[Diagnostic procedures in obscure cervical nodes in adults]

Cervical masses in adult patients should be regarded as metastatic until proven otherwise. Work-up must therefore begin with a thorough search for a possible primary cancer. 90% of all head and neck primaries that present with a cervical mass are located in the oral cavity, pharynx or larynx. Pain [particularly otalgia], dysphagia, nasal obstruction, unilateral hearing loss, and hoarseness are the most common key symptoms of these tumors. Cancer cannot always be ruled out, even with regression of symptoms following antibiotic treatment or normal laboratory findings. If no primary lesion is found, then fine-needle aspiration biopsy of the neck mass is indicated. Only if fine-needle aspiration biopsy fails to come up with a diagnosis, should open [whenever possible excisional] biopsy be performed.