Biopsy of Cervical Node

To the Editor.—  The evaluation of an adult with cervical lymphadenopathy leads to many diagnostic possibilities. This was represented via algorithm by Greenfield and Jordan. One of the major considerations, however, was not given its due importance. Metastatic carcinoma has long been known to be a major cause of cervical lymphadenopathy. One of the fundamental teachings of Martin and Romieu¹ was that asymmetric enlargement of one or more cervical lymph nodes in an adult was cancerous until proved otherwise. Naturally, other possibilities need to be considered, but carcinoma, especially with a primary lesion somewhere in the head and neck, must be close to the top of the diagnostic list and should not be considered as an afterthought.This is compounded by the authors, who direct the algorithm toward nurses and physician assistants who may not have acquired the skills of thoroughly examining the head and neck (nasopharyngoscopy and indirect