FNAB of Lymph Nodes in the Head and Neck region

Lymph node fine needle aspiration biopsies in the head and neck region are one of the most common sites for FNAB apart from the thyroid and salivary gland. FNAB of lymph nodes is an efficient, accurate minimally invasive, cost-effective procedure to assess lymphadenopathy in the head and neck (H&N) region, whether by the long-established and successful palpation technique or utilizing ultrasound guidance. The diagnosis of reactive processes, specific infections, metastatic carcinomas and recurrent lymphomas is well established. The primary diagnosis of many lymphomas supported by ultrasound, immunocytochemistry, flow cytometry, fluorescent in situ hybridization, cytogenetic and increasingly next-generation sequencing in an integrated multidisciplinary process is routine in many centres and establishes the residuum of cases which need excision biopsy and full histopathological pathology and IHC workup. Assessment of the clinical history and ultrasound findings should take place whenever possible prior to the FNAB. The FNAB procedure and the making of direct smears are crucially important, and ROSE is highly recommended.