Ultrasound-guided fine-needle aspiration for retrojugular lymph nodes in the neck

Abstract

Background: No study on ultrasound-guided fine-needle aspiration (US-FNA) for the diagnosis of retrojugular lymph node has been reported. The present study aimed to introduce US-FNA techniques for retrojugular lymph node and to evaluate their efficacy.

Methods: Of the 788 patients who underwent US-FNA of the cervical lymph node, 41 patients underwent US-FNAs of retrojugular lymph node and were included in this study. The adequacy and efficacy of US-FNA of retrojugular lymph node and related complications during or after the procedure were assessed.

Results: Of the 41 patients, 35 (85.4%) were adequately diagnosed in cytological analysis; four predominantly cystic lymph nodes were identified. Based on cytohistopathology results, thyroglobulin measurement, tuberculosis polymerase chain reaction, and sonographic follow-up, malignant (n = 26) and benign (n = 15) lymph nodes were confirmed. When six lymph nodes with inadequate cytology were classified as benign and malignant, the sensitivity, specificity, positive and negative predictive values, and accuracy of US-FNA in differentiating malignant from benign lesions were 69.2% and 92.3%, 100% and 100%, 100% and 100%, 65.2% and 88.2%, and 80.5% and 95.1%, respectively. No substantial complications related to the US-FNA procedure were observed.

Conclusions: The present US-FNA method may be helpful for the diagnosis of retrojugular lymph node.

Figure 1

A 48-year-old woman with a retrojugular lymph node in left side of neck on follow-up ultrasound (US) after total thyroidectomy for papillary thyroid carcinoma (4.1 × 5.3 × 5.5 mm). The retrojugular lymph node was diagnosed as ‘lymph node metastasis from papillary thyroid carcinoma’ in cytology after US-FNA, and the patient underwent radioisotope therapy without neck surgery. A. Perpendicular puncture: a spot away from the lateral wall of the internal jugular vein. B. Lateral angulation of the syringe-needle unit (the echogenic line (arrows) indicates the needle shaft and tip). C. A successful puncture of the target after an appropriate approach of the syringe-needle unit (the echogenic line (arrows) indicates the needle shaft and tip). D. Drawings illustrating how to approach a lymph node located in the retrojugular area. Initially, the needle is perpendicularly inserted at the periphery of the internal jugular vein (left). The syringe-needle unit is then angled and the needle tip is wedged into the lesion (middle and right).