Cervical Lymph Node Biopsy
This chapter describes a cervical lymph node biopsy as performed by an open neck incision. The majority of cervical lymphadenopathy in children is benign and self-limited. Cervical lymphadenopathy that is persistent more than 6–12 weeks may represent a more sinister pathology, and a cervical lymph node biopsy is warranted to rule out malignancy or another pathologic process. Other high-risk features include lymph nodes that are fixed to surrounding structures, are firm, greater than 2 cm, or if there are multiple sites of adenopathy. Ultrasound may be used to better characterize the lymph node and to rule out other potential causes of a neck mass. Fine needle aspiration is a less invasive alternative but is frequently nondiagnostic as tissue architecture is typically required for diagnosis. In addition to standard procedural risks, the primary risk of cervical lymph node biopsies is the potential for damage to surrounding structures. The most commonly cited injury to adjacent structures is the spinal accessory nerve. The critical steps of the procedure involve an incision over the enlarged lymph node, identification and removal of the lymph node, and incision closure.