Supraclavicular masses: Results of a series of 309 cases biopsied by fine needle aspiration

Background. The purpose of this study was to determine the current distribu tion of diseases resulting in supraclavicular swelling or lymphadenopathy a s diagnosed by fins needle aspiration (FNA) biopsy. Methods: Supraclavicular aspirates in this retrospective 5-year study from a large public hospital were classified as neoplastic, infectious, inflamma tory, reactive, and nondiagnostic. Results: Malignancy was present in 55% of the 309 aspirates (47% metastatic , 8% lymphoma). Age was most predictive of malignancy (32% for age less tha n or equal to 41 years, 68% for age >40 years). Lymphoma occurred equally i n both groups, but the lymphoma:metastasis ratio was much higher in younger patients (1:1.6 for age less than or equal to 41 years versus 1:11 for age >40 years). Ethnic origin was related to tumor type, metastatic uterine ce rvical carcinoma being most frequent in Hispanics, and lymphoma in Caucasia ns. Primary oropharyngeal sites were unusual; most malignancies originated in the lung, breast, or cervix. Left or right side did not discriminate for either the presence or type of tumor. The 43 aspirates from human immunode ficiency virus (HIV) positive (+) patients were predominantly inflammatory, infectious, or reactive; lymphoma was infrequent (7%). Overall, 39 patient s had mycobacterial infection; aspirate smears or culture were positive in 19. Three other FNAs grew Staphylococcus aureus and one stained for Cryptoc occus. Aspirates were not informative in 24 cases (8%). The sensitivity of FNA for malignancy was 97%, specificity was 98%, and positive predictive va lue 98%. Conclusion: Aspiration biopsy is an excellent diagnostic tool for supraclav icular masses. Patients over 40 years old are likely to have metastatic mal ignancy, from breast, lung, or infradiaphragmatic sites. Aspirates with inf lammation and those from HIV+ patients should undergo extensive culture. (C ) 1999 John Wiley & Sons, Inc.