Comparison of ultrasound‐guided core biopsy versus fine‐needle aspiration biopsy in the evaluation of salivary gland lesions

Ultrasound‐guided core biopsy provides many benefits compared with fine‐needle aspiration cytology and has begun to emerge as part of the diagnostic work‐up for a salivary gland lesion. Although the increased potential for tumor‐seeding and capsule rupture has been extensively discussed, the safety of this procedure is widely accepted based on infrequent reports of tumor‐seeding. In fact, a review of the literature shows only 2 cases of salivary tumor seeding following biopsy with larger‐gauge needle characteristics, with 2 reported cases of salivary tumor seeding following fine‐needle aspiration cytology. However, the follow‐up interval of such studies (<7 years) is substantially less than the 20‐year follow‐up typically necessary to detect remote recurrence. Studies on tumor recurrence of pleomorphic adenoma, the most common salivary gland lesion, suggest that as many as 16% of tumor recurrences occur at least 10 years following initial surgery, with average time to recurrence ranging anywhere from 6.1 to 11.8 years postoperatively. Despite the benefits of ultrasound‐guided core biopsy over fine‐needle aspiration biopsy, which include both improved consistency and diagnostic accuracy, current studies lack adequate patient numbers and follow‐up duration to confirm comparable safety profile to currently accepted fine‐needle aspiration cytology. In this report we: (1) compare the relative benefits of each procedure, (2) review evidence regarding tumor seeding in each procedure, (3) discuss time course and patient numbers necessary to detect tumor recurrence, and (4) describe how these uncertainties should be factored into clinical considerations. © 2012 Wiley Periodicals, Inc. Head Neck, 35 : 1657–1661, 2013     

False‐negative rate of ultrasound‐guided fine‐needle aspiration cytology for identifying axillary lymph node metastasis in breast cancer patients

Axillary nodal status remains an important determinant of prognosis and of the therapeutic strategy in patients with a newly diagnosed breast cancer. The aim of this study was to assess the false‐negative rate of ultrasound (US)‐guided fine‐needle aspiration cytology (FNAC) in axillary node staging at breast cancer diagnosis. All patients with a newly diagnosed breast cancer who had an indeterminate or suspicious axillary node sampled with an FNAC between 2007 and 2014 were included in the study. FNAC results were compared to the final histopathological results of surgically removed axillary lymph nodes. Patient demographics, tumor, and nodal characteristics were analyzed. Diagnostic accuracy tests were performed using IBM SPSS, version 22. A total of 3515 patients with breast cancer were identified, 675 of whom had ultrasound‐guided FNAC of ipsilateral axillary lymph nodes (mean age: 55 years; Range: 26‐84). A benign (C2) result was observed in 52% (n = 351) and a malignant (C5) result in 35% (n = 238). C1 was obtained in 11% (n = 76), C3 in 0.6% (n = 4), and C4 in 0.9% (n = 6). Of the 238 patients with a malignant (C5) FNAC, 99.6% had confirmed axillary lymph node metastatic disease on histopathology. Of the 351 patients with benign FNAC (C2), 31% (n = 108) of patients had a positive lymph node on histology. The false‐negative rate of preoperative FNAC remains too high (31%) to omit definitive surgical staging of the axilla. The high diagnostic accuracy when a positive FNAC is obtained allows appropriate tailored decisions regarding definitive therapy.