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It is one of the quirks of the neck lymph node system that supraclavicular nodes (level 4 nodes in the AJCC criteria) are not draining the neck, but rather the mediastinum. So when I see a malignant looking level 4 supraclavicular node the thorax (breasts , lungs, mediastinum) need assessment to determine the source. Other levels in the neck drain from local neck sources, but level 4 is different.
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