Should I Consult an ENT Specialist for Neck Lymph Node Pathology?

Q: Should I Consult an ENT Specialist for Neck Lymph Node Pathology?

Elsa： Currently, there are three methods that can be adopted： the first is the lymph node biopsy from the supraclavicular lymph nodes, which should be manageable by the thoracic surgeon; the second involves a needle biopsy of the retroperitoneal mass guided by a radiologist using

Is it correct to perform pathological biopsies of cervical lymph nodes in thoracic surgery?

Hello, doctor.
Two months ago, I experienced discomfort and pain in my lower abdomen, which led me to visit a gastroenterology clinic for examination.
Due to some abnormalities, I was referred to a major hospital for further testing.
I have undergone evaluations by specialists in gastroenterology, hematology-oncology, and thoracic surgery, and I am currently being seen by the thoracic surgeon.

The CT scan results have raised concerns among the three doctors about a possible lymphoproliferative disorder.
The CT scan indicated that the lymph nodes are located in the retroperitoneal space, slightly above the left kidney.
Additionally, there is some swelling in the lymph nodes located just below the left side of my neck, above the clavicle, which is not painful but is noticeably enlarged.

Previously, I underwent an ultrasound-guided fine needle aspiration to obtain a sample from the cervical lymph nodes for examination.
However, both the pathology and cytology results came back normal.
The thoracic surgeon has suggested performing surgery to excise one of the lymph nodes from the area above the left clavicle for pathological analysis.
However, during physical examination, it is difficult to precisely locate the cervical lymph nodes, and there is no guarantee that the lymph node removed will be related to the abdominal lymphadenopathy.
I would like to inquire whether I should discuss the issue of the cervical lymph node biopsy with an otolaryngologist.

Elsa, 30~39 year old female. Ask Date: 2011/11/29

Dr. Fan Sheng reply Oncology

Elsa: Currently, there are three methods that can be adopted: the first is the lymph node biopsy from the supraclavicular lymph nodes, which should be manageable by the thoracic surgeon; the second involves a needle biopsy of the retroperitoneal mass guided by a radiologist using CT imaging; and the third is to randomly perform a bone marrow biopsy, which may or may not yield lymphoma.
Wishing you all the best!

Reply Date: 2011/11/29

More Info

When it comes to the evaluation of neck lymph nodes, especially in the context of potential lymphadenopathy or concerns about lymphoma, consulting an ENT (Ear, Nose, and Throat) specialist can be a prudent step. Given your situation, where multiple specialists have raised concerns about possible lymphatic issues, it is essential to have a comprehensive approach to your diagnosis and treatment.

Why Consult an ENT Specialist?
1. Expertise in Lymphatic Disorders: ENT specialists are well-versed in the anatomy and pathology of the head and neck region, including lymph nodes. They can provide insights into whether the lymphadenopathy is reactive (due to infection or inflammation) or indicative of a more serious condition, such as lymphoma.

2. Comprehensive Evaluation: An ENT can perform a thorough examination of your neck and throat, which may include flexible endoscopy to visualize the upper aerodigestive tract. This can help identify any abnormalities that imaging studies might miss.

3. Guidance on Further Testing: Given that you have already undergone ultrasound and fine needle aspiration (FNA) with normal results, an ENT can help determine if further imaging (like MRI or CT scans) or biopsies are warranted. They can also assess the need for a surgical biopsy if the lymph node in question remains suspicious despite previous tests.

4. Multidisciplinary Approach: Your case involves multiple specialties, including gastroenterology and thoracic surgery. An ENT can coordinate with these specialists to ensure that all aspects of your health are considered, especially since lymphatic drainage from the abdomen can affect neck lymph nodes.

Addressing Your Concerns
- Normal Pathology Results: The fact that your previous pathology and cytology results were normal is reassuring but does not completely rule out the possibility of a lymphatic malignancy. Lymphoma can sometimes present with normal cytology, especially in its early stages. Therefore, ongoing monitoring and evaluation are crucial.

- Surgical Considerations: The recommendation for surgical excision of a lymph node is often based on the need for a definitive diagnosis. If the lymph node is accessible and there is a suspicion of malignancy, excisional biopsy can provide more tissue for a thorough pathological examination.

- Location and Accessibility: You mentioned difficulty in palpating the lymph node for surgical planning. An ENT specialist can use imaging guidance to assist in locating the lymph node accurately, which can improve the chances of obtaining a representative sample during surgery.

Next Steps
1. Schedule a Consultation: Reach out to an ENT specialist to discuss your case. Bring all relevant medical records, including imaging studies and pathology reports, to facilitate a comprehensive evaluation.

2. Discuss Symptoms and Concerns: Be open about your symptoms, including the abdominal discomfort and any other systemic symptoms (like weight loss, night sweats, or fever). This information can help the ENT specialist assess your overall health and the potential implications of your lymphadenopathy.

3. Consider a Multidisciplinary Meeting: If possible, request a meeting that includes your gastroenterologist, thoracic surgeon, and ENT specialist. This collaborative approach can ensure that all aspects of your condition are addressed and that you receive a cohesive treatment plan.

4. Follow-Up: After your consultation, ensure that you have a clear follow-up plan. Whether it involves further imaging, surgical intervention, or monitoring, having a structured approach will help alleviate anxiety and ensure timely management of your condition.

Conclusion
In summary, consulting an ENT specialist is a wise decision given your concerns about neck lymph nodes and the potential for lymphatic malignancy. Their expertise can provide clarity and direction in your diagnostic journey. Remember, early intervention and thorough evaluation are key in managing any potential health issues effectively.

Similar Q&A

Which Specialist to Consult for Suspected Lymph Node Enlargement?

Director Tsai inquired about some areas on the body that feel somewhat like lymphadenopathy and somewhat like muscle. Which specialty can help examine and differentiate whether there is lymphadenopathy?

Dr. Cai Ruiyuan reply Family Medicine
Hello: Since each physician has different areas of expertise, if you have a mass in the head and neck region, it is advisable to consult an otolaryngologist. For masses in other areas, you may start by seeing a general surgeon. I hope this response helps address your concerns.

Should I Get a CT Scan or Consult an ENT Specialist for My Concerns?

I have been troubled by a neck tumor for a long time, so I went to see a doctor. He only performed a physical examination and determined that I have lymphadenopathy, but this lymph node measures 2.5 cm, almost 3 cm, and there is also a small mass nearby that has recently increase...

Dr. Zheng Jueyi reply Otolaryngology
Hello, you can either undergo a CT scan or consult an otolaryngologist to assess whether there are any issues in the nasopharynx. If abnormalities are found, a nasopharyngeal biopsy will be necessary to confirm the diagnosis. You may choose the option that is more convenient base...

Understanding Lymph Node Issues: When to See an ENT Specialist

Hello Dr. Chen: You mentioned that a biopsy can be chosen. Do all hospitals have this procedure available? I have a lump that is not very noticeable and can only be felt when pressed. If there are similar lumps in the neck, could this possibly be related to lymphadenopathy? Addit...

Dr. Chen Jianzhi reply Otolaryngology
Dear Mr. Chang, Hello. Based on your literal inquiry, a puncture is a relatively simple procedure that is generally available in most hospitals. I agree with your last thought; you can visit a nearby otolaryngology clinic for a physician to perform a physical examination. Consul...

Which Specialist to See for Enlarged Lymph Nodes in the Neck?

Hello, doctor: If I feel swollen lymph nodes in my neck, which specialty should I see? I noticed that large hospitals have an otolaryngology department that specializes in head and neck tumors, but isn't lymphoma supposed to be seen by a hematology-oncology specialist? Could...

Dr. Zheng Jueyi reply Otolaryngology
Hello: It is recommended to first visit the ENT department for an examination, and if necessary, you will be referred to the hematology department for evaluation. Wishing you safety and health. Sincerely, Dr. Cheng Jue-Yi, Director of the ENT Department, Taoyuan General Hospital,...