Clinical and sonographic factors influencing diagnostic yield of ultrasound-guided core biopsy of cervical lymph nodes

AIM Cervical lymphadenopathy can indicate various benign or malignant conditions. While ultrasound-guided core biopsy is commonly used for diagnosis, its effectiveness can vary. Our study aimed to determine factors that affect the diagnostic yield of this procedure, potentially guiding appropriate patient referrals towards either more invasive diagnostic procedures, such as open biopsy or less intensive approaches like ongoing follow-up. MATERIALS AND METHODS A retrospective study was conducted evaluating ultrasound-guided core biopsies performed for cervical lymphadenopathy at a single institution. Imaging features and technical details were documented. Two radiologists collected data from formal procedure reports and recorded sonographic images. Data were then correlated with histopathologic reports. RESULTS The study included 136 patients with final diagnoses of lymphoproliferative disease (95 patients, 69.8%), reactive lymphadenopathy (24 patients, 17.6%), and carcinoma (17 patients, 12.5%). Twenty-four of the initial biopsies were nondiagnostic (17.6%), requiring diagnosis through surgery, follow-up, or repeated biopsy. Of the 24 nondiagnostic biopsies, 17 were eventually identified as reactive lymph nodes, and 7 harboured lymphoproliferative disease. All carcinoma cases were detected on the initial biopsy. Larger lymph node size correlated with higher diagnostic yield ( P < 0.01). No correlation was found with needle gauge ( P = 0.13), proximity to large vessels ( P = 0.68), or overshoot potential ( P = 0.26). CONCLUSION Our study results show that smaller lymph node size and the presence of a fatty hilum are correlated with reduced diagnostic yield. Patients with unfavourable characteristics should be considered for imaging surveillance, fine-needle aspiration (FNA), or an open biopsy.