Core Biopsy and FNA: A Comparison of Diagnostic Yield in Lymph Nodes of Different Ultrasound Determined Malignant Potential

Background: The tissue diagnosis of lymphoma and metastases is commonly obtained from affected lymph nodes. The lymph nodes chosen for biopsy are often the consequence of their appearance on ultrasound, which determines their risk of malignancy. Two frequently used percutaneous sampling techniques are core biopsy and fine needle aspiration (FNA). While core biopsy obtains a larger tissue sample and provides a degree of architectural information, FNA is considered less invasive and has the advantage of immediate confirmation of adequacy by the attending cytologist. Anecdotally, core biopsy is more commonly used when a lymph node is suspected of harboring neoplasia, however a feature of malignancy is hypercellularity, which theoretically should increase the diagnostic yield of FNA. Aim: The aim of this project was to compare the diagnostic capability of FNA and core biopsy in lymph nodes of different malignant potential, as defined by ultrasound, and determine if the radiologic appearance can guide clinicians in their choice of sampling technique. The project also reviewed the role of clinical experience in both the choice of sampling technique and diagnostic yield. Methods: Retrospective study of percutaneous lymph node biopsies performed at a large tertiary hospital between July 2016 and March 2018. The associated ultrasounds were reviewed and the lymph nodes were classified as high or low risk of malignancy by their sonographic appearance. The end point for analysis was the capacity for FNA or core biopsy to provide a definitive diagnosis. The diagnostic yield was then separately assessed for lymph nodes of high and low malignant potential. The effect of clinical experience on diagnostic yield was also examined, by comparing the outcomes of radiology consultants and radiology trainees. Results: 296 lymph node biopsies were reviewed and statistical analysis was performed using logistic regression analysis. Core biopsy, in comparison with FNA, was used twice as often in lymph nodes of high malignant potential, supporting the aforementioned anecdotal evidence. Core biopsy demonstrated superior diagnostic yield in comparison with FNA, providing a diagnostic sample 45% ( P = 0.313) more often in low-risk lymph nodes and 209% ( P = < 0.05) more often in high-risk lymph nodes. Consultant radiologists used FNA 81% more often than core biopsy in lymph nodes of high malignant potential, while radiology trainees used core biopsy 104% more often than FNA in the same group. In high-risk lymph nodes, trainees were 117% ( P = 0.105) more likely to obtain a diagnostic sample than consultants. Conclusion: Core biopsy is superior to FNA in the tissue sampling of lymph nodes regardless of ultrasound determined risk of malignancy. Biopsies obtained by radiology trainees provided a diagnosis twice as often as those obtained by radiology consultants. This appeared to be the consequence of consultant preference for FNA over core biopsy.

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Leptin Levels in Lymph Node Aspiration Biopsy is a Predictor of Smoking Tendencies: A Pilot Study

10.21203/rs.3.rs-137734/v1 ◽

2020 ◽

Author(s):

Fares Qeadan ◽

Rosstin Ahmadian ◽

Emily Alden ◽

Erica Pascetti ◽

Lily Y. Gu ◽

...

Keyword(s):

Lymph Node ◽

Pilot Study ◽

High Risk ◽

Lymph Nodes ◽

Cancer Diagnosis ◽

Low Risk ◽

Hilar Lymph Node ◽

University Of New Mexico ◽

Cytokine Profiles ◽

Significant Difference

Abstract Background: Cytokine profiles have traditionally been explored in serum due to its ease of accessibility and the diagnostic and assessment capabilities in a clinic setting. Utilization of additional cytokine depots, such as hilar lymph nodes, has not thoroughly been explored. In this study, we examined the cytokine profile of mediastinal and hilar lymph node fine needle aspirates to identify markers capable of differentiating high-risk smokers (>30 pack-years) from low-risk smokers (<30 pack-years), independent of current cancer diagnosis. Methods: We used the cytokine profiles of 27 patients from a pro-spective convenience pilot study conducted at the University of New Mexico. Logistic regression analysis was employed.Results: A significant difference in mean cytokine values for Leptin was discovered between patients categorized as low-risk and high-risk pack year smokers (p=0.034). Additionally, mean cytokine values of Leptin did not differ between patients by cancer diagnosis (malignant vs. benign). Our analysis demonstrated Leptin as a fair marker for discriminating between high-risk smokers and low-risk smokers (AUC 0.73). Conclusions: We conclude Leptin is an optimal cytokine to discriminate between high-risk and low-risk smokers. To our knowledge, this is the first study to assess the ability of Leptin to serve as such an indicator via hilar lymph nodes.

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Utilization of pelvic lymph node dissection for low-risk prostate cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.6_suppl.86 ◽

2017 ◽

Vol 35 (6_suppl) ◽

pp. 86-86

Author(s):

Parth K. Modi ◽

Megan Bock ◽

Sinae Kim ◽

Eric A. Singer ◽

Rahul Parikh

Keyword(s):

Lymph Node ◽

High Risk ◽

Lymph Nodes ◽

High Volume ◽

Pelvic Lymph Node Dissection ◽

Low Risk ◽

Rural Residence ◽

Risk Prostate Cancer ◽

Low Risk Prostate Cancer ◽

Risk Patients

86 Background: National guidelines suggest against pelvic lymph node dissection (PLND) for patients with low-risk prostate cancer (PCa). However, the actuarial rate of PLND in this population is unknown. This study aimed to characterize the use of PLND in contemporary cohort of men with low-risk PCa undergoing robotic assisted radical prostatectomy (RARP). Methods: The National Cancer Database was queried for PCa patients who underwent RARP from 2010 to 2013. Patients who underwent PLND were identified and patient clinicodemographic and hospital characteristics were abstracted. The primary outcome measure was receipt of PLND. Secondary outcome measures included number of lymph nodes evaluated and number of lymph nodes positive for cancer. Unadjusted and multivariate regression analyses were conducted to identify predictors of receipt of PLND. Analysis of clustered data was employed to account for hospital-level correlation in utilization. Results: Of 51,971 patients with low-risk PCa who underwent RARP, 19,059 (36.7%) received PLND. Lymph node positivity was identified in 0.4% of low-risk patients and 4.6% of intermediate/high risk patients. Predictors of PLND in low-risk patients included rural residence (OR 1.157), treatment at academic institutions (OR 1.492) or high-volume (OR 1.327) facilities. Mean number of lymph nodes obtained in low-risk patients was lower than in intermediate- or high-risk patients (4.74 vs 5.86, P < 0.0001). In multivariate analysis, black race was associated with significantly fewer lymph nodes retrieved. Intermediate or high risk PCa; rural residence; and treatment at an academic, high-volume, or West region facility were independently associated with a higher yield of retrieved lymph nodes. Conclusions: PLND is performed for greater than one-third of low-risk PCa patients undergoing RARP in this large hospital-based data set. Our study demonstrated a low likelihood (0.4%) of detecting nodal metastasis in this population, thus validating the national recommendations against PLND. Rural residence and treatment at high-volume and academic centers are associated with receipt of PLND. Reasons for the variation in practice patterns should be investigated to improve the quality of PCa care.

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Twenty-one-gene recurrence score (RS) in germline (g)CHEK2 mutation-associated versus sporadic breast cancers (BC): A multi-site case-control study.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.10531 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. 10531-10531

Author(s):

Anosheh Afghahi ◽

Sydney Marsh ◽

Alyse Winchester ◽

Dexiang Gao ◽

Hannah Parris ◽

...

Keyword(s):

Lymph Node ◽

Genetic Testing ◽

High Risk ◽

Case Control Study ◽

Case Control ◽

Low Risk ◽

Mutation Status ◽

T Stage ◽

Chek2 Mutation ◽

Control Study

10531 Background: Genomic assays, such as RS, are used to determine chemotherapy benefit in early-stage, estrogen receptor (ER)- and/or progesterone receptor (PR)-positive, HER2 negative BC patients (pts). Currently, guidelines to use pts’ germline genetic testing results to guide adjuvant therapy are lacking. Several reports have indicated worse outcomes for BC pts with g CHEK2 pathogenic variants (PV). We investigated whether PV in CHEK2 were associated with increased RS. Methods: Patient-level clinical data and RS were derived from electronic medical records of seven medical centers between years 2013-17. Confirmation of RS using the Genomic Health provider portal was performed. 38 pts with germline PV in CHEK2 (15 pts/39.5% with c.1100delC mutation) and RS score (cases) were matched with BC pts whose genetic testing did not identify PV (controls) using a 1:2 matching schema. Pts were matched based on age at diagnosis and lymph node (LN) status. LN negative pts were further matched based on T-stage. A multivariate random intercept linear mixed model of CHEK2 mutation status on RS was performed, adjusting for PR. A secondary ordinal univariate analysis was conducted that categorized RS into low, intermediate and high risk ( < 18, 18-30, and > 30, respectively). P-values were reported based on a null hypothesis of no effect against a two-sided alternative. Results: The median RS for cases was 19.5 (interquartile range [IQR]: 15 to 25) and the median RS for controls was 18 (IQR: 12 to 22). A greater proportion of cases were categorized as high risk (10.5%) compared to controls (5.6%), and a smaller proportion of cases were categorized as low risk (36.8%) compared to controls (49.3%). Cases had higher grade and increased proportion of PR-negative BC as compared with controls (grade 1: 12.1% of cases versus 32.4% of controls; PR-negative: 7.9% of cases versus 5.6% of controls). The variables used to match cases and controls (age, lymph node status, and T-stage) had similar summary statistics. The RS was 1.97-point higher in pts with g CHEK2 PV compared to controls, after adjusting for PR (95% confidence interval [CI]: 1.02-point lower to 4.96-point higher; p = 0.194). The secondary analysis of CHEK2 mutation status on an ordinal RS risk group yielded comparable results; on average, the odds of being high risk compared to the combined intermediate/low risk groups was 1.72 times higher in cases compared to controls (95% CI: 0.77 to 3.80; p = 0.181), but these differences were not significant. Conclusions: Our case-control study did not show a statistically higher RS for BC that develops in pts with g CHEK2 PV. Further studies are warranted to evaluate the association between type of CHEK2 PV (frameshift versus missense) and other modifying genetic variables and RS.

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Presurgical, ultrasound-guided anchor-wire marking of impalpable cervical lymph nodes

The Journal of Laryngology & Otology ◽

10.1258/0022215054516241 ◽

2005 ◽

Vol 119 (8) ◽

pp. 627-628 ◽

Cited By ~ 13

Author(s):

J A Bryant ◽

N J Siddiqi ◽

E J Loveday ◽

G H Irvine

Keyword(s):

Lymph Node ◽

High Risk ◽

Lymph Nodes ◽

Cervical Lymph Node ◽

Ultrasound Guidance ◽

Operating Time ◽

High Risk Patient ◽

Wire Localization ◽

Ultrasound Guided ◽

Cervical Lymph Nodes

This case illustrates the surgical use of wire localization, a well tried technique from a different field of surgery, in the removal of an ultrasound-detected, impalpable deep lower cervical lymph node in a high-risk patient. A localization needle with an echogenic tip was placed freehand under ultrasound guidance, immediately before surgery. The imaging and marking of the impalpable cervical lymph node resulted in a precise surgical dissection and a reduction in operating time whilst minimizing risks to the patient and staff.

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Risk Taking Behaviour Associated with Alcohol use among College Student

Asian Journal of Nursing Education and Research ◽

10.52711/2349-2996.2021.00076 ◽

2021 ◽

pp. 317-320

Author(s):

Puspanjali Mohapatro ◽

Rashmimala Pradhan

Keyword(s):

High Risk ◽

Alcohol Use ◽

Risk Taking ◽

Rating Scale ◽

Sampling Technique ◽

Risk Behaviour ◽

Low Risk ◽

Living Standard ◽

Risky Behaviour ◽

High Risk Behaviour

Objective: This study is designed to examine the risk taking behaviours that are harmful to students at a selected university. In this case, high-risk behaviours have been studied, such as harmful behaviours, coercion, smoke, alcohol contain substance abuse, and drug addiction. Materials and methods: Current study which is a type of descriptive survey research. The sample of this study included 200 students from a selected university in Bhubaneswar, who were selected through a convenient sampling technique. The Self -structured questionnaire tool has been used for a to collect socio demographic variables. A Structured checklist developed to measure risk taking behaviour. For this section rating scale was adopted with score was low risk, medium risk and high risk. In this study, score range 14-28 divided in to 3 scales- Low risk (14-18), Medium (19-24), High (25-28). A behavioural rating scale was used to analyse the behaviour. Results: The results showed that the increase in risky behaviour among students was 87% and higher for boys than girls and 40% for campus students had a higher risk of alcohol use. About 69.5% of the age group 19-27 were involved in alcohol consumption due to level of high living standard, high sources of income and happiness. Conclusion: The results of the study on identification of risky behaviours to precedence among students, by accessing a high-risk behaviour profile will help policymakers accurately identify student behaviours to make plan for promoting health improvements activity, with to linking the group's real needs and challenges.

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Detection of Lymph Node Metastases in Patients With Prostate Cancer: Comparing Conventional and Digital [18F]-fluorocholine PET-CT Using Histopathology as Reference

10.21203/rs.3.rs-552089/v1 ◽

2021 ◽

Author(s):

Mimmi Bjöersdorff ◽

Christopher Puterman ◽

Jenny Oddstig ◽

Jennifer Amidi ◽

Sophia Zackrisson ◽

...

Keyword(s):

Prostate Cancer ◽

Lymph Node ◽

High Risk ◽

Lymph Nodes ◽

Lymph Node Metastases ◽

Reconstruction Algorithms ◽

High Risk Prostate Cancer ◽

Pet Ct ◽

Risk Prostate Cancer ◽

Node Metastases

Abstract Background: Positron emission tomography-computed tomography (PET-CT) can be used to detect and stage metastatic lymph nodes in intermediate to high-risk prostate cancer. Improvements to hardware, such as digital technology, and to software, such as reconstruction algorithms, have recently been made. We compared the capability of detecting regional lymph node metastases using conventional and digital silicon photomultiplier (SiPM)-based PET-CT technology for [18F]-fluorocholine (FCH). Extended pelvic lymph node dissection (ePLND) histopathology was used as the reference method.Methods: Retrospectively, a consecutive series of patients with prostate cancer who had undergone staging with FCH PET-CT before ePLND were included. Images were obtained with either a conventional or a SiPM-based PET-CT and compared. FCH uptake in pelvic lymph nodes beyond the uptake in the mediastinal blood pool was considered to be abnormal.Results: One hundred eighty patients with intermediate or high-risk prostate cancer were examined using a conventional Philips Gemini PET-CT (n = 93) between 2015 and 2017 or a digital GE Discovery MI PET-CT (n = 87) from 2017 to 2018. Images that were obtained using the Philips Gemini PET-CT system showed 19 patients (20%) with suspected lymph node metastases compared with 40 patients (46%) using the GE Discovery MI PET-CT. Sensitivity, specificity, and positive and negative predictive value (PPV and NPV) were 0.30, 0.84, 0.47, and 0.72, respectively, for the Philips Gemini and 0.60, 0.58, 0.30, and 0.83, respectively for GE Discovery MI. Area under the curve (AUC) in a receiver operating characteristics (ROC) analysis was similar between the two PET-CT systems (0.58 and 0.58, P = 0.8).Conclusions: A marked difference in sensitivity and specificity was found for the different PET-CT systems, although similar overall diagnostic performance. This is probably due to differences in both hard- and software, including reconstruction algorithms, and should be considered when new technology is introduced.

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Diagnostic yield of biopsies of cervical lymph nodes using a large (14-gauge) core biopsy needle

Apmis ◽

10.1111/apm.12058 ◽

2013 ◽

Vol 121 (12) ◽

pp. 1119-1130 ◽

Cited By ~ 7

Author(s):

Ole M. Pedersen ◽

Hans J. Aarstad ◽

Turid Løkeland ◽

Leif Bostad

Keyword(s):

Lymph Nodes ◽

Core Biopsy ◽

Diagnostic Yield ◽

Cervical Lymph Nodes ◽

Biopsy Needle

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A nomogram with lymph node status predicts survival and the benefit of postoperative adjuvant therapy in IIIA-N2 Non-small cell lung cancer patients after surgery

10.21203/rs.3.rs-98065/v2 ◽

2020 ◽

Author(s):

Ye Chen ◽

Lei Dong ◽

Minjing Li ◽

Fei He ◽

ChenHui Qiu ◽

...

Keyword(s):

High Risk ◽

Lymph Nodes ◽

Survival Benefit ◽

Risk Group ◽

High Risk Group ◽

Small Cell ◽

Low Risk ◽

Small Cell Lung ◽

Moderate Risk ◽

Nsclc Patients

Abstract Objective: This study aimed at establishing a novel nomogram predicting overall survival and investigating the survival benefit of various postoperative adjuvant treatments (POAT) in IIIA-N2 Non-small cell lung cancer (NSCLC) patients after surgery.Methods: Data of IIIA-N2 NSCLC patients between 2004 and 2016 were collected from the Surveillance, Epidemiology, and End Results (SEER). Patients were excluded if the information regarding follow-up time and clinicopathological features were incomplete. Through Univariate and multivariate analyses, independent prognostic factors were identified and integrated into the construction of nomogram. The survival benefit of POAT was evaluated in model-defined low-risk, intermediate-risk, and high-risk subgroups, respectively.Results: In total, 4389 patients were finally included for analysis. Patients’ age, sex, T stage, differentiation grade, examined lymph nodes number (ELN), metastatic lymph nodes number (MLN), and metastatic lymph nodes ratio (LNR) were identified as independent prognostic factors and were integrated into the construction of nomogram. The C-index and calibration curves indicated that the predictive performance of the nomogram was satisfactory. Patients were then categorized into three prognostic groups with the increasing risk of all-cause of death. The prognosis of patients receiving POAT (POCT or PORT plus POCT) and patients receiving surgery alone was comparable in low-risk group, while POCT could significantly prolong survival for IIIA-N2 NSCLC patients after surgery in moderate-risk and high-risk groups. Only patients in high-risk group could benefit from the combination of postoperative radiotherapy (PORT) and postoperative chemotherapy (POCT).Conclusion: In this large-cohort retrospective study, A survival-predicting nomogram and risk stratification model were established to estimate prognosis in IIIA-N2 NSCLC patients. Surgery alone was recommended as the first choice of treatment to patients in low-risk group. POCT was recommended for patients in moderate-risk group, and the combination of PORT and POCT was recommended for patients in high-risk group. This study may provide additional integration, introspection, and improvement for therapeutic decision-making.

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Influence of Biopsy Gleason Score on the Risk of Lymph Node Invasion in Patients With Intermediate-Risk Prostate Cancer Undergoing Radical Prostatectomy

Frontiers in Surgery ◽

10.3389/fsurg.2021.759070 ◽

2021 ◽

Vol 8 ◽

Author(s):

Mike Wenzel ◽

Felix Preisser ◽

Benedikt Hoeh ◽

Maria N. Welte ◽

Clara Humke ◽

...

Keyword(s):

Prostate Cancer ◽

Lymph Node ◽

High Risk ◽

Radical Prostatectomy ◽

Gleason Score ◽

International Society ◽

Low Risk ◽

Intermediate Risk ◽

Risk Prostate Cancer ◽

Biopsy Gleason Score

Objective: To analyze the influence of biopsy Gleason score on the risk for lymph node invasion (LNI) during pelvic lymph node dissection (PLND) in patients undergoing radical prostatectomy (RP) for intermediate-risk prostate cancer (PCa).Materials and Methods: We retrospectively analyzed 684 patients, who underwent RP between 2014 and June 2020 due to PCa. Univariable and multivariable logistic regression, as well as binary regression tree models were used to assess the risk of positive LNI and evaluate the need of PLND in men with intermediate-risk PCa.Results: Of the 672 eligible patients with RP, 80 (11.9%) men harbored low-risk, 32 (4.8%) intermediate-risk with international society of urologic pathologists grade (ISUP) 1 (IR-ISUP1), 215 (32.0%) intermediate-risk with ISUP 2 (IR-ISUP2), 99 (14.7%) intermediate-risk with ISUP 3 (IR-ISUP3), and 246 (36.6%) high-risk PCa. Proportions of LNI were 0, 3.1, 3.7, 5.1, and 24.0% for low-risk, IR-ISUP1, IR-ISUP 2, IR-ISUP-3, and high-risk PCa, respectively (p < 0.001). In multivariable analyses, after adjustment for patient and surgical characteristics, IR-ISUP1 [hazard ratio (HR) 0.10, p = 0.03], IR-ISUP2 (HR 0.09, p < 0.001), and IR-ISUP3 (HR 0.18, p < 0.001) were independent predictors for lower risk of LNI, compared with men with high-risk PCa disease.Conclusions: The international society of urologic pathologists grade significantly influence the risk of LNI in patients with intermediate- risk PCa. The risk of LNI only exceeds 5% in men with IR-ISUP3 PCa. In consequence, the need for PLND in selected patients with IR-ISUP 1 or IR-ISUP2 PCa should be critically discussed.

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Utilization and impact of surgical technique on the performance of pelvic lymph node dissection at radical prostatectomy: Results from the SEARCH database.

Journal of Clinical Oncology ◽

10.1200/jco.2015.33.7_suppl.73 ◽

2015 ◽

Vol 33 (7_suppl) ◽

pp. 73-73

Author(s):

Kathleen F. McGinley ◽

Xizi Sun ◽

Lauren E. Howard ◽

William J. Aronson ◽

Martha K. Terris ◽

...

Keyword(s):

Lymph Node ◽

High Risk ◽

Radical Prostatectomy ◽

Surgical Technique ◽

Lymph Node Dissection ◽

Risk Group ◽

Pelvic Lymph Node Dissection ◽

Low Risk ◽

Node Dissection ◽

Over Time

73 Background: Performance of a pelvic lymph node dissection (PLND) with radical prostatectomy (RP) is critical for staging and treatment of high-risk prostate cancer (PC). Conversely, performance of a PLND in low-risk PC contributes to morbidity with minimal benefit. Robot-assisted laparoscopic RP (RARP) is associated with decreased PLND use. We evaluated PLND use over time, stratified by PC risk group and surgical technique. Methods: We used SEARCH to identify men who had open RP (ORP) or RARP from 2006-2013 with complete data. Univariable logistic regression was used to test the association between age, race, BMI, number of positive cores, AUA risk group, year, center, and surgical technique on PLND use. Multivariable logistic analysis was used to examine surgical technique and PLND performance stratified by AUA risk-group. Spearman correlation was used to examine temporal changes in PLND utilization stratified by risk-group and surgical technique. Results: 1,439 men met inclusion criteria. Of these, 66% had a PLND. On univariable analysis, age, year, number of positive cores, AUA risk group, center, and surgical technique were significantly associated with PLND performance (all p<0.02). On multivariable analysis, when adjusted for age, race, BMI, number of positive cores, year, and center, RARP was associated with a 89% decreased use of PLND in the low-risk group, 85% decreased in intermediate risk, and 86% decreased in high risk men (all p≤0.002). Over time, PLND was increasingly used with RARP in low-risk patients (p=0.022); a trend of increased PLND performance with RARP in high risk men was noted (p=0.077) reaching ~85% in 2012-2013 vs. ~95% in ORP. For ORP, PLND use did not significantly change over time except a trend of fewer PLND in low-risk men which decreased to ~35% (p=0.064) in 2012-2013. Conclusions: Regardless of risk group, PLND is markedly less likely to be performed when a RARP is done. While improved over time, PLND remains over-utilized in low-risk men and under-utilized in high risk men regardless of surgical technique.

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