RESUMEN
BACKGROUND: Accurate lymph node staging is essential for adequate prognostication and therapy planning in patients with non-small cell lung cancer (NSCLC). FDG-PET/CT is a sensitive tool for the detection of metastases, including non-palpable supraclavicular lymph node (SCLN) metastases. Histological proof of metastatic spread and mutation analysis is crucial for optimal staging and therapy. The aim of this study was to investigate the value of ultrasound-guided fine needle aspiration cytology (FNAC) and core biopsy (CB) of FDG active, non-palpable SCLN's in patients with suspicion for lung cancer. METHODS: Twelve consecutive patients with suspected lung cancer and FDG-positive SCLN underwent FNAC (n = 11) and/or CB (n = 10) and were included and evaluated retrospectively in this study. Cytologic and/or histologic evaluation was performed to confirm initially suspected diagnosis (lung cancer), to confirm N3 stage, and to screen for driver mutations in lung adenocarcinoma. RESULTS: FNAC alone showed diagnostic success in 11/11 cases (100%), CB alone in 9/10 patients (90%), and the combination of both procedures was successful in 12/12 cases (100%). Lymph node metastases from NSCLC (7 adenocarcinoma, 2 squamous cell carcinoma) could be confirmed in 9 patients. Other diagnoses were small cell lung cancer (SCLC), breast cancer and sarcoidosis. There was enough material for immunhistochemistry in all patients. For molecular testing, material from this lymph node biopsies and lung biopsy was used. In two patients with adenocarcinoma of the lung driver mutations were detected (EGFR Exon 19 deletion and ALK rearrangement) out of the lymph node metastasis. CONCLUSIONS: US-guided combined FNAC and CB of FDG positive supraclavicular lymph nodes in patients with suspected lung cancer is a safe and effective procedure to confirm N3-stage and to obtain representative material for molecular testing.
Asunto(s)
Carcinoma de Pulmón de Células no Pequeñas/diagnóstico , Biopsia por Aspiración con Aguja Fina Guiada por Ultrasonido Endoscópico/métodos , Neoplasias Pulmonares/diagnóstico , Ganglios Linfáticos/patología , Anciano , Quinasa de Linfoma Anaplásico , Biopsia con Aguja Gruesa , Carcinoma de Pulmón de Células no Pequeñas/genética , Carcinoma de Pulmón de Células no Pequeñas/patología , Clavícula , Receptores ErbB/genética , Femenino , Fluorodesoxiglucosa F18/metabolismo , Humanos , Neoplasias Pulmonares/genética , Neoplasias Pulmonares/patología , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Tomografía Computarizada por Tomografía de Emisión de Positrones , Proteínas Tirosina Quinasas Receptoras/genética , Reproducibilidad de los Resultados , Estudios RetrospectivosRESUMEN
Besides well-known physiologic uptake of Ga-DOTATATE in spleen, pituitary gland, pancreatic head, adrenals, kidney, and urinary bladder, sometimes unusual areas of uptake are found. We report a case of a 53-year-old woman who had vague pain in abdomen for which abdominal CT was done showing a contrast-enhancing lesion in the pancreatic tail. It was suspected to be of neuroendocrine origin and Ga-DOTATATE PET/CT showed a corresponding focal uptake. Spleen-preserving pancreatic tail resection was performed. Pathology revealed the diagnosis of an accessory intrapancreatic spleen (AIPS).