Malignant neck lumps: a measured approach

The options currently available for establishing the histological diagnosis of a neck mass are open biopsy or a measured approach involving head and neck examination, fine-needle aspiration biopsy (FNAB) and panendoscopy. We present the results of 10 patients initially managed by open biopsy and 22 who were subject to the alternative approach. All had a histological diagnosis of squamous carcinoma. Seven of the open biopsy patients developed problems related to the biopsy that later adversely affected their management. There were no such problems in the other group. Patients undergoing open biopsy required a mean of one further general anaesthetic and a mean inpatient stay of 7 days longer than the patients in the second group. FNAB in our hospital was shown to be reliable (91% accurate, 93% sensitive, 97% specific), especially for squamous malignancy (100% specific). The relative merits of the two methods are discussed. It is our belief that open biopsy should not be used as a first-line investigation of a neck mass.