Supraclavicular masses: results of a series of 309 cases biopsied by fine needle aspiration.

BACKGROUND: The purpose of this study was to determine the current distribution of diseases resulting in supraclavicular swelling or lymphadenopathy as diagnosed by fine needle aspiration (FNA) biopsy.
METHODS: Supraclavicular aspirates in this retrospective 5-year study from a large public hospital were classified as neoplastic, infectious, inflammatory, reactive, and nondiagnostic.
RESULTS: Malignancy was present in 55% of the 309 aspirates (47% metastatic, 8% lymphoma). Age was most predictive of malignancy (32% for age < or =41 years, 68% for age >40 years). Lymphoma occurred equally in both groups, but the lymphoma:metastasis ratio was much higher in younger patients (1:1.6 for age < or =41 years versus 1:11 for age >40 years). Ethnic origin was related to tumor type, metastatic uterine cervical carcinoma being most frequent in Hispanics, and lymphoma in Caucasians. Primary oropharyngeal sites were unusual; most malignancies originated in the lung, breast, or cervix. Left or right side did not discriminate for either the presence or type of tumor. The 43 aspirates from human immunodeficiency virus (HIV) positive (+) patients were predominantly inflammatory, infectious, or reactive; lymphoma was infrequent (7%). Overall, 39 patients had mycobacterial infection; aspirate smears or culture were positive in 19. Three other FNAs grew Staphylococcus aureus and one stained for Cryptococcus. Aspirates were not informative in 24 cases (8%). The sensitivity of FNA for malignancy was 97%, specificity was 98%, and positive predictive value 98%.
CONCLUSION: Aspiration biopsy is an excellent diagnostic tool for supraclavicular masses. Patients over 40 years old are likely to have metastatic malignancy, from breast, lung, or infradiaphragmatic sites. Aspirates with inflammation and those from HIV+ patients should undergo extensive culture.