Efficacy of ultrasound-guided core needle biopsy in cervical lymphadenopathy: A retrospective study of 6,695 cases

Objectives To determine the diagnostic yield of ultrasound-guided core needle biopsy (US-CNB) in cervical lymphadenopathy and identify the factors influencing the diagnostic accuracy of US-CNB. Methods We retrospectively reviewed the records of 6,603 patients with cervical lymphadenopathy who underwent 6695 US-CNB procedures between 2004 and 2017. Results Adequate specimens were obtained in 92.19 % (6,172/6,695) of cases. Most lymph nodes (67.65 %) were malignant (metastatic carcinoma 4,131; lymphoma 398). The overall accuracy of US-CNB for differentiating benign from malignant lesions was 91.70 % (6,139/6,695). Among biopsies in which adequate material was obtained, the sensitivity, specificity and accuracy of US-CNB were 99.70 %, 100 % and 99.46 %, respectively. The success or failure of US-CNB for the diagnosis of lymphadenopathy was significantly correlated with node size, nature (malignant vs. benign), and location as well as penetration depth, but not with needle size (p = 0.665), number of core tissues obtained (p = 0.324), or history of malignancy (p = 0.060). There were no major procedure-related complications. Conclusions US-CNB is a safe and effective method of diagnosing cervical lymphadenopathy, and our findings may help optimise the sampling procedure by maximising its diagnostic accuracy and preserving its minimally invasive nature. Key Points • US-CNB is useful for the diagnosis of cervical lymphadenopathy. • US-CNB is safe to perform on lymph nodes located near vital structures. • Larger, malignant, level IV lymph nodes yield sufficient tissue samples more easily.