Nonpalpable Supraclavicular Lymph Nodes in Lung Cancer Patients: Preoperative Characterization with 18F-FDG PET/CT
Yon Mi Sung1,2,
Kyung Soo Lee1,
Byung-Tae Kim3,
Seonwoo Kim4,
O Jung Kwon5,
Joon Young Choi3 and
Seoung-Oh Yang6
1 Department of Radiology and Center for Imaging Science, Samsung Medical
Center, Sungkyunkwan University School of Medicine, 50, Ilwon-dong,
Kangnam-gu, Seoul 135-710, Korea.
2 Present address: Department of Medical Imaging, Toronto General Hospital,
University Health Network, Toronto, ON, Canada.
3 Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan
University School of Medicine, Seoul, Korea.
4 Biostatistics Unit, Samsung Biomedical Research Institute, Seoul, Korea.
5 Division of Pulmonary and Critical Care Medicine, Department of Medicine,
Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul,
Korea.
6 Department of Nuclear Medicine, Eulji Medical Center, Eulji University School
of Medicine, Daejeon, Korea.
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Fig. 1A —55-year-old man with adenocarcinoma of lung and false-negative
interpretation on contrast-enhanced CT. Contrast-enhanced CT scan shows
supraclavicular lymph node (arrow) not detected at initial
interpretation because of beam-hardening artifact due to contrast medium.
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Fig. 1B —55-year-old man with adenocarcinoma of lung and false-negative
interpretation on contrast-enhanced CT. CT (B), PET (C), and
integrated PET/CT (D) scans show increased FDG uptake (arrow)
in right supraclavicular lymph node (4.9 mm in short-axis diameter) with
maximum standardized uptake value of 4.2.
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Fig. 1C —55-year-old man with adenocarcinoma of lung and false-negative
interpretation on contrast-enhanced CT. CT (B), PET (C), and
integrated PET/CT (D) scans show increased FDG uptake (arrow)
in right supraclavicular lymph node (4.9 mm in short-axis diameter) with
maximum standardized uptake value of 4.2.
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Fig. 1D —55-year-old man with adenocarcinoma of lung and false-negative
interpretation on contrast-enhanced CT. CT (B), PET (C), and
integrated PET/CT (D) scans show increased FDG uptake (arrow)
in right supraclavicular lymph node (4.9 mm in short-axis diameter) with
maximum standardized uptake value of 4.2.
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Fig. 1E —55-year-old man with adenocarcinoma of lung and false-negative
interpretation on contrast-enhanced CT. Photomicrograph of specimen from
sonographically guided aspiration biopsy shows malignant cells suggestive of
non-small cell carcinoma (H and E, x200).
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Fig. 2A —78-year-old man with squamous cell carcinoma of lung and
false-positive interpretation on integrated PET/CT. CT (A), PET
(B), and PET/CT (C) scans show physiologic muscle uptake
(arrow) at scalene muscle with maximum standardized uptake value of
3.6 simulating metastatic lymph node in left supraclavicular area. No
abnormality was found on contrast-enhanced CT or sonography.
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Fig. 2B —78-year-old man with squamous cell carcinoma of lung and
false-positive interpretation on integrated PET/CT. CT (A), PET
(B), and PET/CT (C) scans show physiologic muscle uptake
(arrow) at scalene muscle with maximum standardized uptake value of
3.6 simulating metastatic lymph node in left supraclavicular area. No
abnormality was found on contrast-enhanced CT or sonography.
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Fig. 2C —78-year-old man with squamous cell carcinoma of lung and
false-positive interpretation on integrated PET/CT. CT (A), PET
(B), and PET/CT (C) scans show physiologic muscle uptake
(arrow) at scalene muscle with maximum standardized uptake value of
3.6 simulating metastatic lymph node in left supraclavicular area. No
abnormality was found on contrast-enhanced CT or sonography.
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Fig. 3A —63-year-old woman with adenocarcinoma of lung and false-positive
interpretation at both integrated PET/CT and contrast-enhanced CT.
Contrast-enhanced CT scan shows supraclavicular lymph node (arrow)
with short-axis diameter of 5.1 mm in right supraclavicular area.
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Fig. 3B —63-year-old woman with adenocarcinoma of lung and false-positive
interpretation at both integrated PET/CT and contrast-enhanced CT. CT
(B), PET (C), and PET/CT (D) scans show increased FDG
uptake (arrow) in right supraclavicular lymph node with maximum
standardized uptake value of 6.6.
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Fig. 3C —63-year-old woman with adenocarcinoma of lung and false-positive
interpretation at both integrated PET/CT and contrast-enhanced CT. CT
(B), PET (C), and PET/CT (D) scans show increased FDG
uptake (arrow) in right supraclavicular lymph node with maximum
standardized uptake value of 6.6.
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Fig. 3D —63-year-old woman with adenocarcinoma of lung and false-positive
interpretation at both integrated PET/CT and contrast-enhanced CT. CT
(B), PET (C), and PET/CT (D) scans show increased FDG
uptake (arrow) in right supraclavicular lymph node with maximum
standardized uptake value of 6.6.
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Fig. 3E —63-year-old woman with adenocarcinoma of lung and false-positive
interpretation at both integrated PET/CT and contrast-enhanced CT.
Photomicrograph of lymph node biopsy specimen shows chronic granulomatous
inflammation with caseation necrosis suggestive of tuberculosis. Lymphocytes
and fibrous tissue (not shown) only were found at aspiration cytologic
examination. (H and E, x40)
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