5P - Reliable EGFR mutation testing in ultrasound guided supraclavicular lymph node fine needle aspirates: A cohort study with diagnostic performance ana...

Date 17 April 2015
Event ELCC 2015
Session Poster lunch
Topics Imaging, Diagnosis and Staging
Lung and other Thoracic Tumours
Pathology/Molecular Biology
Presenter Amir Awwad
Citation Annals of Oncology (2015) 26 (suppl_1): 1-5. 10.1093/annonc/mdv043
Authors A. Awwad1, S. Tiwari2, V. Sovani3, D. Baldwin4, M. Kumaran1
  • 1Radiology Department, Nottingham University Hospitals NHS Trust-QMC, NG7 2UH - Nottingham/UK
  • 2Radiology Department, Nottingham University Hospitals NHS Trust-QMC, NG7 - Nottingham/UK
  • 3Histopathology Department, Nottingham University Hospitals NHS Trust-QMC, NG7 - Nottingham/UK
  • 4Respiratory Medicine Unit, David Evans Research Centre, Nottingham University Hospitals NHS Trust-City Hospital Campus, NG7 51PB - Nottingham/UK

Abstract

Aim/Background

Fifteen to thirty percent of lung cancer patients will have supraclavicular and cervical lymphadenopathy (SCLN). Ultrasound (US) guided Fine Needle Aspiration (FNA) Cytology is regarded as an effective diagnostic tool in small size lymph nodes and impalpable Positron Emission Tomography (PET) detected nodes. We evaluated our diagnostic service performance, in relation to the adequacy of samples for epidermal growth factor receptor (EGFR) mutation. However, to our knowledge, there has been no confirmation that US guided FNA of neck and SCN samples are adequate for EGFR mutation detection. Therefore, we evaluated our diagnostic service performance of US guided NA of SCN with regard to adequacy of samples for detection of EGFR mutations.

Methods

Retrospective data analysis from electronic records, searching for all suspected lung cancer referrals that underwent US of the neck ± FNA, over a continuous period of four years.

Results

Of 306 cases with suspected lung cancer referred to our department for US- FNA of SCLN, 228 patients underwent the procedure. Of the remaining 78 patients, Lymph nodes (LNs) were not detected in 52, and 26 patients' LNs appeared benign. Cytological diagnosis was established in 171 patients (75%) for treatment decisions without further investigations. The remaining 57 patients had further investigations; 45 re-confirmed the US guided FNA diagnosis. The average LN size was 12.9mm and positive cytology was obtained in LNs ranging from 3 to 45mm. Of 57 adenocarcinoma cases, 34 were tested for EGFR confirming 4 positive, 25 negative and 5 insufficient samples. No complications were recorded.

US Guided FNA vs Sensitivity % (CI) Specificity % (CI) PPV % (CI) NPV % (CI) PLR NLR
All Further Tests 76.9 (63.2 to 87.5) 100 (47.9 to 100) 100 (91.1 to 100) 29.4 (10.4 to 55.9) NA 0.23 (0.2 to 0.4)
Core LN Biopsy 81.2 (59.7 to 94.7) 100 (16.6 to 100) 100 (81.3 to 100) 20 (3.3 to 71.2) NA 0.18 (0.1 to 0.5)
Bronchial Washings 69.2 (38.6 to 90.7) 100 (30.5 to 100) 100 (66.2 to 100) 42.9 (10.4 to 81.3) NA 0.3 (0.1 to 0.7)
Lung Biopsy 57.1 (18.8 to 89.6) 100 (16.6 to 100) 100 (40.2 to 100) 25 (4.1 to 79.7) NA 0.4 (0.2 to 1.0)

Conclusions

US guided FNA of SCLN remains an important diagnostic tool in lung cancer. Adequate tissue can be obtained for reliable diagnosis from LNs and for EGFR mutational analysis, without the need for more invasive and expensive investigations in more than 80% of cases.

Disclosure

All authors have declared no conflicts of interest.