Journal of Ultrasound

, Volume 22, Issue 1, pp 59–64 | Cite as

A clinical compilation of lymph node pathologies comparing the diagnostic performance of biopsy methods

  • Deniz ÖzelEmail author
  • Tamer Aydın
Original Article



It is critical to obtain sufficient tissue, both in quality and quantity, in biopsy applications for histopathological review. Our aim was to compare fine-needle aspiration cytology (FNAC) and core needle biopsy (CNB) techniques in terms of their diagnostic performance in lymph node biopsies. This was a clinical compilation, and histopathological results from biopsies were also evaluated.


A total of 242 patients and 246 lymph nodes were prospectively evaluated. All histopathologic specimens were obtained through ultrasonography-guided biopsies performed at our institute between April 2015 and October 2017. Histopathological results were grouped according to diagnostic performance, and the mean performance scores of the two methods were compared.


For FNAC, the mean diagnostic score was calculated to be 1.63, whereas for CNB, the mean diagnostic score was calculated to be 1.89. The difference between diagnostic scores of the two techniques was statistically significant (p < 0.01).


We recommend that interventional radiologists perform vacuum-assisted biopsies if there are no financial hindrances or evidence of psychological issues in patients. We recommend this not only for lymph nodes of malignant appearance but also for those that appear benign.


US-guided biopsy Fine-needle biopsy Core needle biopsy Lymph nodes 



E’ un requisito importante della biopsia linfonodale ottenere un campione sufficiente in termini di qualità e quantità per la diagnosi. Il nostro obiettivo è stato confrontare tecniche di citologia con ago sottile (FNAC) e biopsia con ago (CNB) in termini di prestazioni diagnostiche nelle patologie linfonodali.


Sono stati valutati prospetticamente un totale di 242 pazienti e 246 linfonodi. Tutti i campioni cito-istopatologici sono stati ottenuti eseguendo una biopsia ecoguidata nella nostra istituzione dall’aprile 2015 all’ottobre 2017. I risultati cito-istopatologici sono stati confrontati in base alle prestazioni diagnostiche ottenute: in particolare sono stati confrontate le medie degli score diagnostici delle due metodiche (FNAC vs CNB).


Per FNAC il punteggio diagnostico medio è stato di 1,63, mentre per la CNB di 1,89. La differenza tra i punteggi diagnostici delle due tecniche era statisticamente significativa (p < 0.01).


Lo studio dimostra la necessità di eseguire CNB ecoguidata per la diagnosi differenziale tra linfoadenopatie maligne e benigne, fatte salve problematiche di costi o di rifiuto da parte dei pazienti.



This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest. The authors received no financial support for the research, authorship, and/or publication of this article.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. This study was approved by our Institute’s Research Ethics Committee. Date: 06.02.2018 No: 825.

Informed consent

Informed consent was obtained from all individual participants included in the study.


  1. 1.
    Ying M, Bhatia KSS, Lee YH, Yuen B, Ahuja AT (2014) Review of ultrasonography of malignant neck nodes: greyscale, Doppler, contrast enhancement and elastography. Cancer Imaging 13(4):658–669CrossRefGoogle Scholar
  2. 2.
  3. 3.
    Joachim Harry L, Jeffrey Mederios L (2009) Joachim’s lymph node pathology, 4th edn. Lippincott Williams & Wilkins, USAGoogle Scholar
  4. 4.
    Koss Leopold G (2006) Koss diagnostic cytology, 5th edn. Lippincott Williams & Wilkins, USAGoogle Scholar
  5. 5.
  6. 6.
    Nakano Y, Noguchi M, Yokoi-Noguchi M, Ohno Y, Morioka E, Kosaka T et al (2017) The roles of 18F-FDGPET/CT and US-guided FNACC in assessment of axillary nodal metastases in breast cancer patients. Breast Cancer 24(1):121–127CrossRefGoogle Scholar
  7. 7.
    Fleischman GM, Thorp BD, Difurio M, Hackman TG (2016) Accuracy of ultrasonography-guided fine-needle aspiration in detecting persistent nodal disease after chemoradiotherapy. JAMA Otolaryngol Head Neck Surg 142(4):377–382CrossRefGoogle Scholar
  8. 8.
    Burke C, Thomas R, Inglis C, Baldwin A, Ramesar K, Grace R et al (2011) Ultrasound-guided core biopsy in the diagnosis of lymphoma of the head and neck. A 9 year experience. Br J Radiol 84(1004):727–732CrossRefGoogle Scholar
  9. 9.
    Rautiainen S, Masarwah A, Sudah M, Sutela A, Pelkonen O, Joukainen S et al (2013) Axillary lymph node biopsy in newly diagnosed invasive breast cancer: comparative accuracy of fine-needle aspiration biopsy versus core-needle biopsy. Radiology 269:54–60CrossRefGoogle Scholar
  10. 10.
    Sharma G, Jung AS, Maceri DR, Rice DH, Martin SE, Grant EG (2011) US-guided fine-needle aspiration of major salivary gland masses and adjacent lymph nodes: accuracy and impact on clinical decision making. Radiology 259(2):471–478CrossRefGoogle Scholar
  11. 11.
    Siegel RL, Miller KD, Jemal A (2018) Cancer statistics, 2018. CA Cancer J Clin 68(1):7–30CrossRefGoogle Scholar
  12. 12.
    de Kerviler E, Benet C, Brière J, de Bazelaire C (2012) Image-guided needle biopsy for diagnosis and molecular biology in lymphomas. Best Pract Res Clin Haematol 25(1):29–39CrossRefGoogle Scholar
  13. 13.
    Ganott MA, Zuley ML, Abrams GS, Lu AH, Kelly AE, Sumkin JH et al (2014) Ultrasound guided core biopsy versus fine needle aspiration for evaluation of axillary lymphadenopathy in patients with breast cancer. ISRN Oncol 4(2014):703160Google Scholar
  14. 14.
    Ahn HS, Kim SM, Jang M, La Yun B, Kim SW, Kang E et al (2013) Comparison of sonography with sonographically guided fine-needle aspiration biopsy and core-needle biopsy for initial axillary staging of breast cancer. J Ultrasound Med 32(12):2177–2184CrossRefGoogle Scholar
  15. 15.
    Bohelay G, Battistella M, Pagès C, de Margerie-Mellon C, Basset-Seguin N, Viguier M et al (2015) Ultrasoundguided core needle biopsy of superficial lymph nodes: an alternative to fine-needle aspiration cytology for the diagnosis of lymph node metastasis in cutaneous melanoma. Melanoma Res 25(6):519–527CrossRefGoogle Scholar
  16. 16.
    Jankowski C, Hudry D, Vaillant D, Varbedian O, Mejean N, Guy F et al (2015) Evaluation of axillary involvement by ultrasound-guided lymph node biopsy: a prospective study. Gynecol Obstet Fertil 43(6):431–436CrossRefGoogle Scholar
  17. 17.
    Saha S, Woodhouse NR, Gok G, Ramesar K, Moody A, Howlett DC (2011) Ultrasound guided core biopsy, fine needle aspiration cytology and surgical excision biopsy in the diagnosis of metastatic squamous cell carcinoma in the head and neck: an eleven years experience. Eur J Radiol 80(3):792–795CrossRefGoogle Scholar
  18. 18.
    Zosimas D, Lykoudis PM, Vashisht R (2016) Preoperative ultrasound guided percutaneous axillary biopsy in breast cancer patients: fine needle aspiration cytology versus core biopsy. Ann Ital Chir 87:509–516Google Scholar
  19. 19.
    Skelton E, Jewison A, Okpaluba C, Sallomi J, Lowe J, Ramesar K et al (2015) Image-guided core needle biopsy in the diagnosis of malignant lymphoma. Eur J Surg Oncol 41(7):852–858CrossRefGoogle Scholar
  20. 20.
    de Kerviler E, de Bazelaire C, Mounier N, Mathieu O, Brethon B, Brière J et al (2007) Image-guided core-needle biopsy of peripheral lymph nodes allows the diagnosis of lymphomas. Eur Radiol 17:843–849CrossRefGoogle Scholar
  21. 21.
    Groneck L, Quaas A, Hallek M, Zander T, Weihrauch MR (2016) Ultrasound-guided core needle biopsies for workup of lymphadenopathy and lymphoma. Eur J Haematol 97(4):379–386CrossRefGoogle Scholar
  22. 22.
    Stigt JA, Boers JE, Boomsma MF (2015) Ultrasound-guided tissue core biopsies in supraclavicular lymph nodes in patients with suspected thoracic malignancies. Respiration 90(5):412–415CrossRefGoogle Scholar
  23. 23.
    Abe H, Schmidt RA, Kulkarni K, Sennett CA, Mueller JS, Newstead GM (2009) Axillary lymph nodes suspicious for breast cancer metastasis: sampling with US-guided 14-gauge core-needle biopsy–clinical experience in 100 patients. Radiology 250(1):41–49CrossRefGoogle Scholar

Copyright information

© Società Italiana di Ultrasonologia in Medicina e Biologia (SIUMB) 2018

Authors and Affiliations

  1. 1.Radiology Clinic, Okmeydanı SUAM HospitalSağlık Bilimleri UniversityIstanbulTurkey
  2. 2.Pathology Clinic, Okmeydanı HospitalSağlık Bilimleri UniversityIstanbulTurkey

Personalised recommendations