Fatih MUTLU, Büşra Yaprak BAYRAK, Özgür ÇAKIR

A Clinicopathological Evaluation of the Patients with Supraclavicular Lymphadenopathy: A Retrospective Analysis

Objective: The accuracy of biopsy technique and pathological reports from supraclavicular lymphadenopathy (ScLAP) biopsies in adults were evaluated. Methods: Five hundred sixty-four lymph node excisions or aspiration biopsies because of lymphadenopathy from all cervical regions were retrospectively assessed. Demographic and clinical data collected included gender, age, preoperative diagnosis, biopsy or cytology type, location of ScLAP, and biopsy diagnosis. Results: After exclusions for a variety of clinical and diagnostic reasons, the final analysis included 156 patients, of whom 34 (21.8%) underwent fine-needle aspiration (FNA), 69 (44.2%) core needle biopsy (CNB), and 53 (34%) excisional biopsies. In this study, 52 (33.3%) benign and 93 (59.6%) malignant diagnoses were reported. Totally, 11 of the 34 (32.3%) FNAs were insufficient for diagnosis. The size of the ScLAP (30 mm) did not affect malignancy risk. Patients aged > 55 years had a significantly greater likelihood of malignancy than younger patients. Logistic regression analysis showed that malignancy risk assessed by odds ratio (OR) was increased by male gender (P = .004; OR = 1.428; 95% CI 1.106-1.842), left side (P = .003; OR = 1.502; 95% CI 1.125-2.005) and age > 55 years (P = .007; OR = 2.631; 95%CI 1.275-5.431). Conclusion: Regardless of size, biopsy or cytology should be performed in all appropriate masses. Although the size of the lymph node had no effect on malignancy risk, male gender, older age, and left side were associated with a significant increase in the likelihood of malignancy. Keywords:Clinicopathology

PDF

___

1. Pynnonen MA, Gillespie MB, Roman B, et al. Clinical practice guideline: evaluation of the neck mass in adults executive summary. Otolaryngol Head Neck Surg. 2017;157(3):355-371. [CrossRef]
2. López F, Rodrigo JP, Silver CE, et al. Cervical lymph node metastases from remote primary tumor sites. Head Neck. 2016;38(suppl 1): E2374-E2385. [CrossRef]
3. Oztarakcı H, Sagıroglu S. Neck masses: evaluation, differential diagnosis and approach. Arch Med Rev J. 2017;26:238-250. [CrossRef]
4. Ellison E, LaPuerta P, Martin SE. Supraclavicular masses: results of a series of 309 cases biopsied by fine needle aspiration. Head Neck. 1999;21(3):239-246. [CrossRef]
5. Gaddey HL, Riegel AM. Unexplained lymphadenopathy: evaluation and differential diagnosis. Amfam Physician. 2016;94(11):896-903.
6. Chau I, Kelleher MT, Cunningham D, et al. Rapid access multidisciplinary lymph node diagnostic clinic: analysis of 550 patients. Br J Cancer. 2003;88(3):354-361. [CrossRef]
7. Wong KS, Krane JF, Jo VY.Heterogeneity of p16 immunohistochemistry and increased sensitivity of RNA in situ hybridization in cytology specimens of HPV-related head and neck squamous cell carcinoma. Cancer Cytopathol. 2019;127(10):632-642. [CrossRef]
8. Özkan EA, Göret CC, Özdemir ZT, et al. Evaluation of peripheral lymphadenopathy with excisional biopsy: six-year experience. Int J Clin Exp Pathol. 2015;8(11):15234-15239.
9. McHenry CR, Cooney MM, Slusarczyk SJ, Khiyami A. Supraclavicular lymphadenopathy: the spectrum of pathology and evaluation by fine-needle aspiration biopsy. Am Surg. 1999;65(8):742-746.
10. Gupta RK, Naran S, Lallu S, Fauck R. The diagnostic value of fine needle aspiration cytology (FNAC) in the assessment of palpable supraclavicular lymph nodes: a study of 218 cases. Cytopathology. 2003;14(4):201-207. [CrossRef]
11. Nasuti JF, Mehrotra R, Gupta PK. Diagnostic value of fine-needle aspiration in supraclavicular lymphadenopathy: a study of 106 patients and review of literature. Diagn Cytopathol. 2001;25(6):351- 355. [CrossRef]
12. Chen CN, Lin CY, Chi FH, et al. Application of ultrasound-guided core biopsy to minimal-invasively diagnose supraclavicular fossa tumors and minimise the requirement of invasive diagnostic surgery. Med (Baltim). 2016;95(4):e2172. [CrossRef]
13. Aldridge T, Kusanale A, Colbert S, Brennan PA. Supraclavicular metastases from distant primaries: what is the role of the head and neck surgeon? Br J Oral Maxillofac Surg. 2013;51(4):288-293. [CrossRef]
14. Kiricuta IC, Willner J, Kölbl O, Bohndorf W. The prognostic significance of the supraclavicular lymph node metastases in breast cancer patients. Int J Radiat Oncol Biol Phys. 1994;28(2):387-393. [CrossRef]
15. van Vledder MG, van der Hage JA, Kirkels WJ, et al. Cervical lymph node dissection for metastatic testicular cancer. Ann Surg Oncol. 2010;17(6):1682-1687. [CrossRef]
16. Weinstock MS, Patel NA, Smith LP. Pediatric cervical lymphadenopathy. Pediatr Rev. 2018;39(9):433-443. [CrossRef]
17. Popescu MR, Călin G, Strâmbu I, et al. Lymph node tuberculosis - an attempt of clinico-morphological study and review of the literature. Rom J Morphol Embryol. 2014;55(2)(suppl):553-567.
18. Saifullah MK, Sutradhar SR, Khan NA, et al. Diagnostic evaluation of supraclavicular lymphadenopathy. Mymensingh Med J. 2013;22(1):8-14.
19. Darnal HK, Karim N, Kamini K, Angela K. The profile of lymphadenopathy in adults and children.Med J Malaysia. 2005;60(5):590-598.
20. National cancer Instıtuate. Age and cancer. Risk. Accessed May 01, 2021. (available at: https ://ww w.can cer.g ov/ab out-c ancer /caus es-pr event ion/r isk/a ge.