Jooae Choe MD, Presenter: Nothing to Disclose

Mi Young Kim MD, PhD, Abstract Co-Author: Nothing to Disclose

Chang-Min Choi, Abstract Co-Author: Nothing to Disclose

Hwa Jung Kim, Abstract Co-Author: Nothing to Disclose

Jung Hwan Baek, Abstract Co-Author: Nothing to Disclose

To evaluate the role of ultrasonography(US)-guided supraclavicular lymph node(SCN) for detecting metastasis and epidermal growth factor receptor(EGFR) mutation in lung cancer.

This retrospective study was approved by the institutional review board. We enrolled 253 consecutive patients (167 men, 86 women; 36-86 years) who underwent US-guided core biopsy (using 18G cutting needle) of SCN from Jan. 2011 to Dec. 2013. Two independent radiologists measured sizes of SCNs in short and long dimensions on US and chest CT images. Gold standard for the evaluation of target SCN was combination of CT, FDG-PET/CT, US-guided biopsy, pathology, and subsequent CT after treatment. TNM stages, SUV on FDG-PET/CT, and findings of SCNs on US and CT were compared between the positive(disease group) and the negative(control group) for metastasis. Diagnostic performance was compared between US-guided biopsy and CT. The prevalence of EGFR mutations of SCNs harboring adenocarcinoma and biopsy-related morbidity were evaluated.

Final diagnoses were adenocarcinoma (n = 183), squamous cell carcinoma (n = 54), other non-small cell lung cancer (n = 11), and small cell cancer (n = 5). Disease group (n = 207, 82%) was associated with higher frequency of adenocarcinoma (n = 158, p = .009), higher TNM stages (p = 0.022 for T, p < .001 for N, p < .001 for M, respectively), larger mean short (10 vs 6 mm)/long (15 vs 11 mm) dimensions on US (p < .001), larger mean short (10 vs 7 mm)/long (15 vs 11 mm) dimensions on CT (p < .001), and higher SUVs (7.2 vs 2.7, p < .001) than control group (n = 46, 18%). Interclass correlation coefficient was 0.827 to 0.917. SCN metastasis was missed on CT in 57 patients(22.5%), and among them, 33 patients(13.0%) were positive for malignant cells on US-guided biopsy. Analysis of EGFR mutation in SCN was feasible in 122(71.5%) of 181 patients. EGFR mutations were positive in 40 patients(32.8%) [28(23.0%) in exon 19, 10(8.1%) in exon 21, 2(1.6%) in exon 18]. None of patients had biopsy related morbidity.

US-guided SCN biopsy is a reliable and safe method for tissue confirmation of metastatic lung cancers and evaluation of mutations. The metastasis rate of SCN is higher with adenocarcinoma, larger sizes, higher SUVs, and higher TNM stages.

US-guided biopsy might substitute invasive percutaneous or bronchoscopic biopsy of patients who have initially advanced lung cancer with enlarged SCN.

Choe, J, Kim, M, Choi, C, Kim, H, Baek, J, Ultrasonography-guided Biopsy of Supraclavicular Lymph Nodes for Diagnosis of Metastasis and Identifying Harboring Epidermal Growth Factor Receptor (EGFR) Mutation in Lung Cancer.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14010445.html