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Neck mass - Large Biopsy 3-6 cm
Biopsy
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Biopsies of neck masses.
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Neck Mass - Large Biopsy 3-6 cm
- Why is it done?
- To obtain tissue samples from palpable neck masses measuring 3-6 cm in diameter for histopathological diagnosis and identification of the underlying disease process
- To differentiate between benign and malignant lesions including lymphomas, metastatic cancers, and thyroid disorders
- To evaluate palpable lymphadenopathy and determine if lymph nodes are reactive, neoplastic, or infectious in nature
- Indicated when imaging studies (ultrasound, CT, MRI) show suspicious features or when non-invasive diagnostic methods are inconclusive
- Typically performed after imaging workup and when fine needle aspiration (FNA) is non-diagnostic or has yielded indeterminate results
- To guide treatment planning and determine prognosis based on definitive tissue diagnosis
- Normal Range
- This is a tissue biopsy procedure; results are not reported as numerical values but rather as qualitative histopathological findings
- Normal/Negative Result: Benign tissue architecture, reactive hyperplasia, or absence of malignancy; may indicate inflammatory lymphadenitis, viral infection sequelae, or benign proliferative processes
- Abnormal/Positive Result: Presence of malignant cells, lymphoma, metastatic disease, or specific infectious organisms; includes thyroid malignancy, squamous cell carcinoma, adenocarcinoma, or other neoplastic processes
- Specimen Quality: Adequate tissue representative of the lesion with sufficient cellularity for histological evaluation; inadequate specimens may require repeat biopsy
- Unit of Measurement: Tissue cores or fragments, typically 3-6 cores obtained for biopsy specimens; specimen length usually 15-25 mm depending on needle gauge
- Interpretation
- Benign Findings: Lymphoid hyperplasia, granulomatous inflammation, chronic lymphadenitis, or reactive changes; indicates non-malignant etiology and typically does not require oncologic intervention
- Malignant Findings: Presence of atypical/abnormal cells with increased nuclear-to-cytoplasmic ratio, abnormal mitoses, and architectural disarray; requires staging studies and oncologic consultation
- Lymphoma: Hodgkin lymphoma (presence of Reed-Sternberg cells) or non-Hodgkin lymphoma subtypes (diffuse large B-cell, follicular, nodal marginal zone); requires immunophenotyping and flow cytometry confirmation
- Metastatic Disease: Presence of malignant cells inconsistent with primary neck pathology; immunohistochemistry aids in determining primary site of origin
- Infectious Etiologies: Tuberculous or fungal granulomas, microorganisms visible on special stains (acid-fast bacilli, fungal organisms); special stains and cultures assist in diagnosis
- Thyroid Lesions: Papillary thyroid carcinoma, follicular neoplasm, medullary carcinoma, or anaplastic carcinoma; classified using Bethesda System for Reporting Thyroid Cytopathology
- Factors Affecting Interpretation: Specimen adequacy, tissue orientation, degree of fixation, presence of crush artifact, and prior chemotherapy or radiation effects on tissue morphology
- Associated Organs
- Primary Organ Systems: Lymphatic system, thyroid gland, salivary glands (parotid, submandibular), pharyngeal structures, and upper respiratory tract
- Common Associated Conditions - Benign: Lymphadenitis, chronic infections (tuberculosis, atypical mycobacteria), granulomatous disease, sarcoidosis, Sjögren syndrome, and autoimmune lymphoproliferative syndrome
- Common Associated Conditions - Malignant: Hodgkin lymphoma, non-Hodgkin lymphoma, thyroid cancer (papillary, follicular, medullary, anaplastic), squamous cell carcinoma of head and neck, metastatic adenocarcinoma, and melanoma
- Potential Complications Related to Abnormal Results: Cancer progression, metastatic spread to distant organs (lungs, liver, bone), airway compromise if mass enlarges, vocal cord involvement with voice changes, and thyroid dysfunction
- Procedural Complications: Needle tract seeding (rare), bleeding or hematoma formation, infection at biopsy site, nerve injury (hypoglossal, recurrent laryngeal), and temporary discomfort at injection or biopsy site
- Related Organ Involvement: Secondary involvement of esophagus (dysphagia), larynx (dysphonia), trachea (stridor), chest cavity (mediastinal involvement), and superior vena cava syndrome in advanced malignancy
- Follow-up Tests
- Immunohistochemistry (IHC): Further characterize cell types, determine lymphoma subtypes, identify origin of metastatic carcinoma, and assess thyroid markers (TTF-1, calcitonin)
- Flow Cytometry: Immunophenotyping for suspected lymphomas; detects abnormal lymphocyte populations and determines lymphoma subtypes
- Molecular/Cytogenetic Studies: FISH (fluorescence in situ hybridization), gene mutation analysis (BRAF V600E, RAS mutations), chromosomal abnormalities, and clonality studies for lymphomas
- Special Stains: Gram stain, acid-fast bacilli (AFB) stain, fungal stains, silver stains (GMS), and periodic acid-Schiff (PAS) for infectious organisms
- Culture Studies: Bacterial, mycobacterial, and fungal cultures if infection suspected; results available in 2-8 weeks depending on organism
- PET-CT or CT/MRI Staging: For malignant diagnoses to assess for metastatic disease, lymph node involvement, and treatment planning; typically within 2-4 weeks of diagnosis
- Thyroid Function Tests (TSH, Free T4): If thyroid biopsy reveals malignancy or nodular disease to assess functional status
- Tumor Markers: CEA (carcinoembryonic antigen), AFP (alpha-fetoprotein), or calcitonin depending on cancer type identified
- Oncology and Head/Neck Surgery Consultation: Recommended for all malignant diagnoses to determine treatment modality (surgery, chemotherapy, radiation, immunotherapy)
- Monitoring Frequency: Benign results - clinical follow-up in 2-4 weeks; malignant results - staging within 2-4 weeks and treatment initiation within 4-6 weeks; surveillance imaging per oncology protocols after treatment
- Fasting Required?
- Fasting Status: No - fasting is not required for this biopsy procedure
- Pre-Procedure Preparation: Normal breakfast and lunch may be consumed; however, avoid heavy or fatty meals 2 hours before procedure if sedation is planned
- Medications - Hold: Aspirin and non-steroidal anti-inflammatory drugs (NSAIDs) 5-7 days before procedure; anticoagulants (warfarin, apixaban, rivaroxaban, dabigatran) - timing per interventional radiologist; clopidogrel (Plavix) and other antiplatelet agents 7-10 days prior unless cardiac stent in place
- Medications - Continue: Continue all other medications as prescribed unless instructed otherwise by the interventional radiologist or physician
- Pre-Procedure Laboratory Studies: Coagulation studies (PT/INR, PTT, platelet count) required if on anticoagulation or antiplatelet therapy; renal function (creatinine, BUN) if contrast administration anticipated
- Imaging Studies Prior to Biopsy: Ultrasound, CT, or MRI imaging should be available to guide needle placement; bring imaging CD if from outside facility
- Sedation: If moderate sedation is planned, nothing by mouth (NPO) for 6 hours prior to procedure; arrange for responsible adult to drive post-procedure; void before procedure
- Infection Prevention: Shower or wash neck area morning of procedure; avoid perfumes, lotions, and makeup on neck; wear comfortable, loose-fitting clothing
- Post-Procedure Instructions: Resume normal diet unless instructed otherwise; avoid strenuous activity for 24-48 hours; keep biopsy site clean and dry; apply ice pack for swelling; minor discomfort normal (use acetaminophen; avoid NSAIDs for 48 hours)
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