Diagnostic Accuracy for Malignancy in Open Surgical Biopsy of Neck Lymph Nodes

Abstract

Received June 13, 2014 Revised July 18, 2014 Accepted August 11, 2014 Address for correspondence Han-Sin Jeong, MD, PhD Department of OtorhinolaryngologyHead and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 135-710, Korea Tel +82-2-3410-3579 Fax +82-2-3410-3879 E-mail hansin.jeong@gmail.com Background and ObjectivesZZThe open surgical biopsy (OSB) of neck lymph nodes is considered a definite diagnostic procedure; however, the diagnostic accuracy of this procedure has not been fully studied. Thus, we aimed to identify the false negative rates of OSB for malignancy and the possible causes of misdiagnosis that might severely affect patient prognosis. Subjects and MethodZZWe extracted the data from 495 OSB of neck lymph nodes between 2005 and 2012. The diagnostic accuracy of OSB of neck lymph nodes was estimated based on rebiopsy. In addition, we reviewed possible clinical factors related to false negativity, cause of misdiagnosis and its clinical impacts. ResultsZZThe false negative rate of OSB of neck nodes was 2.2% with a risk of 3.8% false diagnosis among subjects with initial ‘benign’ results. The cases of the initial misdiagnosis (n=7) had the dismal outcomes (4 deaths, 1 disease progression). The main cause of misdiagnosis was the failure to target the disease-affected lymph nodes (85.7%). Malignancy-related symptoms persisted in all cases of misdiagnosis, which required re-biopsy. ConclusionZZAccurate targeting of lymph nodes, close monitoring of clinical symptoms and comparison of biopsy results with symptoms are very important to reduce false negativity for malignancy in OSB of neck lymph nodes. Korean J Otorhinolaryngol-Head Neck Surg 2014;57(12):841-6