Diagnostic value of fine‐needle aspiration in supraclavicular lymphadenopathy: A study of 106 patients and review of literature

Abstract

The simplicity and safety of the fine-needle aspiration (FNA) make it a useful procedure for the initial evaluation of supraclavicular lymphadenopathy. We analyzed data (106 patients) in combination with the data of three recently published studies (total 301 patients) to make the observations more meaningful. The usefulness of various ancillary techniques such as special histochemical stains (SHC), immunohistochemistry (IHC), and flow cytometry (FCM) in establishing specific diagnoses was also examined. Analysis of the combined data from 407 patients helps to reinforce certain trends observed by previous investigators such as the marked predominance of metastatic carcinoma (63%) over lymphoid malignancies (9%), reactive (19%) and infectious processes (2%), and the tendency of abdominal and pelvic primary carcinomas to metastasize to the left supraclavicular lymph node (SCLN) (88%). In addition, the current study confirms utility of performing IHC, FCM, and SHC on the aspirate material obtained from supraclavicular lymph nodes, because in 19 of the 22 cases (86%), these ancillary techniques provided supplemental diagnostic information critical to patient management.

Level 5 Lymphadenopathy Warrants Heightened Suspicion for Clinically Significant Pathology

“…There have, however, been studies reviewing biopsies of nodes in the 'supraclavicular' region, particularly regarding the diagnostic yield of FNAC. Such studies have found malignancy rates of between 55 and 71 %, with a higher lymphoma:metastatic carcinoma ratio in subjects younger than 40 when compared to those above 40 years [6][7][8][9][10]. In one of these studies, the actual malignancy rate was found to be as high as 86.5 % (n = 45) on final histology of excisional biopsy [7].…”

“…Although FNAC is a well-established first diagnostic tool for the evaluation of lymph nodes [3], only core biopsy or excision biopsy will be sufficient for the formal diagnosis of lymphoma when further analytical techniques are unavailable, such as immunohistochemistry, flow cytometry and specific stains [9,[14][15][16]. The British Society of Pathologists recommend whole node specimens where possible due to the volume of tissue required for testing to secure a diagnosis [16].…”

Supraclavicular Metastasis from Infraclavicular Organs: Retrospective Analysis of 18 Patients

“…Left sided supraclavicular lymph node (Virchow's) has represented the final common pathway of the infradiaphragmatic sites (8). As a result; infradiaphragmatic tumors from abdominopelvic region has mostly metastasized to left supraclavicular fossa whereas supradiaphragmatic tumors from thoracic cavity could metastasize to both right and left region (9). Left supraclavicular lymph nodes might be involved in gastric carcinoma metastasis (Virchow's node) (3).…”

Pattern of Lymphadenitis as Detected by Fnac in a Hospital Based Study on the West Lucknow Population.

“…The cytological criteria for the diagnosis of possible tubercular lymphadenitis is epithelioid cell granulomas with or without multinucleated giant cells and presence or absence of caseating necrosis [4].It should be kept in mind that lymphadenopathy is the most common presentation of extra pulmonary tuberculosis [6,7]. Pediatric cervical lymphadenopathy is a challenging medical condition for the patient, the parent, and the physician.…”

“…However biopsy still remains important in accurate and definite diagnosis of a tumor [6]. Cytoimmunochemistry is opening up newer doors for diagnostic cytopathology specially in the field of oncology [7]. Some authors state that cytology is a more readily accepted methodology for the evaluation of deep seated lymph nodes where surgical resection is not possible.…”