Cervical Lymph Node Features Predictive of Suboptimal Adequacy During Ultrasound‐Guided Fine‐Needle Aspiration in Thyroid Cancer Patients

• Published in: Journal of ultrasound in medicine Vol. 41; no. 1; pp. 135 - 145
• Main Authors: Chen, Joshua Vic, Morgan, Tara A., Liu, Chienying, Khanafshar, Elham, Choi, Hailey H.
• Format: Journal Article
• Language: English
• Published: Hoboken, USA John Wiley & Sons, Inc 01.01.2022
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Biopsy, Fine-Needle; Female; fine‐needle aspiration; Humans; lymph node; Lymph Nodes; Male; metastasis; Middle Aged; neck ultrasound; Retrospective Studies; thyroid cancer; Thyroid Neoplasms - diagnostic imaging; Ultrasonography, Interventional; Young Adult; fine-needle aspiration; thyroid cancer; neck ultrasound; metastasis; lymph node
• ISSN: 0278-4297; 1550-9613; 1550-9613
• DOI: 10.1002/jum.15688

Purpose To determine the rate of cytologic and diagnostic adequacy and identify features associated with suboptimal tissue sampling in ultrasound‐guided fine‐needle aspiration (US‐FNA) of suspected nodal disease in thyroid cancer patients. Methods A single‐institution pathology database was queried for lymph node FNA reports in thyroid cancer patients from 2014 to 2019. Charts were reviewed for demographics, body mass index (BMI), prior thyroidectomy, cancer type, and subsequent surgery. Ultrasound images were retrospectively reviewed for location, size, depth from skin, cystic components, macrocalcification, echogenic foci, and internal vascularity score. Pathology reports were categorized as cellular and diagnostic, hypocellular/acellular but diagnostic with abnormal cells or thyroglobulin levels, or hypocellular and nondiagnostic. Correlation and multivariate regression analyses were performed. Results Initial query yielded 552 lesions in 343 subjects. Following exclusion, 377 lesions in 255 subjects were included. Mean patient age was 48.5 years (14–90), BMI 28.5, and 66.7% female and 33.3% male. The majority (95.3%) had papillary thyroid carcinoma (PTC); and 65.5% had prior thyroidectomy. 17.7% of lesions were hypocellular/acellular (suboptimal), and 5.6% nondiagnostic. Patient factors had no association (P >.05). Right‐sidedness and hypovascularity were associated with hypocellularity (P <.05). Higher long/short‐axis ratio and cystic foci were weakly associated. On multivariate analysis, right‐sidedness (odds ratio [OR] 1.99; confidence interval [CI] 1.10–3.57) and lower vascularity score (OR 0.54; CI 0.39–0.73) were predictive of suboptimal sampling. Conclusion US‐FNA has high diagnostic yield and cellular sample rate. Lesion size had no effect. Right‐sidedness and lower vascularity scores were predictive of suboptimal tissue. Identifying these features and expected sample adequacy rates can inform management decisions for thyroid cancer patients with cervical lymphadenopathy. Access the CME test here and search by article title.