Supraclavicular lymphadenopathy: The spectrum of pathology and evaluation by fine-needle aspiration biopsy

Fine-needle aspiration biopsy (FNAB) has emerged as an important modality f or the evaluation of supraclavicular lymphadenopathy. To determine the spec trum of pathology and the efficacy of FNAB, all patients with supraclavicul ar lymphadenopathy evaluated from 1990 to 1997 were analyzed for: 1) a prio r history of malignancy; and 2) the side of the abnormal lymph node, FNAB r esult, and final pathologic diagnosis. FNAB was used to evaluate left- and right-sided supraclavicular lymphadenopathy in 33 and 19 patients, respecti vely. FNAB was malignant in 37 patients (71%), benign in 4 patients (8%), n ondiagnostic in 6 patients (11%), and suspicious in 5 patients (10%). A pri or history of malignancy was present in 30 patients and, of these, 23 (77%) had a malignant FNAB compared with 14 of 22 patients (64%) with no previou s history of cancer (P > 0.05). Of the 37 patients with a malignant FNAB, 2 2 (59%) were from a left supraclavicular node. Abdominal and pelvic tumors uniformly metastasized to a left supraclavicular lymph node, whereas malign ancies of the head and neck, thorax, breast, and skin and lymphoma showed n o significant difference in laterality. There were no false positive or fal se negative FNAB results. In conclusion, the yield of FNAB is similar in pa tients with or without a history of malignancy, justifying the routine use of FNAB as the initial diagnostic test for evaluation of patients with supr aclavicular lymphadenopathy. However, FNAB is not definitive in 21 per cent of patients with supraclavicular lymphadenopathy, emphasizing the importan ce of selective excisional biopsy.