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February 9, 1979

Biopsy of Cervical Node

JAMA. 1979;241(6):566. doi:10.1001/jama.1979.03290320013016

To the Editor.—  Greenfield and Jordan presented a good overview of the primary care management of lymphadenopathy. However, once an infectious cause has been discarded, the advice to perform a biopsy on a persistent lymph node in the neck is unwarranted.In adults, most persistent neck masses are malignant and metastatic, and excluding supraclavicular tumors, the primary site is usually in the head and neck.1 If the mass is malignant, initial biopsy may interfere with therapy in several ways. These include radioresistance from scarring in the biopsy site, tumor recurrence in the neck,2 and complicating subsequent neck dissection flaps. In addition, should the disease in the neck originate from a primary process that is radiocurable, such as carcinoma of the nasopharynx, then surgery is not only ill-advised but meddlesome.3I agree that algorithms are a good way to structure an approach to a clinical problem. The algorithm