![]() ![]() ![]() Werner RA, Andree C, Javadi MS, Lapa C, Buck AK, Higuchi T, et al. It also discusses the pathophysiology, clinical significance, imaging studies, cytological and histopathological features, and the differential diagnosis and prognosis of Virchow’s LNs. This chapter addresses the historical review and surgical anatomy of Virchow’s LNs. The prognosis of malignant infradiaphragmatic tumors after metastasis to Virchow’s node is generally considered to be extremely poor. According to the latest guidelines set by the American Academy of Otolaryngology–Head and Neck Surgery (AAO–HNS), an open biopsy is only necessary if fine needle aspiration cytology (FNAC), core needle biopsy (CNB), physical examinations, and other ancillary tests prove to be nondiagnostic. These nodes provide a safe and reliable target for ultrasound-guided biopsy when necessary and for diagnosis and staging. Moreover, identification of abnormal left supraclavicular lymph nodes (LNs) on imaging without abnormal right supraclavicular LNs can point toward an abdominal primary malignancy. Imaging can aid in the identification of suspicious supraclavicular nodes, which can then be targeted for biopsy to confirm a diagnosis or the presence of metastatic disease. Identification of supraclavicular nodes often dictates therapy and is considered an M1 disease. While these malignancies preferentially metastasize to the left supraclavicular (Virchow’s) nodes, supradiaphragmatic malignancies show no preference between left and right supraclavicular nodal metastases. Virchow’s node is the terminal node of the thoracic duct, and a pathologically enlarged Virchow’s node (Troisier’s sign) may be the first sign of a pelvi-abdominal malignancy. ![]()
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