SUPRACLAVICULAR LYMPH NODES SWOLLEN SOFTWARE

For imaging interpretation, positive FDG uptake in supraclavicular lymph nodes was considered when glucose uptake of the lesion was greater than the surrounding tissue. The physician was unaware of the CT findings or any clinical information except that the patients had primary malignancy.

SUPRACLAVICULAR LYMPH NODES SWOLLEN SOFTWARE

Co-registered scans were displayed with software that enabled image fusion and analysis.ġ8F-FDG PET/CT data sets were prospectively evaluated by one nuclear medicine physician. PET data sets were obtained with an iterative reconstruction and an ordered subset expectation maximization algorithm was performed by the application of segmented attenuation correction (two iterations, 28 subsets) to the CT data. Immediately after non-enhanced CT, PET was performed in the identical transverse field of view.

CT was performed from the head to the pelvic floor according to a standard protocol with the following settings: 130 kVp 30 mA tube rotation time, 0.8 seconds per rotation pitch, 6 section thickness, 5 mm to match the PET section thickness. Scans were acquired using PET/CT system (CTI, Knoxville, TN, USA), consisting of a full-ring PET scanner and a dual-detector-row spiral CT scanner (Somatom Emotion Duo, Biograph, Erlangen, Germany). Scanning was performed 60 minutes after 18F-FDG administration. The mean interval between CECT and 18F-FDG PET/CT was 5.2 days (range, 0-20 days).ġ8F-FDG PET/CT Acquisition and Imaging InterpretationĪll patients fasted for at least 6 hours and had a serum glucose level lower than 140 mg/dL before the IV injection of 18F-FDG. The mean interval between US and 18F-FDG PET/CT was 4.9 days (range, 0-18 days). All patients underwent US examination of the supraclavicular region, CECT of the neck or chest that included the supraclavicular region, and 18F-FDG PET/CT of the whole body. The final status of the supraclavicular lymph nodes was established by US-guided fine-needle aspiration biopsy (FNAB) or by surgical excision biopsy. The histopathological diagnosis of a primary malignancy was confirmed by surgery in 38 cases, by percutaneous needle aspiration biopsy of the primary mass in 12 cases, and by bronchoscopic biopsy in three cases. This retrospective study included 53 supraclavicular lymph nodes in 48 patients with a proven malignancy. We excluded patients who had undergone chemotherapy or radiation therapy, patients who had not undergone pathologic evaluation, and who had no supraclavicular lymph node enlargement. Our institutional review board approved our research study and did not require informed consent from the patients for this retrospective study. To our knowledge, the usefulness of 18F-FDG PET/CT in the characterization and detection of supraclavicular lymph node metastases from various malignancies has not yet been reported.Īccordingly, the purpose of this study is to compare the usefulness of 18F-FDG PET/CT, contrast-enhanced CT (CECT), and US in the diagnosis of metastatic supraclavicular lymph nodes.įrom January 2008 to September 2009, 158 consecutive patients with suspected or proven malignancy underwent US, CECT, and 18F-FDG PET/CT examinations. In combining functional PET data and morphologic CT data, 18F-FDG PET/CT studies have produced promising initial oncologic imaging results ( 17, 18, 19). However, some limitations exist for the use of 18F-FDG PET alone. Moreover, 18F-FDG PET is more accurate than CT for detecting or excluding nodal disease ( 12, 13, 14, 15, 16). Several studies have reported on CT and US methods for assessing supraclavicular lymphadenopathy ( 1, 2, 6, 7, 8, 9, 10, 11).ġ8F-fluorodeoxyglucose positron emission tomography ( 18F-FDG PET) is a noninvasive method that plays an important role in the evaluation of lymph node metastasis in patients with various malignancies. These investigators have suggested that noninvasive imaging techniques such as CT and ultrasound (US) can be used to improve the detection of lymph node metastasis. These lymph nodes are easily accessible by palpation and their enlargement may be the first sign of a metastatic tumor, mostly from lung, head and neck, breast, esophageal, gastric, pancreatic, gynecologic, and prostate cancers ( 1).Įxamination of the supraclavicular lymph node has traditionally been performed by palpation however, this method has been found to be unreliable in the literature ( 2, 3, 4, 5). The supraclavicular lymph nodes comprise a final common pathway of metastatic nodal involvement from various malignancies.

Supraclavicular lymph nodes swollen