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


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.


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

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


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