Physical examination can sometimes detect metastasis to cervical lymph nodes (in the neck). In the past, a surgical biopsy called a scalene node biopsy was often done. It is seldom indicated at this time.
www.smokinglungs.com/nodmet.htm
While there is universal agreement that palpable scalene lymph nodes should be biopsied in the preoperative evaluation of patients with carcinoma of the lung, the role of biopsy of nonpalpable scalene nodes remains unclear.
ats.ctsnetjournals.org/cgi/content/abstract/31/4/322
none had positive scalene nodes. Of those staged N2 by standard mediastinoscopy (n = 20), 6 (30%) had occult scalene nodal involvement. Similarly, 16 patients had centrally located nonsquamous primaries that were staged N3-contralateral by standard mediastinoscopy.
ats.ctsnetjournals.org/cgi/content/full/62/2/338
The particular patient discussed here presented with left scalene nodes and a CT scan that was positive for pretracheal and precarinal adenopathy.
theoncologist.alphamedpress.org/cgi/content/full/9/3/33... theoncologist.alphamedpress.org/cgi/content/full/9/3/330
Scalene node excision with, in some cases, removal of inferior cervical paratracheal-esophageal and upper-anterosuperior mediastinal nodes, is an accurate adjunctive histologic or bacteriofungal diagnostic procedure or both for patients with intrathoracic lesions and certain obscure systemic diseases.
caonline.amcancersoc.org/cgi/content/abstract/19/5/295
Patients with clinical evidence of scalene or supraclavicular node metastasis were excluded. If their para-aortic nodes were tumor-positive, patients underwent scalene lymph node dissection. RESULTS: ... Three patients had microscopically positive scalene lymph nodes (10.7%). In one patient the thoracic duct was injured.
www.medscape.com/medline/abstract/12841666
However, enthusiasm for this procedure at other centers has waned, largely due to a wide discrepancy in the reported rates of occult scalene node ...
linkinghub.elsevier.com/retrieve/pii/S0090825899955713
Fourteen of the thirty-three patients with recurrent pelvic carcinoma had positive left scalene node biopsies. Eight of these fourteen were clinically ...
linkinghub.elsevier.com/retrieve/pii/S0090825881800091
Two to seven scalene lymph nodes were removed, with a mean of 4.0, and one or two of them having the evidence of metastasis, with a mean of 1.8. ... Maloney J.V., Franks R., Makoff D., Sherman P.H. Biopsy of the scalene lymph nodes and the right thoracic duct lymph node for the diagnosis of pulmonary disease.
ejcts.ctsnetjournals.org/cgi/content/full/25/4/492
These findings suggest that unilateral scalene node biopsy did .... Presence of metastasis at scalene nodes with normal serum acid ...
doi.wiley.com/10.1002/jso.2930060108
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