Biopsy of neck lumps in adults should be preceded by examination of the upper aerodigestive tract.

Premature biopsy of a potentially malignant neck node compromises patient survival. Despite documented evidence that biopsy of a malignant neck mass prior to a search for a primary source will increase the incidence of regional recurrence and distance metastasis, patients are often referred for head and neck assessment having already had a positive neck node biopsy. We maintain that biopsy of an asymmetrically enlarged cervical lymph node in an adult should be preceded by full upper aerodigestive tract evaluation to include indirect laryngoscopy, a high resolution computed tomography scan and panendoscopy with free field biopsy.