CHICAGO—Fine needle aspiration can quickly determine whether cancer has spread to pathologically enlarged lymph nodes, but it should not be counted on to diagnose new malignancies or to provide tissue for follow on testing, according to a study published in conjunction with the 2019 American Society of Clinical Oncology Annual Meeting in Chicago.1

Researchers at the San Antonio Military Medical Center evaluated the reliability and utility of fine needle aspiration in 594 patients who had the procedure at their center between January 2010 and December 2015. All patients had pathologically enlarged lymph nodes.

Nearly half of patients (277) had to undergo an second diagnostic procedure. Second procedures excluded those done for therapeutic purposes, such as resection.

Of 277 who needed a second procedure, 237 or 85.6% were determined to have benign conditions based on their first fine needle aspiration. Following the second procedure, 35.5% of those patients had their diagnosis changed to malignant.

The procedure used to obtain the initial fine needle aspiration—bronchoscopy, endoscopy, percutaneous—had no impact on the need for a second procedure, nor did the age of the patient.

“Though fine needle aspiration is a useful procedure for establishing the presence or absence of metastatic disease, our analysis suggests that the ability of the procedure to reliably diagnose or provide sufficient tissue for ancillary testing is limited,” the authors wrote. “Nearly half of the patients in this study were subjected to the risks, cost, and diagnostic delay associated with a second procedure.”

1 Tidwell N, Barnett TL, Thrun CH, Graham BC, Graham LJ. The ability of isolated fine needle aspiration of lymph nodes to provide complete diagnostic information without necessitating additional diagnostic procedures: A retrospective cohort study. J Clin Oncol 37, 2019 (suppl; abstr e18341).