AbstractPurposeThe purpose of this study was to assess the prevalence and clinical implications of false‐positive supraclavicular lymph node (LN) detected on chest computed tomography (CT), using subsequent neck ultrasonography (US) and US‐guided tissue sampling.MethodsAmong 172 patients with suspected supraclavicular LNs identified on CT, 87 underwent neck US or US‐guided tissue sampling. Receiver operating characteristic curve and logistic regression analyses were performed to determine the diagnostic performance of US and independent predictors of false‐positive LNs.ResultsAmong 87 patients, 49 (56.3%) were pathologically confirmed as metastases, 26 (29.9%) were negative for malignancy, and 12 (13.8%) had pseudolesions or schwannomas. The diagnostic indices were as follows: sensitivity, 91.8%; specificity, 92.3%; PPV, 95.7%; NPV, 85.7%; and accuracy, 92.0% (AUC = 0.921; 95% CI: 0.832–0.970, p < 0.001). The false‐positive group had a higher mean age than the true‐positive group (mean age, 69.8 ± 9.2 vs. 63.9 ± 9.8, p = 0.003). Logistic regression analyses revealed that age ≥ 65 years was the only independent predictor of false‐positive LNs (OR = 4.391; 95% CI: 1.037–18.582; p = 0.044).ConclusionSubsequent US can be helpful for evaluating suspicious supraclavicular LNs detected on CT to establish appropriate management, especially in older patients.