Accuracy Of Ultrasound-guided Fine-needle Aspiration Research Articles

Accuracy of ultrasound-guided fine-needle aspiration for small cervical lymph nodes: A retrospective review of 505 cases

PurposeThe overall diagnostic value of fine-needle aspiration (FNA) is not as excellent as that of core needle biopsy (CNB). Limited research has investigated small cervical lymph nodes inaccessible to ultrasound-guided CNB due to technical challenges associated with their small size. Therefore, this study aimed to evaluate the accuracy of ultrasound-guided FNA in determining the etiology of small cervical lymph nodes. MethodsA retrospective analysis was conducted on patients who underwent FNA between May 2018 and May 2021 at our hospital. Cytological, histopathological, and clinical follow-up data were analyzed. The diagnostic yield of FNA was assessed based on sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy calculations. ResultsThis study included 505 patients, each with a small cervical lymph node under evaluation (total number of lymph nodes: 505). The average maximal diameter of the lymph nodes was 14.6 ± 6.2 mm. According to the Sydney system, the cytology results were as follows: Category I in 26 lymph nodes (5.1 %); Category II in 269 (53.3 %); Category III in 35 (6.9 %); Category IV in 17 (3.4 %); and Category V in 158 (31.3 %). We identified 212 malignant cases (203 metastases and 9 lymphomas) and 293 benign lymph nodes. FNA achieved high sensitivity (88.8 %), specificity (99.6 %), PPV (99.4 %), NPV (91.8 %), and overall accuracy (94.8 %) in determining the etiology of small cervical lymph nodes. ConclusionFNA cytology is suitable for small lesions inaccessible by CNB and provides a diagnostic basis for implementing clinically appropriate treatment measures.

O053 An audit of the diagnostic accuracy of ultrasound-guided fine-needle aspiration of axillary lymph nodes in breast cancer, and its pathological significance to axillary nodal burden

Abstract Introduction Axillary lymph nodes have long been recognized as a route for breast cancer to spread systemically, thus the assessment of the axilla with ultrasound should be undertaken if suspicious findings are identified in the breast or axilla. Needle biopsy: (Fine needle aspiration (FNA) or core biopsy (CB) -under imaging guidance- is indicated if enlarged axillary nodes or a mass lesion (U2–5) is identified. Multiple meta-analyses revealed similar specificities between the two methods, however, CB appeared to be more sensitive than FNA when assessing the axilla. Our aim is to detect our breast unit's (ELHT) diagnostic accuracy of US-FNAC of axillary lymph nodes in breast cancer. Methods This was a retrospective audit that looked into all axillary FNAs done in the year 2019. 192 FNAs were evaluated: 23 of which were repeats and only the first FNA was accounted for, 5 were found to be breast masses and were excluded and 4 patients lost to follow up and did not have a final pathology and thus were excluded too. In total, 162 FNAs were examined. Results Multiple accuracy measures were calculated: The absolute sensitivity was found to be 69.69% while the specificity was 86.54% with an absolute diagnostic accuracy of 69.75%. In addition, the false-negative rate was 18.18% and the overall inadequate reports were found to be 12.3%. Conclusion In our breast unit, among this cohort of patients, who had FNAC-axilla, we have reported an overall lower than average sensitivity and specificity rate. Take-home message FNAC for axilla in our trust reported lower than average sensitivity and specificity.

Diagnostic value of 2017 ACR Thyroid Imaging Reporting and Data System (TI-RADS) combined with fine needle aspiration biopsy in thyroid nodules

To evaluate diagnostic value of Thyroid Imaging Reporting and Data System published by American College of Radiology (ACR TI-RADS) in 2017, ultrasound-guided fine-needle aspiration (US-FNA), and the combination of both methods in differentiation between benign and malignant thyroid nodules. The data of US-FNA and ACR TI-RADS are collected from 159 patients underwent thyroid surgery in our hospital, which include a total of 178 thyroid nodules. A Bethesda System for Reporting Thyroid Cytopathology category of ≥IV and an ACR TI-RADS category ≥4 are regarded as diagnosis standards for malignancy in US-FNA and ACR TI-RADS, respectively. The pathological results after surgery are considered as the gold standard. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of the ACR TI-RADS, US-FNA and the combination of both methods for the differential diagnosis of thyroid nodules are calculated, respectively. The sensitivity, specificity and accuracy of ACR TI-RADS are 85.4%, 37.5%and 72.5%, respectively. The sensitivity, specificity and accuracy of US-FNA are 70.0%, 100%and 78.1%, respectively. After combining these two methods, the sensitivity, specificity and accuracy increase to 99.23%, 37.50%and 82.58%, respectively. The sensitivity of ACR TI-RADS is higher than that of US-FAN, and the sensitivity of combining these two methods is also higher than that of using ACR TI-RADS and US-FNA alone. The established ACR TI-RADS can help in selecting the target during nodule puncture, while the combination of ACR TI-RADS and US-FAN can further improve diagnostic ability for detecting malignant thyroid nodules.

A Computer-Aided Diagnosis System and Thyroid Imaging Reporting and Data System for Dual Validation of Ultrasound-Guided Fine-Needle Aspiration of Indeterminate Thyroid Nodules.

PurposeThe fully automatic AI-Sonic computer-aided design (CAD) system was employed for the detection and diagnosis of benign and malignant thyroid nodules. The aim of this study was to investigate the efficiency of the AI-Sonic CAD system with the use of a deep learning algorithm to improve the diagnostic accuracy of ultrasound-guided fine-needle aspiration (FNA).MethodsA total of 138 thyroid nodules were collected from 124 patients and diagnosed by an expert, a novice, and the Thyroid Imaging Reporting and Data System (TI-RADS). Diagnostic efficiency and feasibility were compared among the expert, novice, and CAD system. The application of the CAD system to enhance the diagnostic efficiency of novices was assessed. Moreover, with the experience of the expert as the gold standard, the values of features detected by the CAD system were also analyzed. The efficiency of FNA was compared among the expert, novice, and CAD system to determine whether the CAD system is helpful for the management of FNA.ResultIn total, 56 malignant and 82 benign thyroid nodules were collected from the 124 patients (mean age, 46.4 ± 12.1 years; range, 12–70 years). The diagnostic area under the curve of the CAD system, expert, and novice were 0.919, 0.891, and 0.877, respectively (p < 0.05). In regard to feature detection, there was no significant differences in the margin and composition between the benign and malignant nodules (p > 0.05), while echogenicity and the existence of echogenic foci were of great significance (p < 0.05). For the recommendation of FNA, the results showed that the CAD system had better performance than the expert and novice (p < 0.05).ConclusionsPrecise diagnosis and recommendation of FNA are continuing hot topics for thyroid nodules. The CAD system based on deep learning had better accuracy and feasibility for the diagnosis of thyroid nodules, and was useful to avoid unnecessary FNA. The CAD system is potentially an effective auxiliary approach for diagnosis and asymptomatic screening, especially in developing areas.

Positive rate and accuracy of ultrasound-guided fine-needle aspiration cytology for detecting suspected thyroid carcinoma nodules of different sizes

To analyze the accuracy and positive rate of ultrasound-guided fine-needle aspiration (US-FNA) cytology for detecting suspected thyroid cancer nodules of different sizes. A total of 591 patients with 594 suspected malignant thyroid nodules received examinations with US-FNA cytology. Based on their size, the nodules were divided into group I (4-5 mm), group II (6-10 mm), group III (&gt;10 mm). With the results of pathology as the standard, we analyzed the results of US-FNA cytology for detecting thyroid carcinoma in terms of its accuracy, indeterminate rate, positive predictive value and negative predictive value for nodules of different sizes. The positive rates in group I, group II and group III were 39.2% (40/102), 48.2% (172/357) and 65.2% (88/135), respectively, similar between groups I and II (P=0.107) and differed significantly between groups I and III (P=0.000) and between groups II and III (P=0.001). The accuracy, indeterminate rate, positive predictive value and negative predictive value in the 3 groups were 95.5% (21/22), 97.1% (100/103), and 94.4% (51/54); 2.9% (3/102), 2.8% (10/357), and 1.5% (2/135); 100%, 100%, and 98%; 66.7%, 57.1%, and 33.3%, respectively, showing no significant differences among the 3 groups. The size of the thyroid nodules can affect the positive rate but does not have significant effects on the accuracy, indeterminate rate, positive predictive value or negative predictive value of US-FNA cytology.

Introduction of surgeon‐performed ultrasound to a head and neck clinic: indications, diagnostic adequacy and a new clinic model?

Surgeon-performed ultrasound (SUS) changes management and surgical decision-making. It allows for immediate ultrasound-guided fine-needle aspiration (US-FNA) for the work-up of neck masses, lymph node metastases and thyroid nodules. We examined the introduction of SUS to an Australian Head and Neck cancer unit, identifying situations where it was used, and evaluated the diagnostic adequacy and accuracy of US-FNA. A prospective database was created for all patients undergoing SUS and US-FNA, performed by two head and neck surgeons, between September 2018 and June 2019. The data were retrospectively analysed to identify when SUS was performed. Diagnostic adequacy and accuracy of US-FNA were determined after evaluating formal cytology and histopathology reports. A total of 183 diagnostic, surveillance and interventional SUS scans were performed for multiple indications. A total of 100 US-FNAs were performed on a number of different sites. Diagnostic adequacy and accuracy were 92% and 85%, respectively. After the introduction of SUS to our weekly routine head and neck cancer clinic, we identified multiple situations where it can be used successfully within our clinical landscape. Our diagnostic US-FNA results compared favourably to current literature, without additional need for clinic attendance by consultant radiologists or pathologists, saving valuable hospital resources. This introduction proposes a promising alternative to current neck lump clinic models.

Meta-analysis of the diagnostic accuracy of ultrasound-guided fine-needle aspiration and core needle biopsy in diagnosing axillary lymph node metastasis.

Axillary lymph node status remains a significant prognostic indicator in breast cancer. Here, the diagnostic accuracy of ultrasound-guided fine-needle aspiration (US-FNA) and ultrasound-guided core needle biopsy (US-CNB) in axillary staging was compared. A comprehensive search was undertaken of all published studies comparing the diagnostic accuracy of US-CNB and US-FNA of axillary lymph nodes in breast cancer. Studies were included if raw data were available on the diagnostic performance of both US-FNA and US-CNB, and compared with final histology results. Relevant data were extracted from each study for systematic review. Meta-analysis was performed using a random-effects model. The pooled sensitivity and specificity of US-FNA and US-CNB were obtained using a bivariable model. Summary receiver operating characteristic (ROC) graphs were created to confirm diagnostic accuracy. Data on a total of 1353 patients from six studies met the inclusion criteria and were included in the final analysis. US-CNB was superior to US-FNA in diagnosing axillary nodal metastases: sensitivity 88 (95 per cent c.i. 84 to 91) versus 74 (70 to 78) per cent respectively. Both US-CNB and US-FNA had a high specificity of 100 per cent. Reported complication rates were significantly higher for US-CNB compared with US-FNA (7·1 versus 1·3 per cent; P < 0·001). Conversely, the requirement for repeat diagnostic procedures was significantly greater for US-FNA (4·0 versus 0·5 per cent; P < 0·001). US-CNB is a superior diagnostic technique to US-FNA for axillary staging in breast cancer.

Ultrasound-guided fine needle aspiration cytology in the assessment of cervical metastasis in patients undergoing elective neck dissection.

Background:In head and neck cancer patients, diagnosis of metastatic cervical adenopathy is essential for treatment planning and prognosis assessment. Treatment of patients with head and neck cancer with clinically negative cervical lymph node (N0) remains controversial. While routine neck treatment would result in overtreatment in many patients, observation may delay the diagnosis and decrease the patients’ survival.Objectives:To gain insights into the unclear questions regarding the value of diagnostic modalities in patients with N0 neck, this study was designed to compare the diagnostic efficacy of palpation, ultrasonography (US) and ultrasound-guided fine needle aspiration (USGFNA) in detecting cervical lymph node metastasis.Patients and Methods:Forty-two patients with head and neck cancer who underwent US and USGFNA prior to elective neck dissection were studied. Histopathologic findings of the neck specimens were compared with each diagnostic technique.Results:Of the 53 neck dissection specimens, histopathology showed metastases in 16 cases. The overall accuracy of USGFNA, US and palpation was 96%, 68% and 70%, respectively. The specificity of USGFNA was superior to palpation and US alone. USGFNA had the highest sensitivity, predictive value and accuracy in detecting cervical metastases compared with other performed tests.Conclusions:In our study, USGFNA was superior to palpation and US in detecting metastasis in clinically negative necks. This method can be recommended as a diagnostic tool in preoperative assessment of patients without palpable metastasis, but further investigations are needed before this modality could be considered as an alternative to elective neck dissection.

Ultrasound-guided fine-needle aspiration for retrojugular lymph nodes in the neck

BackgroundNo study on ultrasound-guided fine-needle aspiration (US-FNA) for the diagnosis of retrojugular lymph node has been reported. The present study aimed to introduce US-FNA techniques for retrojugular lymph node and to evaluate their efficacy.MethodsOf the 788 patients who underwent US-FNA of the cervical lymph node, 41 patients underwent US-FNAs of retrojugular lymph node and were included in this study. The adequacy and efficacy of US-FNA of retrojugular lymph node and related complications during or after the procedure were assessed.ResultsOf the 41 patients, 35 (85.4%) were adequately diagnosed in cytological analysis; four predominantly cystic lymph nodes were identified. Based on cytohistopathology results, thyroglobulin measurement, tuberculosis polymerase chain reaction, and sonographic follow-up, malignant (n = 26) and benign (n = 15) lymph nodes were confirmed. When six lymph nodes with inadequate cytology were classified as benign and malignant, the sensitivity, specificity, positive and negative predictive values, and accuracy of US-FNA in differentiating malignant from benign lesions were 69.2% and 92.3%, 100% and 100%, 100% and 100%, 65.2% and 88.2%, and 80.5% and 95.1%, respectively. No substantial complications related to the US-FNA procedure were observed.ConclusionsThe present US-FNA method may be helpful for the diagnosis of retrojugular lymph node.

Axillary lymph node status in breast cancer staging: What patient and tumor factors affect the accuracy of ultrasound-guided fine needle aspiration?

1126 Background: The purpose of the study is to evaluate the accuracy of ultrasound-guided fine needle aspiration (FNA) of axillary lymph nodes(ALNs) in patients with breast cancer and to determine factors that influence accuracy of ultrasound-guided FNA. Methods: Retrospective review of patients with breast cancer who had FNA of ALNs as well as sentinel lymph node excision or complete axillary dissection. Patients treated with neoadjuvant chemotherapy were excluded. 55 axillary FNAs in 54 patients were included in the final analysis. Pathology reports were reviewed for size of the primary tumor, FNA results, number of positive ALNs, and greatest tumor size in ALNs. FNA was performed if a suspicious lymph node was identified. Surgical sentinel lymph node biopsy or full axillary dissection were the reference standard. Micrometastases (&lt; 0.2 mm) and isolated tumor cells in the lymph node were included in the negative group. Atypical and nondiagnostic FNA results were considered negative cytologic results. Significance was analyzed using the Mann-Whitney test. Results: Size of the primary cancer ranged from 0.3 mm to 8.5 cm. The sensitivity of FNA was 73%, with positive predictive value of 97% and negative predictive value of 52%. The NPV of FNA for primary tumors &lt;1 cm, 1.1-2, 2.1-5 and &gt;5 cm is 100%, 36%, 50% and 66% respectively. Correlation of primary tumor size with sensitivity of FNA was not statistically significant. The sensitivity of FNA for lymph nodes with metastatic deposit &lt; 5mm, 6-10mm, 11-15mm, 16-20mm, and 21mm+ is 0%, 57%, 59%, 89%, and 100%, which is statistically significant (p = 0.007). The number of positive ALNs at axillary dissection is not correlated to the sensitivity of FNA. The sensitivity of FNA for 1-3, 4-9 and 10+ positive ALNs is 78%, 64% and 80%. Conclusions: Our findings indicate that FNA of suspicious axillary lymph nodes is valuable even in small tumors, which differs from the literature. The overall negative predictive value of FNA is 52%, so sentinel lymph node biopsy is essential after negative FNA. Sensitivity of FNA increases with the size of the metastatic deposit in the lymph node, but is not correlated to the number of positive ALNs found at dissection.

Diagnosis of thyroid nodules with ultrasound-guided fine needle aspiration: comparison of solid lesion and complex lesion

Objective To compare the efficacy of ultrasound-guided fine-needle aspiration(US-FNA)biopsy in diagnosing solid and complex thyroid nodules with different size. Methods One hundred and seventy-five thyroid FNA biopsies were prospectively performed on 168 patients ranging from 4 to 75 years of age. Sixty-three nodules were surgically excised and the others were clinically followed-up. The cytology diagnoses were categorized into four groups: benign, malignant, suspicious and unsatisfactory. Results There was no significant complication in the all 115 solid and 60 complex thyroid lesions and there were 36and 3 malignant nodules respectively in solid and complex thyroid nodules. The nondiagnostic rates of solid and complex nodules were 7％ and 8％. The accuracy of US-FNA in diagnosing complex thyroid nodules was comparatively equal to that of in solid thyroid nodules. In solid thyroid nodules, the sensitivity and accuracy in ≤1 cm group were similar to that of in ＞1 cm group. Conclusions US-FNA was an accurate and reliable method to diagnose thyroid solid and complex lesions. Key words: Ultrasonography; Biopsy, needle; Thyroid neoplasms

1422: Ultrasound-Guided Fine Needle Aspiration Cytology of the Salivary Gland: A Review of 258 Cases

ObjectiveTo evaluate the diagnostic accuracy and pitfalls of ultrasound-guided fine needle aspiration (US-FNA) for salivary gland lesions.MethodsTwo hundred and fifty-eight US-FNA cytology specimens of salivary gland lesions taken over a 4-year period were reviewed and correlated with the histopathological findings obtained from surgical specimen. The aspirates were derived from parotid gland (218 cases) and submandibular gland (40 cases).ResultsThe major diagnostic categories for cytology were unsatisfactory (34 cases), non-neoplastic lesions (17 cases), benign neoplasm (180 cases), and malignant neoplasm (27 cases). Final pathological review showed that 172 of 192 (90%) benign tumors and 27 of 48 (56%) malignant tumors with adequate US-FNA sampling were accurately diagnosed cytologically. False-negative results were caused by sampling error (11 cases) or misinterpretation of uncommon tumors (10 cases). The overall sensitivity, specificity and accuracy of US-FNA were 83%, 96%, and 90%, respectively.ConclusionUS-FNA cytology is reliable in distinguishing benign and malignant salivary gland tumors and provides accurate diagnosis of most salivary gland lesions. ObjectiveTo evaluate the diagnostic accuracy and pitfalls of ultrasound-guided fine needle aspiration (US-FNA) for salivary gland lesions. To evaluate the diagnostic accuracy and pitfalls of ultrasound-guided fine needle aspiration (US-FNA) for salivary gland lesions. MethodsTwo hundred and fifty-eight US-FNA cytology specimens of salivary gland lesions taken over a 4-year period were reviewed and correlated with the histopathological findings obtained from surgical specimen. The aspirates were derived from parotid gland (218 cases) and submandibular gland (40 cases). Two hundred and fifty-eight US-FNA cytology specimens of salivary gland lesions taken over a 4-year period were reviewed and correlated with the histopathological findings obtained from surgical specimen. The aspirates were derived from parotid gland (218 cases) and submandibular gland (40 cases). ResultsThe major diagnostic categories for cytology were unsatisfactory (34 cases), non-neoplastic lesions (17 cases), benign neoplasm (180 cases), and malignant neoplasm (27 cases). Final pathological review showed that 172 of 192 (90%) benign tumors and 27 of 48 (56%) malignant tumors with adequate US-FNA sampling were accurately diagnosed cytologically. False-negative results were caused by sampling error (11 cases) or misinterpretation of uncommon tumors (10 cases). The overall sensitivity, specificity and accuracy of US-FNA were 83%, 96%, and 90%, respectively. The major diagnostic categories for cytology were unsatisfactory (34 cases), non-neoplastic lesions (17 cases), benign neoplasm (180 cases), and malignant neoplasm (27 cases). Final pathological review showed that 172 of 192 (90%) benign tumors and 27 of 48 (56%) malignant tumors with adequate US-FNA sampling were accurately diagnosed cytologically. False-negative results were caused by sampling error (11 cases) or misinterpretation of uncommon tumors (10 cases). The overall sensitivity, specificity and accuracy of US-FNA were 83%, 96%, and 90%, respectively. ConclusionUS-FNA cytology is reliable in distinguishing benign and malignant salivary gland tumors and provides accurate diagnosis of most salivary gland lesions. US-FNA cytology is reliable in distinguishing benign and malignant salivary gland tumors and provides accurate diagnosis of most salivary gland lesions.

Ultrasonographic contrast medium improves the diagnostic accuracy of ultrasound-guided fine-needle aspiration

Ultrasonographic contrast medium improves the diagnostic accuracy of ultrasound-guided fine-needle aspiration

Accuracy of ultrasound-guided fine-needle aspiration of the liver and cytologic findings in dogs and cats: 97 cases (1990-2000).

To evaluate the accuracy of ultrasound-guided fine-needle aspiration of the liver and cytologic findings in dogs and cats. Retrospective study. 56 dogs and 41 cats. Medical records of dogs and cats evaluated from 1990 to 2000 by use of cytologic and histopathologic examination of the liver were reviewed. Histologic and cytologic diagnoses were categorized as vacuolar hepatopathy, inflammation, neoplasia, cirrhosis, primary cholestasis, shunt, normal, and other. Overall agreement between the histopathologic diagnosis and cytologic diagnosis was found in 17 of the 56 (30.3%) canine cases and 21 of the 41 (51.2%) feline cases. Vacuolar hepatopathy was the category with the highest percentage of agreement. Vacuolar hepatopathy was identified via cytologic examination in 7 of 11 and 15 of 18 dogs and cats, respectively, in which histopathologic examination revealed that it was the predominant disease process. However, it was also the category that was most commonly misdiagnosed via cytologic examination. Inflammatory disease was accurately identified cytologically in 5 of 20 and 3 of 11 dogs and cats, respectively. Acknowledging the limitations of cytology and the extent of discrepancies between cytologic and histopathologic findings in dogs and cats will help clinicians make better decisions in diagnosing liver disease.