Abstract
Introduction: Clinical evaluation of the supraclavicular region is important for patients with suspected lung cancer as it is estimated that 26-42% of them had metastases to supraclavicular lymph nodes at diagnosis. Fine needle aspiration (FNA) cytology provides an easy method of obtaining both a diagnosis and staging.
Aim: To compare the accuracy of FNA of palpable supraclavicular lymph nodes using palpation and ultrasound (US) among patients with suspected lung cancer.
Methods: Over a 30 month period (6/2008 – 12/2010) we examined 71 consecutive patients (54 males, 64.3±11.5 years) suspected for lung cancer with palpable supraclavicular lymph nodes. All patients underwent US and palpation guided FNA at the same time. Samples were studied by immunohistochemical tests.
Results: Sixty-four out of 71 patients had positive cytology by US (sensitivity: 93%) while the sensitivity of palpation was 90% (62/69). Seven patients underwent surgical sampling of lymph nodes and the diagnoses were: 3 patients with adenocarcinoma, 2 with small cell lung cancer (SCLC) and 2 M. tuberculosis. Cytological diagnoses by FNA were: SCLC (23 patients), adenocarcinoma (22), squamous (7), undifferentiated non-small cell lung cancer [NSCLC] (6), unknown origin (2), lymphoma (2), sarcoma (1), and large cell lung cancer (1). Among patients with NSCLC TNM classification was: stage IIIb (24) and IV (12). Patients with SCLC demonstrated: limited (16) and extensive disease (7). No adverse event was observed with both methods.
Conclusion: FNA of palpable supraclavicular lymph nodes using clinical examination among patients with suspected lung cancer is a safe, cost-effective and as accurate as US guided method.
- © 2011 ERS
