An adult has a suspicious level II cervical node and a possible tonsillar primary. Which initial tissue strategy is most appropriate?
NICE recommends considering ultrasound guidance for FNAC or core biopsy of a suspected malignant neck lump. This establishes histology while preserving neck planes and allows HPV-related testing where appropriate.
A. Ultrasound-guided fine-needle aspiration or core biopsy of the node: NICE recommends considering ultrasound guidance for FNAC or core biopsy of a suspected malignant neck lump. This establishes histology while preserving neck planes and allows HPV-related testing where appropriate.
B. Open node biopsy before imaging: Open biopsy may disrupt future neck-dissection fields and should not be the routine first step.
C. Complete tonsillectomy without sampling the node: The node provides a readily accessible route to diagnosis and informs the occult-primary pathway.
D. Observation because HPV-positive nodes grow slowly: HPV-related disease still requires prompt diagnosis and staging.
E. Treat with radiotherapy without histological confirmation: Definitive treatment requires tissue diagnosis except in extraordinary circumstances.
If needle sampling were repeatedly non-diagnostic despite radiological suspicion, the MDT would plan further tissue acquisition rather than defaulting to observation.
Independent Clinora educational preparation material; not official JCIE content, an accredited programme, clinical advice, or a substitute for local policy and specialist judgement.
Back to the Section 1 bank