotherapy, open excisional biopsy is further associated with increased risk of complications such as large vessel injuries and poor wound healing. Are the US-guided FNA/CNB still good enough in the treated neck to provide accurate histologic verification and to replace open excisional biopsy?
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