Opsporing en diagnostiek van supraclaviculaire lymfekliermetastasen bij patiënten met aanwijzingen voor longkanker door palpatie, echografie en CT

To determine the diagnostic contribution of palpation, ultrasound, and CT in detecting supraclavicular lymph node metastases in patients presenting with clinical or radiological symptoms of lung cancer, with as a gold standard cytological investigation of an aspirate of ultrasound-detected enlarged lymph nodes.

Design

Prospective, multicentre.

Method

In a blinded setting, 117 consecutive patients with clinical or radiological symptoms of lung cancer underwent palpation, ultrasound and CT of the supraclavicular regions. Fine needle aspiration cytology was performed in patients with supraclavicular lymph nodes with a short axis > 5 mm detected during ultrasound investigation. Sensitivity of palpation, ultrasound and CT was compared by means of the McNemar test. The relation between palpability and size of lymph nodes metastases was assessed by applying logistic regression.

Results

Supraclavicular metastases were diagnosed cytologically in 30/117 (26) patients; 8/26 (31) patients with small cell lung cancer and 22/91 (24) with non-small cell lung cancer. The sensitivity of ultrasound and CT (0.83) in the detection of supraclavicular metastases was significantly higher than of palpation (0.33). To have a 50 chance of being palpable, metastatic lymph nodes had to have a diameter of at least 22.3 mm. TNM stage was changed in 3/91 patients and further invasive diagnostic procedures were prevented in 11/91 patients with non-small cell lung cancer by proving non-palpable supraclavicular metastases.

Conclusion

In 26 of patients presenting with clinical or radiological symptoms of lung cancer, supraclavicular metastases were detected by ultrasound. Ultrasound and ultrasound-guided fine needle aspiration cytology of supraclavicular lymph nodes deserve a place early in the diagnostics and staging of patients suspected of lung cancer.

Ned Tijdschr Geneeskd 2005;149:189-95