Indications for open cervical node biopsy in HIV-positive patients.
Open node biopsy was the method of choice for diagnosing human immunodeficiency virus (HIV) infection before serologic testing became available. Currently, the otolaryngologist is often called on to assist in the management of HIV-positive patients with troublesome cervical adenopathy. Today's questions are: what is the place of fine-needle aspiration (FNA), and when is open cervical node biopsy indicated. A retrospective review was undertaken of 93 consecutive cervical node biopsies performed by our department during the 5-year period from 1985 to 1989. Twenty of the patients who underwent biopsy were HIV-positive. Of these twenty, ten carried an established diagnosis of acquired immune deficiency syndrome (AIDS). Seventeen of these patients underwent FNA before biopsy. In the eight patients with persistent generalized lymph-adenopathy (PGL) and nontender, nonenlarging nodes, pathologic analysis revealed lymphoid hyperplasia. Five of these patients had antecedent FNA, none demonstrating any pathologic changes. Of the twelve patients with enlarging or tendon nodes, the diagnosis of mycobacterial adenitis was made in eight, Nocardial infection in two, Burkitt's lymphoma in one, and metastatic Kaposi's sarcoma in one. In four of the patients diagnosed with mycobacterial infections, FNA yielded cytologic evidence of acid-fast bacilli and open lymph node biopsy added nothing. In contrast, FNA failed to reveal the diagnosis in both patients with Nocardial infection, and in the two patients with neoplastic disease. We conclude that cervical node biopsy is not indicated in the HIV or AIDS patient with nontender or nonenlarging nodes.(ABSTRACT TRUNCATED AT 250 WORDS)
Burton
F
F
Department of Otolaryngology-Head and Neck Surgery, University of Miami/Jackson Memorial Hospital, FL 33101.
Patete
M L
ML
Goodwin
W J
WJ
D000386:AIDS-Related Complex / Q000175:diagnosis*; D000293:Adolescent; D000328:Adult; D000368:Aged; D001706:Biopsy / Q000379:methods*; D001707:Biopsy, Needle; D002051:Burkitt Lymphoma / Q000175:diagnosis; D005260:Female; D006679:HIV Seropositivity / Q000473:pathology*; D006801:Humans; D006965:Hyperplasia; D008198:Lymph Nodes / Q000473:pathology*; D008206:Lymphatic Diseases / Q000175:diagnosis* / Q000382:microbiology; D008297:Male; D008875:Middle Aged; D009164:Mycobacterium Infections / Q000175:diagnosis; D009333:Neck; D009617:Nocardia Infections / Q000175:diagnosis; D012189:Retrospective Studies; D012514:Sarcoma, Kaposi / Q000175:diagnosis / Q000556:secondary