Cervin J R, Silverman J F, Loggie B W, Geisinger K R
Department of Pathology and Laboratory Medicine, East Carolina School of Medicine, Greenville, NC 27858-4354, USA.
Arch Pathol Lab Med. 1995 Aug;119(8):727-30.
The left supraclavicular lymph node (Virchow's node) may be involved by metastatic malignancies, including those of abdominal or pelvic origin. Almost all previous studies have been based on examination of surgically sampled tissue or postmortem examination. To our knowledge, there has not been a study for nearly 40 years addressing the metastatic pattern to the left supraclavicular lymph node. Furthermore, there has been no study comparing left with right supraclavicular lymph node metastasis or the utilization of fine-needle aspiration biopsy to samples these sites.
A retrospective review of 152 fine-needle aspiration biopsies of supraclavicular lymph nodes was performed, and the neoplasms were grouped into six diagnostic categories from five primary regions.
The patients ranged in age from 2 years to 94 years (average, 55 years) and consisted of 66 males and 83 females. Three patients were biopsied twice. Of the 152 fine-needle aspirations, 87 (57.2%) were of the left supraclavicular lymph node and 65 (42.8%) of the right supraclavicular lymph node. Of the 96 biopsies positive for malignancy, 58 (60.4%) were biopsies of the left and 38 (39.6%) were of the right supraclavicular lymph nodes. Sixteen of 19 pelvic tumors and all six primary abdominal malignancies metastasized to the left supraclavicular lymph node. Thorax, breast, and head and neck malignancies showed no differences in metastatic patterns to the right and left supraclavicular lymph nodes. Ten patients (10.4% of positive nodes) had a diagnosis of non-Hodgkin's lymphoma, leukemia, or Hodgkin's disease. Six patients (7.1% of positive nodes) had a metastasis of unknown primary site, and 19 cases (19.8%) had acute or chronic inflammation; seven of the latter cases demonstrated acid-fast bacilli in the aspirated smears.
Fine-needle aspiration biopsy is an excellent initial procedure in the workup of an enlarged supraclavicular lymph node. Our study confirmed that malignancies originating in the pelvis or abdomen were significantly more likely to metastasize to the left supraclavicular lymph node and that the primary site and types of malignancies that involved the left supraclavicular lymph node were different from those involving the right supraclavicular lymph node.
左锁骨上淋巴结（魏尔啸淋巴结）可能会被转移性恶性肿瘤累及，包括源于腹部或盆腔的肿瘤。几乎所有既往研究均基于对手术切除组织的检查或尸检。据我们所知，近40年来尚无针对左锁骨上淋巴结转移模式的研究。此外，也没有研究比较左、右锁骨上淋巴结转移情况或利用细针穿刺活检对这些部位进行采样。
对152例锁骨上淋巴结细针穿刺活检进行回顾性分析，将肿瘤分为来自五个主要区域的六个诊断类别。
患者年龄从2岁至94岁不等（平均55岁），其中男性66例，女性83例。3例患者接受了两次活检。在152例细针穿刺中，87例（57.2%）为左锁骨上淋巴结穿刺，65例（42.8%）为右锁骨上淋巴结穿刺。在96例恶性肿瘤阳性活检中，58例（60.4%）为左锁骨上淋巴结活检，38例（39.6%）为右锁骨上淋巴结活检。19例盆腔肿瘤中的16例以及所有6例原发性腹部恶性肿瘤均转移至左锁骨上淋巴结。胸部、乳腺以及头颈部恶性肿瘤在左、右锁骨上淋巴结的转移模式上无差异。10例患者（占阳性淋巴结的10.4%）被诊断为非霍奇金淋巴瘤、白血病或霍奇金病。6例患者（占阳性淋巴结的7.1%）有原发部位不明的转移，19例（19.8%）有急性或慢性炎症；后一组病例中有7例在穿刺涂片中发现抗酸杆菌。
细针穿刺活检是评估肿大锁骨上淋巴结的一项出色的初始检查方法。我们的研究证实，起源于盆腔或腹部的恶性肿瘤转移至左锁骨上淋巴结的可能性显著更高，且累及左锁骨上淋巴结的恶性肿瘤的原发部位和类型与累及右锁骨上淋巴结的不同。
