Clinicopathological Evaluation of Supraclavicular Fossa Masses: A Retrospective Study of 108 Patients

Year 2025, Volume: 35 Issue: 4 , 155 - 162 , 16.01.2026

Ömer Faruk Zengin , Taner Kemal Erdağ , Ersoy Doğan , Sermin Özkal , Sulen Sarioglu , Ahmet Ömer İkiz

https://doi.org/10.26650/Tr-ENT.2025.1694986

https://izlik.org/JA38SJ49SK

Abstract

Objective: Supraclavicular fossa masses present a diagnostic challenge because of their location at a critical anatomical junction and their wide range of different aetiologies. There are currently few studies in the literature that particularly address supraclavicular fossa masses, despite the region's clinical relevance. This study aims to analyse patients who presented to our clinic with a mass in the supraclavicular fossa and were diagnosed via open biopsy.

Material and Methods: The medical records of patients who underwent excisional or incisional biopsy for supraclavicular fossa masses in our clinic and were subsequently diagnosed through histopathological examination were retrospectively reviewed. The findings were analysed and discussed.

Results: A total of 108 patients were included in the study, comprising 58 males (53.7%) and 50 females (46.3%), with a mean age of 52.7 years (range: 12-86). Biopsies were performed on the left supraclavicular fossa in 65 patients (60.1%) and on the right in 43 patients (39.9%). Malignant metastases were detected in 54.8% of incisional biopsies and in 23.3% of excisional biopsies. The incidence of malignancy was 65.8% in patients over 40 years of age, compared to 88% in those aged 18–40 years. Malignant pathologies were more common in males (75.9%) than in females (64%). Malignancy was identified in approximately two-thirds of the biopsies from both sides. Histopathological analysis revealed malignant lymphoproliferative disease in 41 patients (37.9%), malignant metastases in 35 (32.4%), inflammatory/reactive processes in 28 (25.9%), and benign mesenchymal neoplasms in 4 (3.7%).

Conclusion: Supraclavicular fossa masses encompass a broad differential diagnosis. Clinicians should maintain a high index of suspicion for malignancy, particularly among adult patients.

Keywords

Supraclavicular fossa , neck neoplasms , differential diagnosis , biopsy , histopathology

References

• Franzen A, Günzel T, Buchali A, Coordes A. Etiologic and differential diagnostic significance of tumor location in the supraclavicular fossa. Laryngoscope 2018;128(3):646-50. google scholar
• Aydin U, Karahatay S, Binar M, Kavakli K, Safali M. Solitary supraclavicular fossa masses. J Craniofac Surg 2016;27(6):544-8. google scholar
• Bayhan Z, Ozdemir K, Gonullu E, Harmantepe AT, Capoglu R, Akin E, et al. Analysıs of dıagnostıc excısıonal lymph node bıopsy results: 12-year experıence of a sıngle center. Acta Clin Croat 2023;62(1):58-64. google scholar
• Poorey VK, Tyagi A. Accuracy of fine needle aspiration cytology in head and neck masses. Indian J Otolaryngol Head Neck Surg 2014;66(5):182-6. google scholar
• Gupta N, Rajwanshi A, Srinivasan R, Nijhawan R. Pathology of supraclavicular lymphadenopathy in Chandigarh, north India: an audit of 200 cases diagnosed by needle aspiration. Cytopathology 2006;17(2):94-6. google scholar
• Matsumoto F, Itoh S, Ohba S, Yokoi H, Furukawa M, Ikeda K. Biopsy of cervical lymph node. Auris Nasus Larynx 2009;36(1):71-4. google scholar
• Vishwanath V, Jafarieh S, Rembielak A. The role of imaging in head and neck cancer: An overview of different imaging modalities in primary diagnosis and staging of the disease. J Contemp Brachytherapy 2020;12(5):512-8. google scholar
• Lee J, Park HY, Kim WW, Park CS, Lee RK, Kim HJ, et al. Value of accurate diagnosis for metastatic supraclavicular lymph nodes in breast cancer: assessment with neck US, CT, and 18F-FDG PET/CT. Diagn Interv Radiol 2021;27(3):323-8. google scholar
• Zhou Z, Liu X, Hu K, Zhang F. The clinical value of PET and PET/CT in the diagnosis and management of suspected cervical cancer recurrence. Nucl Med Commun 2018;39(2):97-102. google scholar
• Ellison E, LaPuerta P, Martin SE. Supraclavicular masses: results of a series of 309 cases biopsied by fine needle aspiration. Head & Neck 1999;21(3):239-46.google scholar
• Saha S, Woodhouse NR, Gok G, Ramesar K, Moody A, Howlett, DC. Ultrasound guided Core Biopsy, Fine Needle Aspiration Cytology and Surgical Excision Biopsy in the diagnosis of metastatic squamous cell carcinoma in the head and neck: an eleven year experience. Eur J Radiol 2011;80(3):792-5. google scholar
• Novoa E, Gürtler N, Arnoux A, Kraft M. Role of ultrasound-guided core-needle biopsy in the assessment of head and neck lesions: a meta-analysis and systematic review of the literature. Head & Neck 2012;34(10):1497-503. google scholar
• Chen CN, Lin CY, Chi FH, Chou CH, Hsu YC, Kuo YL, et al. Application of ultrasound-guided core biopsy to minimal-invasively diagnose supraclavicular fossa tumors and minimize the requirement of invasive diagnostic surgery. Medicine 2016; 95(4):2172. google scholar
• Lang S, Kansy B. Cervical lymph node diseases in children. GMS Curr Top Otorhinolaryngol Head Neck Surg 2014;1:13:Doc08. google scholar
• Sadeghian G, Ubhi J, Ng SM, Ghotbi E, Paraschou K, Morley S, et al. Comparative accuracy of core-needle and open biopsy in diagnosis, subtyping, and grading of head and neck bone and soft tissue sarcomas. Br J Oral Maxillofac Surg 2025;63(8):576-82. google scholar
• Mitra S, Ray S, Mitra PK. Fine needle aspiration cytology of supraclavicular lymph nodes: Our experience over a three-year period. J Cytol 2011;28(3):108-10. google scholar
• Layfield LJ, Pearson L, Walker BS, White SK, Schmidt RL. Diagnostic accuracy of fine-needle aspiration cytology for discrimination of squamous cell carcinoma from adenocarcinoma in non-small cell lung cancer: a systematic review and meta-analysis. Acta Cytol 2018;62(5-6):318-26. google scholar
• Lin HW, Lister MT, Deschler DG. Cystic masses of the supraclavicular fossa: Clinical features and diagnostic strategies. Am J Otolaryngol 2010;31(6):435-41. google scholar
• Ketcham AS, Sindelar WF, Feliz EL, Bagley DH. Diagnostic scalene node biopsy in the preoperative evaluation of the surgical cancer patient: a 5 year experience with 108 cases and literature review. Cancer 1976;38(2):948-52. google scholar
• Yang DJ, Ren GS, Wang XY. Bilateral chylothorax following left supraclavicular lymph node dissection for breast cancer: one case report and literature review. Chin J Cancer 2014;33(6):317-20. google scholar
• Lee M, McClure E, Reinertsen E, Granzow JW. Lymphedema of the upper extremity following supraclavicular lymph node harvest. Plast Reconstr Surg 2015;135(6):1079-82. google scholar
• Boggs SD, Frost EAM. Supraservical lymph node biopsy under local anaesthesia: a cautionary tale! Open J Anesthesiol 2015;5:43-6. google scholar
• Smith ME, Riffat F, Jani P. The surgical anatomy and clinical relevance of the neglected right lymphatic duct: review. J Laryngol Otol 2013;127(2):128-33. google scholar
• Davarci M, Gokce A, Guven EO, Yalcinkaya FR, Esen H, Sevinc A. Metastatic prostate adenocarcinoma presenting as supraclavicular lymphadenopathy: a report of two cases. Contemp Oncol. (Pozn) 2012;16(1):53-5. google scholar
• Hetemoğlu EK, Erbek SS. Predicting malignancy in cervical lymph node: clinical results. KBB-Forum 2019;18(1):28-32. google scholar
• Otto RA, Bowes AK. Neck masses: benign or malignant? Sorting out the causes by age-group. Postgrad Med 1990;88(1):199-204. google scholar
• Jackson SS, Marks MA, Katki HA, Cook MB, Hyun N, Freedman ND, et al. Sex disparities in the incidence of 21 cancer types: Quantification of the contribution of risk factors. Cancer 2022;128(19):3531-40. Radkiewicz C, Bruchfeld JB, Weibull CE, Jeppesen ML, Frederiksen H, Lambe M, et al. Sex differences in lymphoma incidence and mortality by subtype: A population-based study. Am J Hematol 2023;98(1):23-30. Öztürk M, Durmuş K. Boyun kitleleri. In: Koç C, ed. Kulak Burun Boğaz Hastalıkları ve Baş Boyun Cerrahisi. 3rd ed. İstanbul: Güneş Tıp Kitabevi; 2019. p. 863. google scholar