Ultrasonography and ultrasonographically guided fine-needle aspiration biopsy of impalpable cervical lymph nodes in patients with non-small cell lung cancer

Abstract

Background. Neck ultrasonography (US) and ultrasonographically guided fine‐needle aspiration (UGFNA) cytologic examination were used in the staging work‐up of 51 consecutive patients with non‐small cell lung cancer (NSCLC) with clinically impalpable cervical lymphadenopathy. Methods. All patients had chest radiography, fiberoptic bronchoscopic examination, computed tomography (CT) scans of the chest and abdomen, bone scan, and US of the abdomen and the neck. Results. Six patients (12%) were found to have cervical lymph nodes by neck US. The cytologic examination of the lymph node aspirates obtained from UGFNA confirmed the metastasis. The clinical stage thus was changed from Stage IIIa to Stage IIIb in one patient. In the other five patients, UGFNA of cervical lymph nodes prevented more invasive diagnostic procedures. Conclusions. This preliminary study shows that neck US and UGFNA of lymph nodes may be helpful in the pretreatment evaluation of patients with NSCLC with impalpable cervical lymph nodes. However, additional study is needed to confirm this result.

Nonpalpable Supraclavicular Lymph Nodes in Lung Cancer Patients: Preoperative Characterization with 18F-FDG PET/CT

“…In other malignant diseases, such as melanoma [4], esophageal cancer [5], and head and neck cancer [6], sonography and sonographically guided fine-needle aspiration cytologic analysis have proved superior to palpation in the detection and characterization of metastasis in supraclavicular lymph nodes. Twelve percent to 31% of patients presenting with lung cancer and a supraclavicular lymph node with a shortaxis diameter of 5 mm or greater have nonpalpable supraclavicular lymph node metastasis at sonographically guided fine-needle aspiration biopsy [9,13]. In our series, a similar percentage (34%) of nonpalpable supraclavicular nodal metastatic lesions was found.…”

“…Several CT and sonographic methods of assessment of nonpalpable supraclavicular lymphadenopathy have been attempted [7,[9][10][11][12][13][14][15]. PET with 18 F-FDG has been reported to improve the detection of lymph node metastasis and may be more sensitive than other methods because alterations in tissue metabolism generally precede anatomic changes [16].…”

Ultrasound guided fine-needle aspiration biopsy of metastases in nonpalpable supraclavicular lymph nodes in lung cancer patients

“…Chang et al determined the prevalence of SC lymph node metastasis as 12% in 51 patients and the majority of the cases had centrally located tumors [15]. In the current study, 68.5% of the cases had centrally located tumor, and the frequency of supraclavicular lymph node involvement was higher in those cases (p < 0.05).…”

Lung cancer staging

“…Cervical ultrasonography has been shown to be a reliable investigation for detecting metastatic nodes from cancers of the head and neck [100 -102] and may be superior to even CT for detecting cervical nodal spread from lung cancer [103]. This combined cervical ultrasound and FNA approach has detected occult N3 cervical node metastases in 12% to 31% of lung cancer patients [103,104]; however, the criteria used to identify candidates for FNA was size alone on ultrasonography, which, as discussed earlier, is not a reliable indicator for malignant spread to a lymph node.…”