When a doctor finds a lump in a patient’s neck they may decide to take a biopsy. A biopsy is the removal of cells or tissue for analysis to determine the cause of the abnormality.
Different Types of Neck Mass Biopsy
If there is a lump in a patient’s neck, a doctor may decide to take a biopsy. There are a few different ways for a doctor to take a biopsy of the neck.
Fine Needle Aspiration Biopsy
The easiest and most common way to biopsy a neck mass is a fine needle aspiration biopsy (FNA), in which a small needle is placed into the growth and cells are drawn out through a syringe. These cells will then be analyzed under the microscope by a pathologist, who will let the doctor know if there were enough cells to make a diagnosis. If necessary, the doctor may take a number of samples to get more cells. It may take a few days for the pathologist to give the final diagnosis.
Types of FNA Biopsies
“By Feel” FNA
If the doctor is able to physically feel the lump, they can place the needle directly into it to extract cells.
Ultrasound Guided FNA
If the tumor is difficult to locate or is near important structures, ultrasound imaging can be used to help the doctor navigate the needle directly into the mass.
CT-Guided FNA
If neither of the above FNA techniques can sufficiently locate the tumor, the patient may undergo a few low-dose CT scans—first to localize the tumor and then to accurately insert the needle into the mass to extract cells.
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Core-Needle Biopsy
A core-needle biopsy is an alternative to fine needle aspiration (FNA). It is done in the same way as an FNA biopsy, but uses a larger needle and removes a core of tissue from the mass, rather than just a few cells. Because they take more cells, core biopsies can sometimes provide a diagnosis when an FNA is inconclusive.
Open Neck Biopsy
An open neck biopsy involves making an incision over the mass and removing either a piece of the mass (incisional biopsy) or the entire mass (excisional biopsy). The tissue is then sent to a pathologist, who will examine it under a microscope. This method is typically only used if less invasive methods such as an FNA are nondiagnostic.
Sentinel Lymph Node Biopsy
A sentinel lymph node biopsy (SLNB) is a special type of excisional biopsy that is mainly used in skin cancers, such as melanoma and Merkel cell cancers, although this technique is also being used for some oral cancers as well. Cancer cells spread from a tumor to regional lymph nodes by traveling through a channel of lymph and stopping in the first lymph node along the way. A SLNB uses special techniques to locate that first lymph node so that it can be removed and analyzed. If the lymph node is cancerous, the rest of the lymph nodes in the region will need to be removed. If the lymph node is not cancerous, the doctor can safely assume the remaining lymph nodes are also negative and no further removal will be necessary.
- The patient will need to see a nuclear medicine specialist a few hours before surgery. The specialist will inject the area around the primary tumor with a special radio labeled material. Then the head and neck will be imaged over a period of time until the first draining lymph node, or sentinel node, is located.
- Next, the patient will go into surgery. The surgeon will also use a machine called a gamma probe which is passed over the area and will make a noise when it is near the first lymph node. The combination of the imaging and the gamma probe will act as a road map to help the doctor locate and remove the first lymph node.
- Once the lymph node is removed, it will be sent to a pathologist to analyze the cells and help the doctor determine whether additional surgery is necessary.
