Utility of ultrasound-guided supraclavicular lymph node sampling in lung cancer diagnosis – remodelling the pathway in the era of COVID-19

Chia Ling Tey, Cheng Xie, Rachel Benamore, Alastair J Moore, John Park, Anny Sykes, Ambika Talwar, John M Wrightson, Gibran Timothy Yusuf, Najib M Rahman

Abstract


Introduction: Ultrasound guided sampling (USGS) of supraclavicular lymph nodes (SCLN) is a minimally invasive method for obtaining cytological diagnosis in metastatic lung cancer. Same day USGS service may improve timeliness of investigations, minimise hospital visits and reduce invasive procedures.

Methods: We performed a 3-year retrospective analysis of patients with SCLN amenable to biopsy detected on 2 week-wait (2WW) CT. We identified those who underwent USGS or other procedures, diagnostic yield and their timeliness were determined.

Results: 49 patients (26%) had amenable SCLN, of whom 37 (75.5%) had USGS. USGS alone sufficient for 27 (73%) patients. Diagnostic yield is better for larger nodes (<1cm 62.5% positive; ≥1cm 86.2% positive, 95% CI 0.13 - 0.93, p=0.011). The overall diagnostic yield of USGS SCLN was 81% (30/37, 95% CI 65% to 92%). Although faster to obtain USGS, no statistically significant difference was reached between USGS and other methods (USGS median 15.5 days (IQR 11.2), other procedures median 17.5 days (IQR 26.5), Mann-Whitney U p=0.42).

Conclusion: USGS SCLN has potential utility in early lung cancer diagnosis, even in lymph nodes <1cm, and is an underutilized diagnostic investigation. A prospective study of same day 2WW outpatient clinic and USGS procedure is now required to assess its effect on an accelerated diagnostic pathway.


Keywords


ultrasound guided sampling of supraclavicular nodes; lung cancer diagnosis; lung cancer diagnostic pathway

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References


Kumaran M, Benamore RE, Vaidhyanath R, Muller S, Richards CJ, Peake MD, et al. Ultrasound guided cytological aspiration of supraclavicular lymph nodes in patients with suspected lung cancer. Thorax. 2005 Mar;60(3):229–33.

Ahmed M, Daneshvar C, Breen D. Routine neck ultrasound by respiratory physicians in the diagnosis and staging of patients with lung cancer and mediastinal lymphadenopathy: a prospective pilot study. ERJ Open Res. 2020 Jan;6(1):00180–2019.

Hoosein MM, Barnes D, Khan AN, Peake MD, Bennett J, Purnell D, et al. The importance of ultrasound in staging and gaining a pathological diagnosis in patients with lung cancer - a two year single centre experience. Thorax. 2011;66(5):414–7.

Lung cancer: diagnosis and management NICE guideline [Internet]. 2019. Available from: www.nice.org.uk/guidance/ng122

Fultz PJ, Feins RH, Strang JG, Wandtke JC, Johnstone DW, Watson TJ, et al. Detection and Diagnosis of Nonpalpable Supraclavicular Lymph Nodes in Lung Cancer at CT and US. Radiology. 2002 Jan;222(1).

Stigt JA, Boers JE, Boomsma MF. Ultrasound-Guided Tissue Core Biopsies in Supraclavicular Lymph Nodes in Patients with Suspected Thoracic Malignancies. Respiration. 2015 Nov 1;90(5):412–5.

Choe J, Kim MY, Baek JH, Choi CM, Kim HJ. Ultrasonography-guided core biopsy of supraclavicular lymph nodes for diagnosis of metastasis and identification of epidermal growth factor receptor (EGFR) mutation in advanced lung cancer. Med (United States). 2015 Jul 1;94(29).




DOI: http://dx.doi.org/10.36162/hjr.v7i2.493

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