title: Detection and diagnosis of nonpalpable supraclavicular lymph nodes in lung cancer at CT and US.
abstract: OBJECTIVE
  To assess frequency and significance of enlarged nonpalpable supraclavicular lymph nodes by using chest computed tomography (CT) and supraclavicular ultrasonography (US) in patients at initial diagnosis of lung cancer.
  
  
  METHODS
  Fifty-five patients with no prior malignancy who presented with suspected and subsequently proven lung cancer of any stage or a proven but potentially resectable lung cancer were prospectively selected after chest CT. Chest CT and other radiologic findings were reviewed and tabulated. Standardized US technique was used to identify and guide needle biopsy of enlarged supraclavicular lymph nodes (> or =0.5 cm short axis).
  
  
  RESULTS
  Twenty-two (40%) of 55 patients had supraclavicular abnormalities detected at CT and/or US. In 18 (82%) of the 22 patients, supraclavicular abnormalities were recognizable at CT. Seventeen of 22 patients had malignant nodes, and five patients had benign nodes (n = 3), a cyst (n = 1), or an indeterminate lesion (n = 1) at US-guided supraclavicular needle sampling. There were no complications. Supraclavicular metastases (31% of patients) were about as common as the combined number of patients with indeterminate (n = 13) and probably or proven malignant (n = 6) adrenal nodules (35% of patients). Supraclavicular metastases were often associated with mediastinal adenopathy or suspected extrapulmonary nonnodal metastases (P <.05).
  
  
  CONCLUSIONS
  In many patients with lung cancer, chest CT that includes the neck base followed by US-guided sampling of enlarged supraclavicular lymph nodes is a simple and safe method for simultaneously establishing a tissue diagnosis and tumor nonresectability.
authors.affiliation: Department of Radiology, University of Rochester Medical Center, 601 Elmwood Ave, Rochester, NY 14642, USA. patrick.fultz@urmc.rochester.edu
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: Fultz
authors.forename: Richard H
authors.initials: RH
authors.lastname: Feins
authors.forename: John G
authors.initials: JG
authors.lastname: Strang
authors.forename: John C
authors.initials: JC
authors.lastname: Wandtke
authors.forename: David W
authors.initials: DW
authors.lastname: Johnstone
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Watson
authors.forename: Ronald H
authors.initials: RH
authors.lastname: Gottlieb
authors.forename: Susan L
authors.initials: SL
authors.lastname: Voci
authors.forename: Deborah J
authors.initials: DJ
authors.lastname: Rubens
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002968:Clavicle; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology*; D008198:Lymph Nodes / Q000000981:diagnostic imaging*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D018709:Statistics, Nonparametric; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography