What is the evaluation of a left posterior cervical (neck) mass?

From the Guidelines

Evaluation of a left posterior neck mass should begin with a thorough physical examination and detailed patient history, focusing on duration, associated symptoms, and risk factors, as recommended by the clinical practice guideline: evaluation of the neck mass in adults 1. The initial assessment should identify patients at increased risk for malignancy based on the presence of a suspicious history, physical examination characteristics, or additional signs and symptoms, as outlined in the guideline's key action statements 1. Some key points to consider in the evaluation of a neck mass include:

• Avoidance of antibiotic therapy unless there are signs and symptoms of bacterial infection 1
• Identification of patients at increased risk for malignancy based on history and physical examination characteristics, such as fixation to adjacent tissues, firm consistency, size >1.5 cm, and/or ulceration of overlying skin 1
• Performance of a targeted physical examination, including visualization of the mucosa of the larynx, base of tongue, and pharynx, for patients deemed at increased risk for malignancy 1
• Ordering of neck computed tomography (or magnetic resonance imaging) with contrast for patients with a neck mass deemed at increased risk for malignancy, as strongly recommended by the guideline 1
• Consideration of fine-needle aspiration (FNA) biopsy for patients with a neck mass deemed at increased risk for malignancy when the diagnosis remains uncertain, as strongly recommended by the guideline 1 The differential diagnosis for a neck mass includes lymphadenopathy (reactive, infectious, or malignant), thyroid nodules, branchial cleft cysts, lipomas, neurogenic tumors, and metastatic disease, and prompt evaluation is crucial to rule out serious conditions, especially in adults with risk factors such as smoking, alcohol use, or prior radiation exposure 1. The guideline strongly recommends imaging with CT or MRI and FNA biopsy for patients at increased risk for malignancy, and these tests should be prioritized in the evaluation of a left posterior neck mass 1.

From the Research

Evaluation of Left Posterior Neck Mass

• A thorough medical history and physical examination are essential in evaluating a neck mass, including a left posterior neck mass, as stated in 2 and 3.
• The location, time of onset, and duration of the mass are important factors to consider, as they can help guide the differential diagnosis, according to 3.
• Imaging studies, such as computed tomography scanning with contrast, can be a valuable adjunct to the physical examination, as mentioned in 3.
• For posterior neck masses, the majority can be benign, with lipoma being the most common pathology, as found in 4.
• Patients presenting with posterior neck masses can be reassured of a low risk of malignancy, as reported in 4.
• The majority of posterior neck masses can be appropriately evaluated via physical examination and ultrasound, according to 4.
• Referral to a specialist, such as an otolaryngologist, may be warranted to obtain a definitive diagnosis and develop an appropriate treatment plan, as stated in 3 and 5.
• The evaluation of a neck mass, including a left posterior neck mass, should follow evidence-based guidelines, such as those outlined in 6, to ensure effective evaluation and diagnosis.