TY - JOUR
T1 - Evaluation of a scoring system for predicting lymph node malignancy in ultrasound guided fine needle aspiration practice
AU - Wu, Maoxin
AU - Chen, Hua
AU - Zheng, Xiaoyong
AU - Burstein, David E.
PY - 2013/12
Y1 - 2013/12
N2 - Ultrasound-guided fine needle aspiration (USG-FNA) has enabled cytopathologists to accurately diagnose smaller or non-palpable lymph nodes (LN) on a regular basis. Pre-FNA clinical and ultrasonographic factors, such as a patient's age, ratio of short to long axis diameter (S/L ratio), internal echogenicity, and the vascular pattern of a LN, are reported to be able to predict the benign or malignant nature of a LN. This study is designed to test the formula "0.06 × (age) + 4.76 × (S/L ratio) + 2.15 × (internal echo) + 1.80 × (vascular pattern)" generated from the study of Liao et al. as a scoring system for predicting LN malignancy in a cytopathologist operated USG-FNA practice. Eighty-three reports of USG-FNA of LNs issued between 7/1/2008 and 4/28/2010 were reviewed. Patient's age, S/L ratio, internal echo, and vascular pattern were used to generate scores based on the aforementioned formula. A score of seven was used as a cutoff for predicting benign (<7) and malignant (>7) LNs. FNA cytology diagnosis, flow cytometric analysis as well as subsequent surgical diagnosis in some cases served as gold standard for statistical analysis. Among 46 USG-FNA of LNs with scores > 7, 38 were malignant and eight were benign. All 37 USG-FNA of LNs with scores < 7 were proven to be benign. The scoring system achieved 100% sensitivity, 82% specificity, 83% positive predictive value, 100% negative predictive value, and 90% accuracy. Further study of the eight "false-positive" cases revealed that three of them (37.5%) were found to be malignant in follow-up FNA and/or surgical biopsy. This scoring system may serve as a complementary tool in determining how aggressive a FNA procedure should be performed, how a FNA sample of LN should be triaged for ancillary study, and how closely a patient with lymphadenopathy should be followed up.
AB - Ultrasound-guided fine needle aspiration (USG-FNA) has enabled cytopathologists to accurately diagnose smaller or non-palpable lymph nodes (LN) on a regular basis. Pre-FNA clinical and ultrasonographic factors, such as a patient's age, ratio of short to long axis diameter (S/L ratio), internal echogenicity, and the vascular pattern of a LN, are reported to be able to predict the benign or malignant nature of a LN. This study is designed to test the formula "0.06 × (age) + 4.76 × (S/L ratio) + 2.15 × (internal echo) + 1.80 × (vascular pattern)" generated from the study of Liao et al. as a scoring system for predicting LN malignancy in a cytopathologist operated USG-FNA practice. Eighty-three reports of USG-FNA of LNs issued between 7/1/2008 and 4/28/2010 were reviewed. Patient's age, S/L ratio, internal echo, and vascular pattern were used to generate scores based on the aforementioned formula. A score of seven was used as a cutoff for predicting benign (<7) and malignant (>7) LNs. FNA cytology diagnosis, flow cytometric analysis as well as subsequent surgical diagnosis in some cases served as gold standard for statistical analysis. Among 46 USG-FNA of LNs with scores > 7, 38 were malignant and eight were benign. All 37 USG-FNA of LNs with scores < 7 were proven to be benign. The scoring system achieved 100% sensitivity, 82% specificity, 83% positive predictive value, 100% negative predictive value, and 90% accuracy. Further study of the eight "false-positive" cases revealed that three of them (37.5%) were found to be malignant in follow-up FNA and/or surgical biopsy. This scoring system may serve as a complementary tool in determining how aggressive a FNA procedure should be performed, how a FNA sample of LN should be triaged for ancillary study, and how closely a patient with lymphadenopathy should be followed up.
KW - lymph node
KW - scoring system
KW - ultrasound guided FNA
UR - http://www.scopus.com/inward/record.url?scp=84888074886&partnerID=8YFLogxK
U2 - 10.1002/dc.21745
DO - 10.1002/dc.21745
M3 - Article
C2 - 21671411
AN - SCOPUS:84888074886
SN - 8755-1039
VL - 41
SP - 1100
EP - 1106
JO - Diagnostic Cytopathology
JF - Diagnostic Cytopathology
IS - 12
ER -