The value of ultrasound-guided biopsy of fluorodeoxy-glucose positron emission tomography (FDG-PET)-positive supraclavicular lymph nodes in patients with suspected lung cancer

Abstract

BackgroundAccurate lymph node staging is essential for adequate prognostication and therapy planning in patients with non-small cell lung cancer (NSCLC). FDG-PET/CT is a sensitive tool for the detection of metastases, including non-palpable supraclavicular lymph node (SCLN) metastases. Histological proof of metastatic spread and mutation analysis is crucial for optimal staging and therapy. The aim of this study was to investigate the value of ultrasound-guided fine needle aspiration cytology (FNAC) and core biopsy (CB) of FDG active, non-palpable SCLN’s in patients with suspicion for lung cancer.MethodsTwelve consecutive patients with suspected lung cancer and FDG-positive SCLN underwent FNAC (n = 11) and/or CB (n = 10) and were included and evaluated retrospectively in this study. Cytologic and/or histologic evaluation was performed to confirm initially suspected diagnosis (lung cancer), to confirm N3 stage, and to screen for driver mutations in lung adenocarcinoma.ResultsFNAC alone showed diagnostic success in 11/11 cases (100%), CB alone in 9/10 patients (90%), and the combination of both procedures was successful in 12/12 cases (100%). Lymph node metastases from NSCLC (7 adenocarcinoma, 2 squamous cell carcinoma) could be confirmed in 9 patients. Other diagnoses were small cell lung cancer (SCLC), breast cancer and sarcoidosis. There was enough material for immunhistochemistry in all patients. For molecular testing, material from this lymph node biopsies and lung biopsy was used. In two patients with adenocarcinoma of the lung driver mutations were detected (EGFR Exon 19 deletion and ALK rearrangement) out of the lymph node metastasis.ConclusionsUS-guided combined FNAC and CB of FDG positive supraclavicular lymph nodes in patients with suspected lung cancer is a safe and effective procedure to confirm N3-stage and to obtain representative material for molecular testing.

PET and Neck Ultrasound for the Detection of Cervical Lymphadenopathy in Patients with Lung Cancer and Mediastinal Lymphadenopathy

“…The authors reported an SUV max of 2.3 to be the optimum cut-off for differentiating true-and false-positive findings. A smaller study of 12 patients with lung cancer and FDG-avid cervical lymphadenopathy showed supraclavicular metastases from lung cancer in 10 cases; 1 case showed evidence of sarcoidosis and another evidence of metastatic breast cancer [14]. Mean SUV max in Two cases of lymphoma on cytology were later confirmed on surgical excisional biopsy.…”

Patterns of diagnostic procedures for lung cancer pathology in the Middle East and North Africa

“…The use of PET scan may help identify the active disease from collapsed normal lung tissue or benign lesions, or may detect more accessible lesion that was not described with other imaging modalities (19)(20)(21).…”

Metastatic Supraclavicular Lymph Nodes among Patients with Lung Carcinoma in a Tertiary Care Centre: A Descriptive Cross-sectional Study

“…2 , 3 Histological diagnosis of lung cancer is very important for optimal staging and therapy, sampling for which is often obtained under image guidance. 4 …”

“…2,3 Histological diagnosis of lung cancer is very important for optimal staging and therapy, sampling for which is often obtained under image guidance. 4 Percutaneous lung biopsies have one of the highest complication rates of all imaging-guided biopsy procedures. 5,6 Sampling from supraclavicular lymph nodes, if possible, can avoid such complications but still provide us with the histological diagnosis, as even small non-palpable supraclavicular lymph nodes can Free Full Text Articles are Available at www.jnma.com.np harbour metastases.…”