title: Evaluation of a scoring system for predicting lymph node malignancy in ultrasound guided fine needle aspiration practice.
abstract: 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.
authors.affiliation: Department of Pathology, Mount Sinai School of Medicine, New York, New York.
authors.forename: Maoxin
authors.initials: M
authors.lastname: Wu
authors.forename: Hua
authors.initials: H
authors.lastname: Chen
authors.forename: Xiaoyong
authors.initials: X
authors.lastname: Zheng
authors.forename: David E
authors.initials: DE
authors.lastname: Burstein
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002277:Carcinoma / Q000000981:diagnostic imaging / Q000473:pathology* / Q000556:secondary*; D002294:Carcinoma, Squamous Cell / Q000000981:diagnostic imaging / Q000473:pathology / Q000556:secondary; D061765:Endoscopic Ultrasound-Guided Fine Needle Aspiration / Q000145:classification* / Q000379:methods*; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000000981:diagnostic imaging / Q000473:pathology*; D008206:Lymphatic Diseases / Q000000981:diagnostic imaging / Q000473:pathology*; D008207:Lymphatic Metastasis / Q000473:pathology; D008223:Lymphoma / Q000000981:diagnostic imaging / Q000473:pathology; D008297:Male; D008875:Middle Aged