Background: Cervical lymph nodes are frequently involved in patients with lung cancer and indicate inoperability. Some guidelines recommend neck ultrasound (NUS) in patients with bulky mediastinal lymphadenopathy. Positron emission tomography (PET) is indicated for patients with potentially curable disease. Objectives: We aimed to assess the diagnostic yield of NUS and the diagnostic accuracy of PET for cervical lymphadenopathy in this group with a high pre-test probability of N3 disease. Methods: Records of all patients with lung cancer who underwent an NUS over a consecutive 5-year period were reviewed. Only patients with mediastinal lymphadenopathy on computerised tomography (CT) were included. The diagnostic accuracy of PET was assessed with NUS-guided fine needle aspiration cytology used as the reference test. Results: During the study period, 123 patients met the inclusion criteria. Malignant cervical lymphadenopathy was confirmed in 49/123 (39.8% [95% CI 31.1–49.1]). PET-CT had a specificity of 81.1%, sensitivity of 87.5%, negative predictive value of 96.8% and positive predictive value of 50% for the detection of cervical lymphadenopathy, and it contributed no additional staging information in the neck area. Overall, PET led to a change in management in only 2.2% of cases. Conclusion: A significant proportion of patients with lung cancer and mediastinal lymphadenopathy have cervical lymphadenopathy detected by NUS. In this group of patients, PET offers minimal additional value in staging and management.

Keywords:
Lung cancer, Cervical lymphadenopathy, Ultrasound, Positron emission tomography
1.
Meguid RA, Hooker CM, Harris J, Xu L, Westra WH, Sherwood JT, et al: Long-term survival outcomes by smoking status in surgical and nonsurgical patients with non-small cell lung cancer: comparing never smokers and current smokers. Chest 2010; 138: 500–509.
2.
Asamura H, Chansky K, Crowley J, Goldstraw P, Rusch VW, Vansteenkiste JF, et al: The International Association for the Study of Lung Cancer Lung Cancer Staging Project: proposals for the revision of the N descriptors in the forthcoming 8th edition of the TNM classification for lung cancer. J Thorac Oncol 2015; 10: 1675–1684.
3.
Kendirlinan R, Ozkan G, Bayram M, Bakan ND, Tutar M, Gür A, et al: Ultrasound guided fine-needle aspiration biopsy of metastases in nonpalpable supraclavicular lymph nodes in lung cancer patients. Multidiscip Respir Med 2011; 6: 220–225.
4.
Kumaran M, Benamore RE, Vaidhyanath R, Muller S, Richards CJ, Peake MD, et al: Ultrasound guided cytological aspiration of supraclavicular lymph nodes in patients with suspected lung cancer. Thorax 2005; 60: 229–233.
5.
Schmidt-Hansen M, Baldwin DR, Hasler E, Zamora J, Abraira V, Roqué I, Figuls M: PET-CT for assessing mediastinal lymph node involvement in patients with suspected resectable non-small cell lung cancer. Cochrane Database Syst Rev 2014;CD009519.
6.
Detterbeck FC, Lewis SZ, Diekemper R, Addrizzo-Harris D, Alberts WM: Executive summary: diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest 2013; 143(5 suppl): 7S–37S.
7.
Sung YM, Lee KS, Kim B-T, Kim S, Kwon OJ, Choi JY, et al: Nonpalpable supraclavicular lymph nodes in lung cancer patients: preoperative characterization with 18F-FDG PET/CT. AJR Am J Roentgenol 2008; 190: 246–252.
8.
Nakamura S, Okochi K, Kurabayashi T: Dual-time-point fluorodeoxyglucose positron emission tomography for diagnosis of cervical lymph node metastases in patients with head and neck squamous cell carcinoma. J Comput Assist Tomogr 2011; 35: 303–307.
9.
Carlson ER, Schaefferkoetter J, Townsend D, McCoy JM, Campbell PD, Long M: The use of multiple time point dynamic positron emission tomography/computed tomography in patients with oral/head and neck cancer does not predictably identify metastatic cervical lymph nodes. J Oral Maxillofac Surg 2013; 71: 162–177.
10.
National Institute for Health and Care Excellence (NICE): Lung cancer: diagnosis and management. Guidance and guidelines. https://www.nice.org.uk/guidance/cg121 (accessed June 26, 2017).
11.
Ozkan G, Tutar M, Bayram M, Bakan D, Gür A, Camsari G: The impact of ultrasonography-guided fine needle aspiration of no palpable supraclavicular lymph nodes on diagnosis and staging in advanced lung cancer. Tuberk Toraks 2009; 57: 186–191.
12.
Goldstraw P, Chansky K, Crowley J, Rami-Porta R, Asamura H, Eberhardt WEE, et al: The IASLC Lung Cancer Staging Project: proposals for revision of the TNM stage groupings in the forthcoming (eighth) edition of the TNM classification for lung cancer. J Thorac Oncol 2016; 11: 39–51.
13.
Groome PA, Bolejack V, Crowley JJ, Kennedy C, Krasnik M, Sobin LH, et al: The IASLC Lung Cancer Staging Project: validation of the proposals for revision of the T, N, and M descriptors and consequent stage groupings in the forthcoming (seventh) edition of the TNM classification of malignant tumours. J Thorac Oncol 2007; 2: 694–705.
14.
Werner L, Keller FA, Bhure U, Roos JE, Tornquist K, del Sol Pèrez-Lago M, et al: The value of ultrasound-guided biopsy of fluorodeoxy-glucose positron emission tomography (FDG-PET)-positive supraclavicular lymph nodes in patients with suspected lung cancer. BMC Med Imaging 2017; 17: 41.
15.
Arens AIJ, Postema JWA, Schreurs WMJ, Lafeber A, Hendrickx BW, Oyen WJG, et al: FDG-PET/CT limited to the thorax and upper abdomen for staging and management of lung cancer. PLoS One 2016; 11:e0160539.
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2018
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