Focused Neck Ultrasound and Lymph Node Sampling by Respiratory Physicians in Suspected Lung Cancer

Respiration ◽  
2021 ◽  
pp. 1-6
Author(s):  
Maged Hassan ◽  
Thomas Nicholson ◽  
Lindsey Taylor ◽  
Helen McDill ◽  
Rob Hadden ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Fast Track ◽  
Diagnostic Yield ◽  
Cervical Lymphadenopathy ◽  
Molecular Testing ◽  
Routine Practice ◽  
Neck Ultrasound ◽  
Lymph Node Sampling ◽  
Supraclavicular Fossa ◽  
Linear Probe

<b><i>Background:</i></b> Malignant cervical lymphadenopathy in the setting of lung cancer represents N3 disease, and neck ultrasound (NUS) with sampling is described in the Royal College of Radiologists ultrasound training curriculum for the non-radiologists. This study reviews the incorporation of NUS +/− biopsy in the routine practice of a lung cancer fast-track clinic in the UK. <b><i>Methods:</i></b> We retrospectively assessed 29 months of activity of a lung cancer fast-track clinic. Systematic focused NUS was conducted in suspected thoracic malignancy, sampling nodes with a ≥5-mm short axis, under real-time US using a linear probe (5–12 Mhz). Fine-needle aspirations (FNAs) with or without 18 Ga core biopsies were taken. <b><i>Results:</i></b> Between August 2017 and December 2019, of 152 peripheral lymph nodes (LNs)/deposits sampled, 98 (64.5%) were supraclavicular fossa LNs with median [IQR] size 12 [8–18] mm. Core biopsies were performed in 54/98 (55%) patients, while all patients had FNAs. No complications occurred. The representative yield was 90/95 (94.7%) in cases with suspected cancer. No difference was seen between FNA versus core biopsy (<i>p</i> = 0.44). Of the 5 non-diagnostic samples, one was FNA only. The commonest diagnosis was lung cancer in 66/98 (67.3%). PDL-1 was sufficient in 35/36 tested (97.2%). ALK-FISH was successful in 24/25 (96%) cases. EGFR mutation analysis was successful in 28/31 (90.3%) cases. Median time from clinic to initial diagnosis was 7 [5–10] days. Computed tomography (CT) scans reported no significant lymphadenopathy in 18/96 (18.7%) cases, yet 10/18 (55.5%) cases were positive for malignancy. <b><i>Conclusion:</i></b> Neck nodal sampling by respiratory physicians was safe, timely, with a high diagnostic yield and suitability for molecular testing. Neck US can provide a timely diagnosis in cases that may be missed by CT alone.

scholarly journals PET and Neck Ultrasound for the Detection of Cervical Lymphadenopathy in Patients with Lung Cancer and Mediastinal Lymphadenopathy

Respiration ◽  
2018 ◽  
Vol 96 (2) ◽  
pp. 138-143 ◽  
Author(s):  
Mohammed Ahmed ◽  
Antoinette Flannery ◽  
Cyrus Daneshvar ◽  
David Breen
Keyword(s):  
Lung Cancer ◽  
Cervical Lymphadenopathy ◽  
Mediastinal Lymphadenopathy ◽  
Neck Ultrasound

scholarly journals Ultrasound-Guided Cervical Lymph Node Sampling Performed by Respiratory Physicians

2019 ◽  
Vol 4 (2) ◽  
pp. 1-6
Author(s):  
Mohammed Ahmed ◽  
Cyrus Daneshvar ◽  
David Breen
Keyword(s):  
Lymph Node ◽  
Cervical Lymph Node ◽  
Diagnostic Yield ◽  
Cervical Lymphadenopathy ◽  
Mediastinal Lymphadenopathy ◽  
Competency Assessment ◽  
Neck Lymph Node ◽  
Lymph Node Sampling ◽  
Significant Difference ◽  
Respiratory Physician

Background: A variety of disease processes investigated by respiratory physicians can lead to cervical lymphadenopathy. Ultrasound (US) has revolutionised respiratory investigations, and neck ultrasound (NUS) is increasingly recognised as an additional important skill for respiratory physicians. Objectives: We aimed to assess the feasibility of NUS performed by respiratory physicians in the workup of patients with mediastinal lymphadenopathy. Methods: This is a single-centre retrospective cohort study. All patients that underwent US-guided cervical lymph node sampling were included. The diagnostic yield is reported, and specimen adequacy is compared for respiratory physicians and radiologists. Results: Over 5 years, 106 patients underwent NUS-guided lymph node sampling by respiratory physicians compared to 35 cases performed by radiologists. There was no significant difference in the adequacy of sampling between the two groups (respiratory physicians 91.5% [95% CI 84.5–96%] compared to 82.9% [95% CI 66.4–93.4%] for radiologists [p = 0.2]). In the respiratory physician group, a diagnosis was achieved based on lymph node sampling in 89 cases (84%). Neck lymph node sampling was the only procedure performed to obtain tissue in 48 cases (45.3%). Conclusion: NUS and sampling performed by respiratory physicians are feasible and associated with an adequacy rate comparable to that of radiologists. It can reduce the number of invasive procedures performed in a selected group of patients. Guidelines for training and competency assessment are required.

30 Neck ultrasound and cervical lymph node sampling reduces time to diagnosis for lung cancer

Lung Cancer ◽  
2011 ◽  
Vol 71 ◽  
pp. S10
Author(s):  
N. Wilsmore ◽  
C.M. Free ◽  
S. Agrawal ◽  
V. Raj ◽  
A. Bajaj ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Lymph Node ◽  
Cervical Lymph Node ◽  
Neck Ultrasound ◽  
Lymph Node Sampling ◽  
Time To Diagnosis

scholarly journals Rapid On-Site Evaluation of Endobronchial Ultrasound–Guided Transbronchial Needle Aspirations for the Diagnosis of Lung Cancer: A Perspective From Members of the Pulmonary Pathology Society

2017 ◽  
Vol 142 (2) ◽  
pp. 253-262 ◽  
Author(s):  
Deepali Jain ◽  
Timothy Craig Allen ◽  
Dara L. Aisner ◽  
Mary Beth Beasley ◽  
Philip T. Cagle ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Diagnostic Yield ◽  
Needle Aspiration ◽  
Endobronchial Ultrasound ◽  
Current Status ◽  
Molecular Testing ◽  
Ultrasound Guided ◽  
Transbronchial Needle Aspiration ◽  
Site Evaluation ◽  
Diagnosis Of Lung Cancer

Context.— Endobronchial ultrasound–guided transbronchial needle aspiration (EBUS-TBNA) has emerged as a very useful tool in the field of diagnostic respiratory cytology. Rapid on-site evaluation (ROSE) of EBUS-TBNA not only has the potential to improve diagnostic yield of the procedure but also to triage samples for predictive molecular testing to guide personalized treatments for lung cancer. Objective.— To provide an overview of the current status of the literature regarding ROSE of EBUS-TBNA in the diagnosis of lung cancer. Data Sources.— An electronic literature search in PubMed and Google databases was performed using the following key words: cytology, lung cancer, on-site evaluation, rapid on-site evaluation, and ROSE EBUS-TBNA. Only articles published in English were included in this review. Conclusions.— Rapid on-site evaluation can ensure that the targeted lesion is being sampled and can enable appropriate specimen triage. If available, it should be used with EBUS-TBNA in the diagnosis of lung cancer because it can minimize repeat procedures for additional desired testing (ie, molecular studies). Some studies have shown that ROSE does not adversely affect the number of aspirations, total procedure time of EBUS-TBNA, or the rate of postprocedure complications; it is also helpful in providing a preliminary diagnosis that can reduce the number of additional invasive procedures, such as mediastinoscopy. As EBUS technology continues to evolve, our knowledge of the role of ROSE in EBUS-TBNA for the diagnosis of lung cancer will also continue to grow and evolve.

scholarly journals Routine neck ultrasound by respiratory physicians in the diagnosis and staging of patients with lung cancer and mediastinal lymphadenopathy: a prospective pilot study

2020 ◽  
Vol 6 (1) ◽  
pp. 00180-2019
Author(s):  
Mohammed Ahmed ◽  
Cyrus Daneshvar ◽  
David Breen
Keyword(s):  
Lung Cancer ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Cervical Lymphadenopathy ◽  
Mediastinal Lymphadenopathy ◽  
Second Phase ◽  
Neck Node ◽  
Neck Lymph Node ◽  
Neck Ultrasound ◽  
Respiratory Physician

IntroductionCervical lymphadenopathy in lung cancer indicates advanced disease. The presence of mediastinal lymphadenopathy is commonly associated with involvement of neck lymph nodes and some studies suggest routine neck ultrasound (NUS) in this group of patients. We conducted a two-phase study looking at training a respiratory physician to perform ultrasound-guided neck lymph node aspiration in patients with suspected lung cancer.MethodsIn the first phase of the study, one of the authors underwent training in NUS according to predetermined criteria. The adequacy of sampling was prospectively recorded. In the second phase, consecutive patients with suspected lung cancer and mediastinal lymphadenopathy underwent NUS and sampling of abnormal lymph nodes. The outcomes were the adequacy of samples for pathological analysis and molecular analysis, prevalence of cervical lymphadenopathy, and change in stage.ResultsFollowing the period of training, 35 patients underwent neck node sampling with an overall adequacy of 88.6% (95% CI 78.1–99.1%). Cervical lymph node involvement was confirmed in 13 out of 30 patients with lung cancer (43.3%, 95% CI 25.5–62.6%). Further immunohistochemistry and molecular studies were possible in all patients when it was required (nine cases). NUS led to nodal upstaging in four out of 30 (13.3%) cases.ConclusionTraining a respiratory physician to perform NUS and needle sampling to an acceptable level is feasible. Benefits of embedding this procedure in lung cancer diagnosis and pathway staging need to be explored in further studies.

scholarly journals One test for all: whole exome sequencing significantly improves the diagnostic yield in growth retarded patients referred for molecular testing for Silver–Russell syndrome

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Robert Meyer ◽  
Matthias Begemann ◽  
Christian Thomas Hübner ◽  
Daniela Dey ◽  
Alma Kuechler ◽  
...  
Keyword(s):  
Exome Sequencing ◽  
Whole Exome Sequencing ◽  
Diagnostic Yield ◽  
Uniparental Disomy ◽  
Molecular Testing ◽  
Main Body ◽  
Comprehensive Overview ◽  
Maternal Uniparental Disomy ◽  
Whole Exome ◽  
Silver Russell Syndrome

Abstract Background Silver-Russell syndrome (SRS) is an imprinting disorder which is characterised by severe primordial growth retardation, relative macrocephaly and a typical facial gestalt. The clinical heterogeneity of SRS is reflected by a broad spectrum of molecular changes with hypomethylation in 11p15 and maternal uniparental disomy of chromosome 7 (upd(7)mat) as the most frequent findings. Monogenetic causes are rare, but a clinical overlap with numerous other disorders has been reported. However, a comprehensive overview on the contribution of mutations in differential diagnostic genes to phenotypes reminiscent to SRS is missing due to the lack of appropriate tests. With the implementation of next generation sequencing (NGS) tools this limitation can now be circumvented. Main body We analysed 75 patients referred for molecular testing for SRS by a NGS-based multigene panel, whole exome sequencing (WES), and trio-based WES. In 21/75 patients a disease-causing variant could be identified among them variants in known SRS genes (IGF2, PLAG1, HMGA2). Several patients carried variants in genes which have not yet been considered as differential diagnoses of SRS. Conclusions WES approaches significantly increase the diagnostic yield in patients referred for SRS testing. Several of the identified monogenetic disorders have a major impact on clinical management and genetic counseling.

scholarly journals EBUS-TBNA Cytological Samples for Comprehensive Molecular Testing in Non–Small Cell Lung Cancer

Cancers ◽  
2021 ◽  
Vol 13 (9) ◽  
pp. 2084
Author(s):  
Roberto Martin-Deleon ◽  
Cristina Teixido ◽  
Carmen Mª Lucena ◽  
Daniel Martinez ◽  
Ainhoa Fontana ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Small Cell Lung Cancer ◽  
Molecular Characterization ◽  
Cell Lung Cancer ◽  
Small Cell ◽  
Endobronchial Ultrasound ◽  
Molecular Testing ◽  
Small Cell Lung ◽  
Transbronchial Needle Aspiration ◽  
Alternative Source

Clinical guidelines promote the identification of several targetable biomarkers to drive treatment decisions in advanced non-small cell lung cancer (NSCLC), but half of all patients do not have a viable biopsy. Specimens from endobronchial-ultrasound transbronchial needle aspiration (EBUS-TBNA) are an alternative source of material for the initial diagnosis of NSCLC, however their usefulness for a complete molecular characterization remains controversial. EBUS-TBNA samples were prospectively tested for several biomarkers by next-generation sequencing (NGS), nCounter, and immunohistochemistry (PD-L1). The primary objectives were to assess the sensitivity of EBUS-TBNA samples for a comprehensive molecular characterization and to compare its performance to the reference standard of biopsy samples. Seventy-two EBUS-TBNA procedures were performed, and 42 NSCLC patients were diagnosed. Among all cytological samples, 92.9% were successfully genotyped by NGS, 95.2% by nCounter, and 100% by immunohistochemistry. There were 29 paired biopsy samples; 79.3% samples had enough tumor material for genomic genotyping, and 96.6% for PD-L1 immunohistochemistry. A good concordance was found between both sources of material: 88.9% for PD-L1, 100% for NGS and nCounter. EBUS-TBNA is a feasible alternative source of material for NSCLC genotyping and allows the identification of patient candidates for personalized therapies with high concordance when compared with biopsy.

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