The diagnostic yield of cervical lymph node excision biopsy presenting via the head and neck ‘lump‐and‐bump’ clinic

Abstract

Dear Sir, We read with great interest the article by Yeo et al 1 regarding their experience of non-head and neck primaries presenting to their neck lump clinic.Our head and neck 'lump-and-bump' clinic is well established, having started in 1995. We recently conducted a similar review and will summarise our findings, which are comparable with minor interesting differences. MethodA retrospective casenote review of patients who underwent cervical lymph node excision biopsy between January 2007 and June 2013 at our centre was undertaken. ResultsTwo hundred and twelve cervical lymph node biopsies were performed. The median age of presentation was 44 years (range 2-88). Haematological malignancy, predominantly lymphoma, was diagnosed in 95 patients (41.5%). 'Benign' pathology was found in 90 patients (39.3%), which included 39 cases of granulomatous lymphadenitis (17%), 50 simple reactive nodes (21.8%) and 1 case of amyloid infiltration (0.4%).Metastatic carcinoma was diagnosed in 27 patients (11.8%). Primary source data were unavailable for two cases. Eighteen were of non-head and neck origin. The top three primary sources in our series in descending order of frequency were lung (n = 5), unknown primary source (n = 5) and genitourinary (prostate, testicular and renal) (n = 3).Data regarding referral sources were retrieved for 193 cases (90.6%): 49 were referred by haematology (23%), 94 from primary care (45%) and 15 each from paediatricians and respiratory physicians (7%). The remaining 20 cases (9%) were referred from various other allied specialties. DiscussionWe find it interesting that despite our centres being at opposite ends of the country, we report similar figures with regard to both haematological and lung malignancies presenting primarily with cervical lymphadenopathy.Primary head and neck lesions should be diagnosed with clinical examination and formal biopsy plus fineneedle aspiration of associated lymphadenopathy instead of excision biopsy. This explains the small proportion of metastatic head and neck tumours in this series (n = 7).In contrast, our rate of 'benign' pathology may simply reflect a different patient group, as excision biopsy is only performed if initial cytology is inconclusive. Where granulomatous inflammation was found histologically, nineteen cases were Nepalese patients who were later diagnosed with tuberculosis, reflecting the large Ghurkha population in our region. 2 In conclusion, our data show broadly similar rates and types of pathology in a similar neck lump clinic. This information might support departments and individuals aspiring to develop a business case and service strategy, to run similar clinics in other regions of the UK. Conflict of interestThere are no conflict of interests to declare.

Level 5 Lymphadenopathy Warrants Heightened Suspicion for Clinically Significant Pathology

“…Although lymph node biopsy carries a specific risk of accessory nerve damage when undertaken within the posterior triangle [18,19], this risk is extremely low, and the procedure can be carried out safely and easily under local anaesthetic in the right hands. This is an observational study based on the patient demographics and final pathology reports available to us.…”