Use of Prescalene Lymph Node Biopsy in Absence of Palpable Supraclavicular Nodes

In 1949, Albert C. Daniels 1 described a method of biopsy that is useful in diagnosing intrathoracic diseases. The method consists of removal of the lymphnode-bearing adipose tissue overlying the supraclavicular portion of the scalenus anterior muscle. This tissue was found to be easily accessible with the patient under a local anesthetic. Daniels reported five cases in which palpable nodes were absent and the biopsy material was found to contain lymph nodes involved by disease processes of pulmonary origin. The disease process was Boeck's sarcoid in two cases, carcinoma in two cases, and silicosis in one case. From August, 1949, to February, 1953, prescalene lymph node biopsy was done on 41 patients at the Veterans Administration Hospital, Fort Logan and Denver. 2 In these cases, a single density in the roentgenogram of the chest, an unresolving pneumonitis, or an unexplained hydrothorax was present. Bronchoscopic examination was made in every case.