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Malignant neck lumps: a measured approach.

M A Birchall1, N D Stafford, G P Walsh-Waring

  • 1Ear, Nose and Throat Department, St Mary's Hospital, London.

Annals of the Royal College of Surgeons of England
|March 1, 1991
PubMed
Summary
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Open biopsy for neck masses can lead to complications and increased healthcare costs. A measured approach using fine-needle aspiration biopsy (FNAB) is a more reliable and less invasive diagnostic method.

Area of Science:

  • Otolaryngology
  • Oncology
  • Surgical Pathology

Background:

  • Establishing a histological diagnosis for neck masses typically involves open biopsy or a multi-step approach.
  • Open biopsy carries risks of complications that can negatively impact patient management.

Purpose of the Study:

  • To compare the outcomes and complications of open biopsy versus a measured approach for diagnosing neck masses.
  • To evaluate the diagnostic accuracy and reliability of fine-needle aspiration biopsy (FNAB) for squamous cell carcinoma.

Main Methods:

  • Retrospective analysis of 32 patients with squamous carcinoma of the neck.
  • Comparison of outcomes between 10 patients managed with open biopsy and 22 patients managed with a measured approach (including FNAB and panendoscopy).

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Main Results:

  • Open biopsy led to complications in 70% of patients, adversely affecting management.
  • Patients undergoing open biopsy required an average of one additional general anesthetic and stayed 7 days longer in the hospital.
  • Fine-needle aspiration biopsy (FNAB) demonstrated high accuracy (91%), sensitivity (93%), and specificity (97%), particularly for squamous malignancy (100% specific).

Conclusions:

  • Open biopsy should be avoided as a first-line investigation for neck masses.
  • A measured diagnostic approach incorporating FNAB is superior to open biopsy for neck masses, offering better diagnostic yield and fewer complications.