Focused Neck Ultrasound and Lymph Node Sampling by Respiratory Physicians in Suspected Lung Cancer

Area of Science:

• Oncology
• Radiology
• Pulmonology

Background:

• Malignant cervical lymphadenopathy in lung cancer signifies N3 disease.
• Neck ultrasound (NUS) with sampling is a key skill for non-radiologists in lung cancer diagnosis.
• This study evaluates the integration of NUS and biopsy into a UK lung cancer fast-track clinic.

Purpose of the Study:

• To assess the safety, efficacy, and timeliness of NUS with fine-needle aspiration (FNA) and core biopsy for diagnosing lung cancer.
• To determine the diagnostic yield and suitability for molecular testing of nodal samples obtained via NUS.
• To compare NUS findings with CT scans in identifying cervical lymphadenopathy.

Main Methods:

• Retrospective analysis of 29 months of data from a lung cancer fast-track clinic.
• Systematic focused NUS performed on suspected thoracic malignancies.
• Sampling of lymph nodes (LNs) with a short axis ≥5 mm using real-time ultrasound guidance.
• Fine-needle aspirations (FNAs) and/or 18 Ga core biopsies were performed on sampled LNs.

Main Results:

• 152 peripheral LNs/deposits were sampled, with 98 (64.5%) being supraclavicular fossa LNs.
• High diagnostic yield of 94.7% for suspected cancer cases; no significant difference between FNA and core biopsy.
• Molecular testing (PDL-1, ALK-FISH, EGFR) was successful in over 90% of cases.
• Median time to diagnosis was 7 days; NUS identified malignancy in 55.5% of cases with no significant lymphadenopathy on CT.

Conclusions:

• Neck nodal sampling by respiratory physicians is safe, efficient, and yields high-quality samples for molecular analysis.
• NUS provides a timely diagnosis, potentially detecting malignancy missed by CT alone.
• This approach enhances the diagnostic pathway for lung cancer patients.