With the data on history, physical examination, and ultrasound result, we decided that ultrasound guided needle biopsies would be the first line of investigation for these lesions. Informed consent for the procedure was obtained from all the patients before biopsy. In general, FNA was carried out with the array probe guiding the placement of a 22-gauge fine needle within the largest node after sterilization without anesthesia. For CNB, the skin was sterilized and locally anaesthetized with 2% lidocaine. A modified non-advancing, disposable, spring-loaded cutting biopsy needle (Temno biopsy system, Allegiance Healthcare Corporation, McGaw Park, IL, USA) with 15-mm side-notch of 9 cm length and 18-gauge were used. All biopsies were done by the same experienced otolaryngologist (Li-Jen Liao) under real-time ultrasound guidance with freehand technique. Three times of tissue core biopsies were done for each patient. After the biopsy, all patients were asked to compress the puncture site and were evaluated for possible complications such as bleeding or bruising for half an hour before leaving the examination room.