Threshold size criterion to suspect malignant supraclavicular lymph node < 10 mm in esophageal cancer

Yue Huang ^1,2, Jingsai Du ^1,3, Qian Li ⁴

¹Department of Radiology, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, China.
²Department of Radiology, The First Affiliated Hospital of Henan Polytechnic University & The Second People's Hospital of Jiaozuo, Jiaozuo, China.
³Department of Radiology, Xinyang Central Hospital, Xinyang, China.
⁴Department of Ultrasound, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, China.
⁵Radiology Department, Harbin Medical University Cancer Hospital, Harbin, China.
⁶Department of Radiation Oncology, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, China.
⁷Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
⁸Department of Radiology, Anschutz Medical Campus, University of Colorado Denver, Aurora, CO, USA.
⁹Radiology Department, Harbin Medical University Cancer Hospital, Harbin, China. zhouyang094@126.com.
¹⁰Radiology Department, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China. zhenli@hust.edu.cn.
¹¹Department of Radiology, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, China. qjryq@126.com.

⁰Department of Radiology, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, China.

Insights Into Imaging +

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March 5, 2025

View abstract on PubMed

Summary

For esophageal squamous cell carcinoma (ESCC) patients, a short-axis diameter (SAD) greater than 6 mm on CT scans can help predict metastasis in supraclavicular lymph nodes (SCLNs) smaller than 10 mm.

Area Of Science

Radiology
Oncology
Medical Imaging

Background

Accurate staging of esophageal squamous cell carcinoma (ESCC) is crucial for treatment planning.
Supraclavicular lymph nodes (SCLNs) are important sites for metastasis in ESCC.
Predicting metastasis in small SCLNs (< 10 mm) on CT can be challenging.

Purpose Of The Study

To determine the threshold size of supraclavicular lymph nodes (SCLNs) on CT scans that predicts metastasis in esophageal squamous cell carcinoma (ESCC) patients.
To evaluate the diagnostic performance of CT measurements for SCLN metastasis prediction.

Main Methods

Retrospective, multicenter study involving patients with ESCC who underwent ultrasound-guided fine-needle aspiration biopsy (US-FNAB) for SCLNs.
Contrast-enhanced CT images were analyzed to measure SCLN dimensions (SAD, LAD, SD-MPR, LD-MPR) by radiologists.
Receiver operating characteristic (ROC) curve analysis was used to determine the optimal cutoff value for predicting metastasis.

Main Results

The short-axis diameter (SAD) showed excellent inter-reader agreement (ICC = 0.847).
An SAD cutoff value of > 6 mm demonstrated high diagnostic performance in both training and validation sets, with sensitivity ranging from 77.1% to 87.5% and specificity from 80.7% to 74.5%.
SCLNs < 10 mm with an SAD > 6 mm were highly suspicious for malignancy.

Conclusions

Short-axis diameter (SAD) on CT is a valuable metric for suspecting metastasis in supraclavicular lymph nodes (SCLNs) < 10 mm in esophageal squamous cell carcinoma (ESCC) patients.
A threshold SAD of > 6 mm can significantly aid in predicting SCLN metastasis.
This finding can improve the accuracy of staging and guide therapeutic strategies for ESCC.

Keywords:

Computed tomography Diagnostic accuracy Esophageal squamous cell carcinoma Short-axis diameter Supraclavicular lymph node

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