Supraclavicular lymph nodes: An easily accessible site for diagnosis and molecular profiling of malignancies in the era of precision medicine

Abstract

AbstractBackgroundThe supraclavicular lymph node (SCN) is a common metastatic site for malignancies of supra and infra‐diaphragmatic origin and is easily accessible for small biopsy and fine needle aspiration (FNA). In this study, the utility of SCN biopsies was analyzed for diagnosis and ancillary studies.MethodsThe electronic pathology archive was searched for cases of FNA of SCNs accompanied by small core biopsies (1/2016–12/2018). The patients' demographics, diagnosis, and ancillary studies were recorded.ResultsEighty‐eight cases were reviewed (49 females and 39 males), with patients' ages ranging from 23 to 84 years (mean = 52.85 years). Fifty‐four (61.4%) specimens were from the left SCN and thirty‐four (38.6%) from the right. All FNA cases were performed by a radiologist under ultrasound guidance and rapid on‐site evaltion (ROSE) was performed by a cytologist. Nineteen cases (21.6%) were benign and sixty‐nine cases were malignant (78.4%). Carcinoma was the most common malignant neoplasm (52.3%) including 38.2% (13/34) of the right SCN and 61.1% (33/54) of the left SCN cases. Metastatic lung and breast adenocarcinomas (9.1% each) were the most common carcinomas overall. Lymphoma was the second most common malignancy (17.0%) including 17.6% (6/34) of the right SCN and 16.7% (9/54) of the left SCN cases. The majority of cases were accomponied by ancillary studies for diagnosis and prognostic markers. Ancillary studies included immunostains (63 cases, 71.6%), PD‐L1 testing (21 cases, 23.9%), FISH testing (7 cases, 8.0%), flow cytometry (20 cases, 22.7%) and NGS studies (8 cases, 9.1%).ConclusionSupraclavicular lymph nodes are easily accessible and diagnostically useful sites for detection of malignancies and molecular alterations responsive to targeted or immune therapy.