Reducing the Number of Open Node Biopsies Carried Out for Benign Disease

We read with interest this study on diagnostic lymph node biopsy, which found that 45% of cervical nodes had histologically benign disease following open biopsy. It was suggested that the level of care may be representative within many hospitals in the UK. With the increasing use of high-frequency ultrasound, combined with fine needle aspiration cytology where appropriate, the number of diagnostic open biopsies for benign lymphadenopathy should actually be very small. Nodes with worrying features on ultrasound¹ should have an ultrasound-guided fine needle aspiration or, if appropriate (e.g. suspicious for lymphoma), an open biopsy.

A review of over 300 referrals to our head and neck fast-track clinic with cervical lymphadenopathy (run jointly between maxillofacial and ENT departments) found that the number of patients who have had node biopsy, which was subsequently found to be reactive on definitive histology, was less than 8%. Almost all patients have ultrasound, some in a joint ultrasound clinic with both surgeon and radiologist present at the time of imaging. This has significantly reduced the number of open node biopsies carried out for benign disease, confirming that the results reported by Moor and colleagues might not be representative of units in the UK after all.