Clinical significance of supraclavicular lymph node uptake on F-18 FDG PET/CT in lung cancer

Objectives The purpose of this study was to evaluate the clinical significance of supraclavicular lymph node uptake initially detected by F-18 FDG PET/CT, before treatment or during posttreatment follow-up, and to analyze changes in therapeutic plan.

Methods 134 (88 men and 46 women; mean age, 63.1 years) lung cancer patients were evaluated for supraclavicular lymph nodes with perceptible F-18 FDG uptake on PET/CT exams taken from January 2010 through June 2012. Nodal status was confirmed either by pathology or follow-up imaging studies. Any subsequent changes in therapeutic plan were documented, and additional clinical information thought to be relevant, including location of the primary lesion, presence of upper lung inflammation and mediastinal metastases was collected.

Results Of the included PET/CT studies, 43 were taken during clinical follow-up and 91 were done for initial staging. 34/43 (79%) supraclavicular lymph nodes detected on follow-up PET/CT were confirmed as malignant and 13/43 (30%) patients underwent subsequent changes in therapeutic plan. 71/91 (78%) supraclavicular lymph nodes detected on initial PET/CT were confirmed as malignant and 20/91 (22%) patients underwent subsequent changes in therapeutic plan. The overwhelming majority of supraclavicular lymphadenopathies with mediastinal metastasis were malignant. 3/8 (38%) follow-up cases which were negative for mediastinal metastasis had supraclavicular lymph nodes confirmed as malignant, compared to 1/5 (20%) initial cases.

Conclusions Supraclavicular node metastasis is an important clinical factor in therapeutic planning. 32/134 (24%) patients included in this study underwent changes in therapeutic. Furthermore, follow-up studies demonstrated a higher predilection to be metastatic in the absence of mediastinal involvement, compared to initial studies. Therefore, careful consideration must be made when supraclavicular lymph nodes show activity on PET/CT.