An edentulous 72-year-old man with a 50-year history of cigarette smoking presents with a nontender, hard mass in the lateral neck. The simplest way to establish an accurate histological diagnosis of a neck mass suspected to be cancerous is
Isolated enlarged cervical lymph nodes in the adult are malignant nearly 80% of the time (excluding benign tumors of the thyroid gland). They are usually metastatic squamous cell carcinomas arising from primary sources above the clavicles in the aerodigestive tract. Fine-needle aspiration cytology is commonly used to obtain histological confirmation of suspected cancer. Aspiration cytology can usually diagnose carcinoma accurately, but lymphoma may be difficult to identify by this method, and open biopsy is often necessary. Bone marrow biopsy is not indicated prior to lymph node biopsy. It is done as part of the staging process after a diagnosis of lymphoma has been made. Endoscopy and scanning of the oropharynx and nasopharynx are part of the diagnostic workup of a suspected malignant cervical lymph node, but do not provide histological proof of cancer.
Fine needle aspiration cytology
Bone marrow biopsy
Nasopharyngoscopy
CT scan of the head and neck
Transplantation