Cervical ultrasound (US) and US-guided lymph node biopsy as a routine procedure for staging of lung cancer.

Purpose: To assess the value of routine ultrasound evaluation and US-guided fine-needle aspiration biopsy of supraclavicular lymph nodes for the diagnosis, staging and treatment of patients with lung cancer. Materials and Methods: 300 consecutive patients with lung cancer were evaluated with high-resolution ultrasound for the presence of pathological lymph nodes (criteria: short-axis >= 5 mm, rounded shape, missing echogenic hilum). Suspicious lymph nodes were biopsied under ultrasound guidance if the result could influence further patient management Results: In 41 of 257 NSCLC patients (16%) and 15 of 43 (35%) SCLC patients, enlarged lymph nodes were detected, in particular in patients with a CT stage N2 or N3 (NSCLC) or extensive disease (SCLC). 16 lymph node biopsies were positive for malignancy, 4 biopsies were negative for malignancy or not diagnostic. US had a higher sensitivity for the detection of pathological lymph nodes than CT. Conclusion: Routine ultrasound evaluation of supraclavicular lymph nodes reveals suspicious lymph nodes in a high number of patients with lung cancer. High-resolution US is superior to CT in the detection of pathological lymph nodes. Ultrasound-guided biopsy proves malignancy and thereby a N3 or M1 stage. Thus, more invasive and expensive diagnostic procedures can be avoided.