Ultrasound-guided fine needle aspiration cytology of Para-aortic lymph node metastasis in uterine cervical cancer: diagnostic accuracy and impact on clinical decision making
Abstract Objective The main aim of this study was to ascertain the effectiveness of ultrasound-guided fine needle aspiration cytology (US-FNAC) in the diagnosis of para-aortic lymph node (PALN) metastasis in uterine cervical cancer and to establish its potential impact on clinical therapeutic decisi...
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doaj-5f9ad20721e049618ef6571f74ec0d372021-08-29T11:32:35ZengBMCBMC Cancer1471-24072021-08-0121111010.1186/s12885-021-08492-2Ultrasound-guided fine needle aspiration cytology of Para-aortic lymph node metastasis in uterine cervical cancer: diagnostic accuracy and impact on clinical decision makingJunping Liu0Xin Liu1Zhengying Guo2Xiaojuan Lv3Weimin Mao4Dong Xu5Lijing Wang6Department of Ultrasound, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital)Department of Ultrasound, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital)Department of Pathology, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital)Department of Gynecologic Oncology, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital)Zhejiang Key Laboratory of the Diagnosis & Treatment Technology on Thoracic OncologyDepartment of Ultrasound, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital)Department of Ultrasound, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital)Abstract Objective The main aim of this study was to ascertain the effectiveness of ultrasound-guided fine needle aspiration cytology (US-FNAC) in the diagnosis of para-aortic lymph node (PALN) metastasis in uterine cervical cancer and to establish its potential impact on clinical therapeutic decision making. Methods We retrospectively reviewed clinical data from 92 patients diagnosed with cervical cancer with PALN enlargement between 2010 and 2018. Cytological results obtained with US-FNAC were classified by the same experienced cellular pathologists. Diagnostic indicators were determined on the basis of biopsy, imaging and clinical follow-up results. Univariate and multivariate analyses were used to assess the differences of influencing factors. The effect of US-FNAC on clinical decision making was evaluated. Results Cytological results of US-FNAC were categorized as malignancy (n = 62; 67.4%), suspicious malignancy (n = 11; 12.0%), undetermined (n = 5; 5.4%), benign (n = 10; 10.9%), and inadequate (n = 4; 4.3%). Satisfactory biopsy samples were obtained from 95.7% of PALNs sampled (88/92). The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of FNAC in distinguishing benign from malignant cases were 90.1% (95% CI: 0.809–0.953), 100% (95% CI: 0.561–1), 100% (95% CI: 0.938–1), 46.7% (95% CI: 0.223–0.726) and 90.9% (95% CI: 0.848–0.970), respectively. Univariate analysis indicated significant differences in experience of puncture physicians (radiologists) between the correct and wrong diagnosis groups (P < 0.05), which was further confirmed as an independent predictor of diagnostic accuracy in multivariate analysis (p = 0.031, OR = 0.077, 95% CI: 0.354–0.919). All patients tolerated the US-FNAC procedure well and only nine presented slight abdominal discomfort. The therapeutic strategies for 74 patients (80.4%) were influenced by US-FNAC findings. Conclusions US-FNAC was a relatively safe and effective technique for examination of enlarged para-aortic lymph nodes and may therefore serve as a routine diagnostic tool to guide clinical decision making for management of cervical cancer.https://doi.org/10.1186/s12885-021-08492-2Cervical cancerPara-aortic lymph node metastasesFine needle aspiration cytologyDiagnosis accuracyUltrasound |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Junping Liu Xin Liu Zhengying Guo Xiaojuan Lv Weimin Mao Dong Xu Lijing Wang |
spellingShingle |
Junping Liu Xin Liu Zhengying Guo Xiaojuan Lv Weimin Mao Dong Xu Lijing Wang Ultrasound-guided fine needle aspiration cytology of Para-aortic lymph node metastasis in uterine cervical cancer: diagnostic accuracy and impact on clinical decision making BMC Cancer Cervical cancer Para-aortic lymph node metastases Fine needle aspiration cytology Diagnosis accuracy Ultrasound |
author_facet |
Junping Liu Xin Liu Zhengying Guo Xiaojuan Lv Weimin Mao Dong Xu Lijing Wang |
author_sort |
Junping Liu |
title |
Ultrasound-guided fine needle aspiration cytology of Para-aortic lymph node metastasis in uterine cervical cancer: diagnostic accuracy and impact on clinical decision making |
title_short |
Ultrasound-guided fine needle aspiration cytology of Para-aortic lymph node metastasis in uterine cervical cancer: diagnostic accuracy and impact on clinical decision making |
title_full |
Ultrasound-guided fine needle aspiration cytology of Para-aortic lymph node metastasis in uterine cervical cancer: diagnostic accuracy and impact on clinical decision making |
title_fullStr |
Ultrasound-guided fine needle aspiration cytology of Para-aortic lymph node metastasis in uterine cervical cancer: diagnostic accuracy and impact on clinical decision making |
title_full_unstemmed |
Ultrasound-guided fine needle aspiration cytology of Para-aortic lymph node metastasis in uterine cervical cancer: diagnostic accuracy and impact on clinical decision making |
title_sort |
ultrasound-guided fine needle aspiration cytology of para-aortic lymph node metastasis in uterine cervical cancer: diagnostic accuracy and impact on clinical decision making |
publisher |
BMC |
series |
BMC Cancer |
issn |
1471-2407 |
publishDate |
2021-08-01 |
description |
Abstract Objective The main aim of this study was to ascertain the effectiveness of ultrasound-guided fine needle aspiration cytology (US-FNAC) in the diagnosis of para-aortic lymph node (PALN) metastasis in uterine cervical cancer and to establish its potential impact on clinical therapeutic decision making. Methods We retrospectively reviewed clinical data from 92 patients diagnosed with cervical cancer with PALN enlargement between 2010 and 2018. Cytological results obtained with US-FNAC were classified by the same experienced cellular pathologists. Diagnostic indicators were determined on the basis of biopsy, imaging and clinical follow-up results. Univariate and multivariate analyses were used to assess the differences of influencing factors. The effect of US-FNAC on clinical decision making was evaluated. Results Cytological results of US-FNAC were categorized as malignancy (n = 62; 67.4%), suspicious malignancy (n = 11; 12.0%), undetermined (n = 5; 5.4%), benign (n = 10; 10.9%), and inadequate (n = 4; 4.3%). Satisfactory biopsy samples were obtained from 95.7% of PALNs sampled (88/92). The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of FNAC in distinguishing benign from malignant cases were 90.1% (95% CI: 0.809–0.953), 100% (95% CI: 0.561–1), 100% (95% CI: 0.938–1), 46.7% (95% CI: 0.223–0.726) and 90.9% (95% CI: 0.848–0.970), respectively. Univariate analysis indicated significant differences in experience of puncture physicians (radiologists) between the correct and wrong diagnosis groups (P < 0.05), which was further confirmed as an independent predictor of diagnostic accuracy in multivariate analysis (p = 0.031, OR = 0.077, 95% CI: 0.354–0.919). All patients tolerated the US-FNAC procedure well and only nine presented slight abdominal discomfort. The therapeutic strategies for 74 patients (80.4%) were influenced by US-FNAC findings. Conclusions US-FNAC was a relatively safe and effective technique for examination of enlarged para-aortic lymph nodes and may therefore serve as a routine diagnostic tool to guide clinical decision making for management of cervical cancer. |
topic |
Cervical cancer Para-aortic lymph node metastases Fine needle aspiration cytology Diagnosis accuracy Ultrasound |
url |
https://doi.org/10.1186/s12885-021-08492-2 |
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