[Lymph node metastases of unknown primary tumors. Sense and nonsense of a complicated search].
Malignant neoplasms are quite frequently (5% in our material) first diagnosed from their metastases. Detecting the site of the primary usually involves a time-consuming and costly work-up unpleasant for the patient. In a retrospective analysis of 60 cases of supraclavicular, cervical and axillary lymph node metastases, an attempt is made to establish guidelines for more economical and rational investigation. The most important but often neglected leads are provided by history and physical examination. Routine laboratory and X-ray examinations only rarely contribute to rapid detection of the primary. Histological examination of the excised lymph node is very reliable in suggesting possible primaries. A practical guide is given for the approach to a patient with lymph node metastasis of an unknown primary, based on a limited initial work-up and on the histology of the lymph node.