title: Cervical lymph node extirpation for the diagnosis of malignant lymphoma.
abstract: OBJECTIVE
  Lymph node enlargement in the neck is a common presentation of malignant lymphoma (ML) and requires tissue sampling for accurate diagnosis. Although delayed diagnosis may be critical for some patients, unnecessary biopsy should be avoided wherever possible. This study examined the process for determining the necessity to perform a biopsy and evaluated the value of an open biopsy as a diagnostic tool to enable definite subclassification of the disease.
  
  
  METHODS
  The subjects included 20 patients with suspected ML who underwent cervical lymph node extirpation at Okayama Saiseikai general hospital between 2007 and 2010. The decision to perform a biopsy was made based on the results of sonographic evaluation, fine needle aspiration cytology (FNAC), and serum levels of lactate dehydrase (LDH) and soluble interleukin-2 receptor (sIL-2r).
  
  
  RESULTS
  The diagnosis was ML in 15 patients (75%), Castleman's disease in 1 (5%), and benign lymphadenopathy in 4 (20%).
  
  
  CONCLUSIONS
  A lymph node biopsy remains the gold standard for the diagnostic evaluation of ML. Sonographic evaluation combined with serum levels of LDH and sIL-2r is useful in determining the need for biopsy. Many of the cases of ML where it was difficult to determine whether a biopsy should be performed were relatively low grade and critical conditions could be avoided by close observation of the patient.
authors.affiliation: Department of Otolaryngology, Head and Neck Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-Cho, Kita-Ku, Okayama 700-8558, Japan. y.orita@live.jp
authors.forename: Yorihisa
authors.initials: Y
authors.lastname: Orita
authors.forename: Soichiro
authors.initials: S
authors.lastname: Nose
authors.forename: Yasuharu
authors.initials: Y
authors.lastname: Sato
authors.forename: Kentaro
authors.initials: K
authors.lastname: Miki
authors.forename: Shuhei
authors.initials: S
authors.lastname: Domae
authors.forename: Misato
authors.initials: M
authors.lastname: Hirai
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Noyama
authors.forename: Kazuo
authors.initials: K
authors.lastname: Hamaya
authors.forename: Norio
authors.initials: N
authors.lastname: Kasai
authors.forename: Kazunori
authors.initials: K
authors.lastname: Nishizaki
authors.forename: Tadashi
authors.initials: T
authors.lastname: Yoshino
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D044963:Biopsy, Fine-Needle; D005260:Female; D006801:Humans; D006836:Hydro-Lyases / Q000097:blood; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000000981:diagnostic imaging; D008223:Lymphoma / Q000175:diagnosis* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009333:Neck; D015375:Receptors, Interleukin-2 / Q000097:blood; D021701:Sentinel Lymph Node Biopsy; D012995:Solubility; D014463:Ultrasonography; D055815:Young Adult
chemical_list: D015415:Biomarkers; D015375:Receptors, Interleukin-2; D006836:Hydro-Lyases; C045581:lactate dehydratase