Incisional Biopsy For Small Cell Lung Cancer With Neck Metastases

Why Is an Incisional Biopsy Performed in Small Cell Lung Cancer (SCLC) With Neck Metastases?

A 68-year-old female patient presented with complaints of increasing shortness of breath and increasing painless swellings in the neck. A tumoral mass image was detected in the middle section of the left lung on the patient's lung tomography. The patient has a 40 pack/year smoking history. The patient's endoscopic ENT examination and nasopharynx examination were evaluated as normal. In the patient's neck USG evaluation, especially in the left neck region 3, conglomerated, Doppler USG showed atypical increased blood flow pattern, rounded and fatty hilum could not be observed, and metastatic lymphadenopathy was detected. The patient underwent incisional biopsy of the lymph nodes in the left neck region 3 under hospital conditions and sedation anesthesia. General anesthesia was not preferred upon the recommendation of the anesthesiologist and the head and upper body were adjusted to be up. After the biopsy procedure, a hemovac drain was placed and the skin incision area was sutured with 4/0 prolene suture material. The images above and below are photographs taken 1 week after an incisional biopsy. An incisional biopsy is usually performed when there is a neck mass suspected of metastatic spread from known or suspected small cell lung cancer. This procedure involves surgically removing a portion of the abnormal tissue for histopathological examination. It helps confirm the presence of cancer and guides further treatment decisions. After histopathological examination of the excised lymph nodes in our patient, a diagnosis of small cell lung cancer metastasis was made and the patient was referred to an oncologist. Chemotherapy and radiation therapy were planned for the patient.

What Did We Learn from the Incisional Biopsy?

In this case, we performed an incisional biopsy on a patient with neck metastases from small cell lung cancer to:

• Confirm the origin of the neck mass, rule out differential diagnoses
• Assess the extent of metastasis
• Determine the histological features of the tumor
• Guide staging and treatment planning
• The biopsy confirmed metastatic small cell carcinoma in the cervical lymph nodes, consistent with a primary lung origin.

How is an incisional biopsy performed?

The procedure involves the following:

Local or general anesthesia may be preferred. In our patient, due to her poor general condition and respiratory distress, sedation anesthesia was preferred.

After local anesthetic injection, a small surgical incision is made to access the lymph node or neck mass. A portion of the lesion or cervical nodes is removed for histopathological analysis. When making the incision, an adequate amount of tissue should be removed and excessive cauterization of the incision edges should be avoided (which may make borderline cell evaluation difficult). Once the sample tissue is removed, the sample is sent to a pathologist who will analyze it under a microscope to identify cancer cells and their characteristics.

What Are the Risks of an Incisional Biopsy?

While it is generally safe, possible risks include:

• Minor bleeding or infection at the incision site (performing the procedure in sterile conditions and using a hospital environment can reduce these risks)
• Scars
• Temporary pain or swelling
• Rarely, tumor seeding (very rare)

These risks are minimal compared to the benefits of an accurate diagnosis.

What Happens After a Biopsy Confirms Neck Metastases?

At this stage, the patient is confirmed to have widespread lung cancer in their body. Once neck metastases from SCLC are confirmed, the following procedures may be performed:

• Restaging the cancer to assess the extent of spread (this may require additional imaging, PET CT)
• A treatment plan may be initiated, which may include chemotherapy, radiation, or immunotherapy
• Close monitoring of the patient for response to treatment and repeated imaging and blood work

This information is crucial for planning aggressive and targeted treatments.

How Does a Biopsy Help with Treatment Decisions?

A biopsy provides critical information about:

• Tumor type and grade (crucial in determining chemotherapy and radiation protocols)
• Molecular markers (in some cases)
• Extent of local invasion

This guides personalized treatment and helps predict prognosis.

Is Biopsy Always Necessary When Neck Metastases Are Suspected?

In many cases, yes. Although imaging methods can roughly determine that the mass growths in the neck are a cancer spread; a biopsy is required to determine which tumor these growths are caused by or which organ the tumor is metastasizing to the neck. Imaging or clinical findings confirm the diagnosis of metastatic disease in the neck, especially in patients with known lung cancer, and exclude other causes such as infection, lymphoma or other cancers. For example, a benign disease such as kissing disease, which causes advanced lymph node enlargement in the neck, and a carcinogenic disease due to metastasis of a lung tumor can sometimes be distinguished only by biopsy.

What is Small Cell Lung Cancer (SCLC)?

Small Cell Lung Cancer (SCLC) is an aggressive type of lung cancer that tends to grow quickly and spread early, often spreading to other parts of the body. Early diagnosis is important for successful treatment. One common site for metastasis is the lymph nodes in the neck.

Can Small Cell Lung Cancer Spread to the Neck?

Small Cell Lung Cancer often metastasizes to nearby lymph nodes, including those in the neck. This means that the tumor has spread beyond its location and can spread throughout the body. This type of spread is usually a sign that the cancer has reached an advanced stage and requires immediate, aggressive treatment.

What Are the Symptoms of Neck Metastases in SCLC?

Common symptoms of neck metastases in SCLC include:

• Swelling or lumps in the neck (usually painless swellings)
• When advanced, pain or discomfort in the throat may occur
• Patients may experience increased systemic symptoms such as fatigue, weight loss, and loss of appetite as the tumor burden increases
• Simultaneous growth of the tumor in the lungs may cause severe difficulty breathing, as in the patient here
• Difficulty swallowing
• Hoarseness or voice changes
• Fatigue or weakness

These symptoms may indicate cancer spread and should be evaluated immediately by a healthcare provider.

How Are Neck Metastases in SCLC Diagnosed?

A lump in the neck that grows and grows without any cause or pain may indicate a tumoral metastasis.

Diagnosis usually includes:

Physical Exam: Checking for a mass or swelling. During the ear, nose and throat examination, full endoscopic evaluation, nasopharynx, oropharynx, hypopharynx and larynx endoscopic examination can be performed. In contrast to infection-related lymph node enlargement, which can be oval and slightly painful, painless round or clustered (conglomerated) lymph nodes can be detected during palpation.

Imaging Tests: CT scan, PET scan or MRI to visualize cancer spread. Neck USG and Doppler USG may reveal findings such as atypical lymph node perfusion, loss of oval shape and inability to observe the fatty echogenic hilus.

Biopsy: A tissue sample can be taken from the neck lymph nodes to confirm the presence of cancer cells. In our patient, an incisional biopsy was performed on the left neck and a diagnosis of SCLC neck metastasis was made.

What are the Treatment Options for Neck Metastases in Small Cell Lung Cancer?

Treatment depends on the stage of the cancer and may include:

Chemotherapy: This is the main treatment for SCLC, usually combined with radiation. Our patient also received chemotherapy first.

Radiation Therapy: Targeted to the neck to shrink metastases.

Immunotherapy: Can be used to boost immune response in some cases. This treatment can be decided after immunohistochemical studies.

Palliative Care: Helps manage symptoms and improve quality of life in advanced cases

Early detection and a multidisciplinary approach can help improve outcomes.

How Do Neck Metastases Affect Prognosis in SCLC?

The presence of neck metastases usually indicates more advanced disease and can affect the overall prognosis. This indicates that the disease is more advanced and widespread. It can mean that patients have a shorter 5-year survival. However, with prompt and aggressive treatment, patients can experience relief of symptoms and, in some cases, long-term survival.

When Should You See a Doctor?

If you have been diagnosed with SCLC and notice any changes in your neck, such as swelling, pain, or new lumps, contact your oncologist immediately. An evaluation of neck lumps by an ENT specialist is helpful in diagnosis and treatment. Early intervention is important in managing metastatic spread.

Search result link where you can find articles prepared by Dr. Murat Enöz about neck biopsy and published on this website (you can also reach previous articles by clicking "more posts" at the end of the page) >> https://www.ent-istanbul.com/search?q=neck+biopsy

Source links >> Metastatic Lung Cancer to the Head and Neck: A Clinico-Pathological Study on 21 Cases with Narrative Review of the Literature - PMC

Murat Enoz, MD, Otorhinolaryngology, Head and Neck Surgeon

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