title: Supraclavicular lymph nodes detected by 18F-FDG PET/CT in cancer patients: assessment with 18F-FDG PET/CT and sonography.
abstract: OBJECTIVE
  The purposes of this study were to assess the diagnostic accuracy of 18F-FDG PET (FDG PET) for the detection of metastatic supraclavicular lymph nodes (LNs) and to propose an optimal diagnostic strategy with additional sonography, contrast-enhanced CT (CECT), or both.
  
  
  METHODS
  One hundred supraclavicular LNs initially detected using FDG PET were examined using sonography. Regardless of the imaging findings, all 100 supraclavicular LNs underwent sonography-guided fine-needle aspiration biopsy. The maximum standardized uptake values (SUVsmax) of the supraclavicular LNs were measured, and a receiver operating characteristic (ROC) analysis was performed to determine the cutoff SUVmax. Then we evaluated the diagnostic performance of FDG PET and figured out the optimal combination of FDG PET and sonography or CECT to improve the diagnostic accuracy of the imaging studies and minimize procedures.
  
  
  RESULTS
  In total, 86 of 100 PET-detected supraclavicular LNs were malignant. With application of the cutoff value obtained by ROC analysis (SUVmax=3.0), the diagnostic accuracy of FDG PET was 75.0% with a sensitivity of 74.4% and specificity of 78.6%. For supraclavicular LNs with an SUVmax of more than 3.0, FDG PET showed a positive predictive value of 95.5%; for supraclavicular LNs with an SUVmax of 3.0 or less, sonography excluded all false-negative FDG PET cases and showed a high negative predictive value of 100%. When sonography was selectively applied to cases with an SUVmax of 3.0 or less, the overall diagnostic accuracy increased to 92%.
  
  
  CONCLUSIONS
  Our study revealed a high incidence rate of metastasis in PET-detected supraclavicular LNs in cancer patients. We believe that our proposed diagnostic workflow could decrease unnecessary diagnostic procedures in the evaluation of PET-positive supraclavicular LNs in cancer patients with reliability.
authors.affiliation: Department of Radiology, Division of Nuclear Medicine, Research Institute of Radiological Science, Yonsei University College of Medicine, 134 Shinchon-dong, Seodaemun-gu, Seoul 120-752, South Korea.
authors.forename: Jae-hoon
authors.initials: JH
authors.lastname: Lee
authors.forename: Jinna
authors.initials: J
authors.lastname: Kim
authors.forename: Hee Jung
authors.initials: HJ
authors.lastname: Moon
authors.forename: Arthur
authors.initials: A
authors.lastname: Cho
authors.forename: Mijin
authors.initials: M
authors.lastname: Yun
authors.forename: Jong Doo
authors.initials: JD
authors.lastname: Lee
authors.forename: Won Jun
authors.initials: WJ
authors.lastname: Kang
mesh_terms: D000328:Adult; D000368:Aged; D044963:Biopsy, Fine-Needle; D002968:Clavicle; D003287:Contrast Media; D003937:Diagnosis, Differential; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D007472:Iohexol / Q000031:analogs & derivatives; D008207:Lymphatic Metastasis / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging / Q000379:methods*; D009369:Neoplasms / Q000473:pathology*; D049268:Positron-Emission Tomography; D011237:Predictive Value of Tests; D012372:ROC Curve; D019275:Radiopharmaceuticals; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D018084:Ultrasonography, Interventional
chemical_list: D003287:Contrast Media; D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18; D007472:Iohexol; C038192:iopromide