Efficacy of fine-needle aspiration in diagnosing cervical nodal metastasis from nasopharyngeal carcinoma after radiotherapy.
OBJECTIVE
Our purpose was to study the effect of previous radiotherapy (RT) on the efficacy of fine-needle aspiration (FNA) in diagnosing cervical nodal metastasis in nasopharyngeal carcinoma (NPC).


METHODS
Case-control study.


METHODS
The diagnostic efficacy of FNA in a group of patients with residual or recurrent cervical lymphadenopathy after previous RT for NPC was compared with a cohort of patients with primary NPC before RT during the same period.


RESULTS
Between 2008 and 2010, 50 patients were included for each group in the study. The specificity (100% vs. 88%, P = .12) and positive predictive value (100% vs. 89%, P = .12) was comparable in the two groups. However, the sensitivity (82% vs. 40%, P = .04), negative predictive value (NPV; 74% vs. 36%, P = .03), and accuracy (88% vs. 54%, P = .05) were significantly worse after previous RT. Previous RT was the only factor that was significantly associated with worse diagnostic efficacy (P = .001). When used together with plasma Epstein-Barr virus (pEBV)-DNA level and magnetic resonance imaging (MRI) findings (triple assessment), the diagnostic efficacy was significantly improved, especially regarding sensitivity (40% vs. 98%, P = .01), NPV (36% vs. 96%, P = .02), and accuracy (54% vs. 97%, P = .03).


CONCLUSIONS
Diagnostic efficacy of FNA for residual or recurrent cervical lymph node metastasis in NPC is significantly reduced after previous RT. To ensure that the proper diagnosis is made early, triple assessment using FNA, pEBV-DNA, and MRI should be adopted in this scenario.
Division of Head and Neck Surgery, Department of Surgery, University of Hong Kong Li Ka Shing Faculty of Medicine, Queen Mary Hospital, Hong Kong, China. chanjyw@gmail.com
Jimmy Yu Wai
JY
Chan
Richie Chiu Lung
RC
Chan
Velda Ling Yu
VL
Chow
Victor Shing Howe
VS
To
William Ignace
WI
Wei
D044963:Biopsy, Fine-Needle / Q000379:methods*; D002277:Carcinoma; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D000077274:Nasopharyngeal Carcinoma; D009303:Nasopharyngeal Neoplasms / Q000473:pathology* / Q000532:radiotherapy; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity