Clinicopathological analysis of 400 cervical lymph node biopsies in patients with suspected malignancy

BACKGROUND: Cervical lymphadenopathy has a wide differential diagnosis ranging from benign inflammatory conditions to malignant diseases. When clinical evaluation and cytological methods are inconclusive, surgical lymph node biopsy remains the gold standard for definitive diagnosis. AIMS/OBJECTIVES: This study aimed to evaluate the clinicopathological distribution of diagnostic cervical lymph node biopsies performed in patients with cervical lymphadenopathy at a tertiary referral center. MATERIAL AND METHODS: This retrospective study included 400 patients who underwent excisional or incisional cervical lymph node biopsy for diagnostic purposes between January 2021 and December 2025. RESULTS: The mean age was 37.2 ± 22.4 years; 51.2% of patients were male and 25.3% were younger than 18 years. 57.2% of the biopsies were malignant, 39.2% benign, and 3.5% non-diagnostic. Malignancy was associated with male sex, older age, and larger lymph node size; the malignancy rate reached 92.9% when the lymph node size was ≥5 cm. The most frequent malignant category was leukemia/lymphoma (41.5%), followed by metastatic malignancy (14.5%). CONCLUSIONS AND SIGNIFICANCE: Surgical biopsy for cervical lymphadenopathy provides a high diagnostic yield in a tertiary care setting, with a substantial malignancy burden. Early tissue diagnosis may reduce diagnostic delay, particularly for large (≥5 cm) and lower-neck/supraclavicular lymph nodes.