Comparative Analysis of Biopsy Techniques for Cervical Lymphoma: A Retrospective Cohort Review.

Abstract

Introduction: Lymphoma is the most common neck mass malignancy in adults but can present diagnostic challenges due to controversy surrounding the best initial biopsy approach. In this study, the authors characterize the diagnostic pathway in adults with lymphoma (or leukemia) presenting initially as a neck mass and examine the biopsy procedures required for diagnosis in a large community-based practice setting.

Methods: Using data from a retrospective cohort of 4103 adults referred to otolaryngology with a neck mass (5% found to be malignant), the authors identified the subset with lymphoma (or leukemia) and examined the time to diagnosis and the number and type of biopsies required for diagnosis.

Results: Among 73 adults with lymphoma or leukemia that initially presented with a neck mass (25% diffuse large B-cell lymphoma, 32% Hodgkin lymphoma, 18% follicular lymphoma, and 25% other lymphoma/leukemia), 70% required repeated biopsies for diagnosis. Overall, 93% required a core-needle biopsy (CNB) or an excisional biopsy for diagnosis, although 64% of patients underwent fine-needle aspiration (FNA) for their first biopsy. Patients undergoing initial FNA were diagnosed a median of 19 days after presentation (95% required additional biopsy), whereas those undergoing initial CNB were diagnosed a median of 5 days after presentation (only 25% required additional biopsy).

Discussion: These data highlight the limited diagnostic utility of FNA for lymphoma presenting as a neck mass and support consideration of CNB when lymphoma is suspected in a neck mass to minimize repeat biopsy and time to diagnosis.

Conclusion: Lymphoma represents a diagnostic challenge. CNB represents an opportunity to improve diagnostic efficiency, although additional research is needed to ascertain impacts on cost and side effects in various health care environments.