Tumor markers in fine-needle aspiration washout for cervical lymphadenopathy in patients with known malignancy: preliminary study

Abstract

OBJECTIVE: The purposes of our study were to assess whether tumor marker concentration in fine-needle aspiration (FNA) washout from cervical lymph nodes (LNs) differs between metastatic and nonmetastatic LNs and whether tumor marker concentrations in FNA washout can contribute to the diagnosis of metastatic LNs.

SUBJECTS AND METHODS: Ultrasound-guided FNA was performed for 157 neck nodes in 157 patients, including 136 patients with known malignancy (28 breast, 34 lung, 41 head and neck, seven esophagus, nine cervix, 10 gastrointestinal [GI] tract, and seven ovary cancers) and 21 patients without known malignancy (control group). Immediately after an FNA cytology specimen was obtained, the needle was rinsed with 1 mL of normal saline solution, and variable tumor marker concentrations were measured in the washout: carcinoembryonic antigen (CEA) and cancer antigen (CA) 15-3 for breast; CEA and cytokeratin 19 fragment for lung; squamous cell antigen for head and neck, esophagus, and cervix; CEA and CA 19-9 for GI; CA 125 for ovarian cancer; and all the tumor marker concentrations for the control group. The tumor marker concentration was compared between the metastatic and nonmetastatic LNs in the control group and between the metastatic and nonmetastatic LNs in the known malignancy group, according to the known malignancy.

RESULTS: At final diagnosis, 104 LNs were metastatic and 53 were nonmetastatic (including 21 LNs in the control group). The tumor marker concentrations of cases with negative or nondiagnostic cytologic results were evaluated. The sensitivity of FNA cytology alone was compared with the combined sensitivity of FNA cytology and tumor marker concentration. Metastatic LNs had higher corresponding FNA tumor marker concentrations than did nonmetastatic LNs in both the control and known malignancy groups (p < 0.05), except for CA 19-9 in GI cancer. Eight of 10 cases (80%) with negative or nondiagnostic cytologic results but metastatic LNs at final diagnosis showed elevated tumor marker concentrations. The sensitivity of FNA cytology (90.4%) increased to 98.1% when combined with tumor marker concentration (p < 0.05). Tumor marker concentrations in FNA washout with cervical metastatic LNs were elevated in comparison with those of nonmetastatic LNs.

CONCLUSION: Evaluation of tumor marker concentrations in FNA washout could improve the detection of metastatic LNs in patients with known malignancy.