Same day diagnosis of neck lumps using ultrasound-guided fine-needle core biopsy

Abstract

ore biopsy in the neck is a relatively new technique that uses mall-bore needles (18 or 20G) and a spring-loaded biopsy evice for harvesting samples of tissue.1,2 It has many benets over fine needle aspiration cytology (FNAC), as the core f tissue can be used for both histological and immunohisochemical analysis and this results in more accurate typing nd grading of tumours. Ultrasound-guided core biopsy requires formal tissue proessing that has made it, until now, unsuitable for same day iagnosis. We describe an alternative that allows accurate iagnosis to be made within an hour of sampling (Fig. 1). A 53-year-old man who had previously had a squamous ell carcinoma excised from his nose presented with an nlarged node in the left submandibular triangle. FNAC conrmed a metastatic squamous cell carcinoma, and the neck nd chest were staged using computed tomography (CT). his confirmed a node 14 mm× 9 mm in the jugulodigastric egion; it was not enlarged on CT criteria, but corresponded to he palpable lesion. No other nodes were evident and the lungs ooked normal except for previous sarcoid damage (Fig. 2). After discussion a left level IV selective neck dissection as planned. Two days before operation he returned to the linic with a new pea-sized nodule in the left parotid region. his lesion was of uncertain importance, and a repeat FNAC as not diagnostic. Ultrasound the following day confirmed 9 mm solid nodule in the superficial lobe of the left parotid land that we suspected was a nodal metastasis; two samles were taken with an 18G needle under local anaesthesia.