Cystic cervical metastases: incidence and diagnosis using fine needle aspiration biopsy.

BACKGROUND

Seventeen patients presenting with a cystic cervical metastasis were identified after either having undergone excision of a cyst, initially diagnosed as a branchial cyst but subsequently found to be malignant, or after having had fluid aspirated from a neck mass that ultimately proved to be malignant while undergoing fine needle aspiration biopsy.

METHODS

Patients had primary cancer documented at a variety of primary sites, including hypopharynx (3 patients), oropharynx (2 patients), lower lip (2 patients), nasopharynx, supraglottis, oral cavity, and prostate (1 patient each). Six cases (35%) remained occult.

RESULTS

In nearly half of the cases (8 of 17), there was no evidence of the primary cancer at presentation. In the same period, 25 branchial cysts were encountered, giving an incidence of unsuspected carcinoma in cervical cysts of 24% (8 of 33).

CONCLUSION

In contrast to previous studies in which smaller numbers of patients underwent the procedure, we found fine needle aspiration to be very helpful in the assessment of these lesions, having a sensitivity of 73% in diagnosing malignancy.