The value of scalene node biopsy in intrathoracic disease

The value of scalene node biopsy as a diagnostic procedure in intrathoracic disease is established beyond doubt. The percentage of positive biopsies depends on the thoroughness with which the operation is carried out and is especially high in cases of sarcoidosis. The results of the present study bear out the author's previously published views on the lymphatic drainage of the lungs and give a guide to the question of which side should be explored. Right-sided lesions always give rise to pathological changes on the right. In cases where no lymph nodes are palpable, the right supraclavicular region should be explored irrespective of whether the lesion in the chest is on the left or right. Similarly, in bilateral lesions a right scalene node biopsy is advised. Only when the left supraclavicular nodes are palpable should this side be operated upon. A bilateral exploration is only justifiable where a right scalene node biopsy is negative and the case cannot be diagnosed by any other means.