Ultrasound-guided fine-needle aspiration cytology of non-palpable supraclavicular lymph nodes in sarcoidosis

Purpose: The aim of this prospective study was to determine the incidence of enlarged supraclavicular lymph nodes by US and the diagnostic yield of US-guided aspiration cytology in the diagnosis of sarcoidosis. Methods: During a 54-month period, all consecutive patients with a clinical suspicion of sarcoidosis underwent supraclavicular US at the Kiljava Hospital, Finland. All patients with enlarged supraclavicular lymph nodes underwent US-guided fine-needle aspiration biopsy (FNAB) of the lymph node. Results: Of a total of 250 patients, 27 (10.8%) had enlarged supraclavicular lymph nodes at US. All these were non-palpable at clinical examination. The cytological specimen was quantitatively sufficient in 25 of the 27 cases (93%). In 22 (88%) of these, the cytological diagnosis was granulomatous inflammation suggestive of sarcoidosis. Three aspirates yielded reactive hyperplasia and 2 specimens were insufficient. No complications occurred. The patients were followed for 2-42 months (mean 19 months), and the diagnosis of sarcoidosis was confirmed clinically in all cases. Conclusion: Supraclavicular US detects non-palpable enlarged lymph nodes in 1/10 of the patients with suspected sarcoidosis. In this subgroup of patients, US combined with aspiration cytology may give cytological evidence of granulomatous disease similar to sarcoidosis and more invasive diagnostic methods can be avoided.