From the Guidelines
The best approach for a neck mass involves a systematic evaluation beginning with a thorough history and physical examination to identify patients at increased risk for malignancy, as recommended by the clinical practice guideline: evaluation of the neck mass in adults 1.
Key Components of Evaluation
- Initial assessment should focus on risk factors such as age, smoking history, alcohol use, and duration of the mass.
- For adults with a neck mass, clinicians should identify those at increased risk for malignancy based on the absence of infectious etiology, duration of the mass, and physical examination characteristics such as fixation to adjacent tissues, firm consistency, size >1.5 cm, and/or ulceration of overlying skin 1.
Diagnostic Workup
- Imaging with CT or MRI with contrast is recommended for patients with a neck mass deemed at increased risk for malignancy, as it helps localize and characterize the mass, assess for additional nonpalpable masses, and screen visualized organs for potential sites of primary malignancy 1.
- Fine-needle aspiration (FNA) biopsy is recommended instead of open biopsy for patients with a neck mass deemed at increased risk for malignancy when the diagnosis remains uncertain, due to its lower risk of complications and ability to provide a tissue diagnosis 1.
Management
- Management depends on the diagnosis, with antibiotics recommended for bacterial infections, observation for viral lymphadenopathy, surgical excision for concerning masses, or specific treatment for thyroid disorders.
- Clinicians should document a plan for follow-up to assess resolution or final diagnosis for patients not at increased risk for malignancy, and explain the significance of being at increased risk and recommended diagnostic tests to patients deemed at increased risk 1.
Importance of Guidelines
- The clinical practice guideline: evaluation of the neck mass in adults provides an evidence-based framework for decision-making strategies, but it is not intended to replace clinical judgment or establish a protocol for all individuals with this condition 1.
From the Research
Approach to Neck Mass
The approach to a neck mass involves a careful medical history and a thorough physical examination to guide the need for further evaluation and management [ 2, 3 ].
Key Components of Evaluation
- A thorough gathering of historical information, including the location of the mass, its time of onset, and duration 3
- A complete physical examination to determine the size, consistency, and mobility of the mass 4
- Imaging studies, such as computed tomography scanning with contrast, may be used as an adjunct to the physical examination 3
- Ultrasound can play a useful role in the initial evaluation and management of adults presenting with a neck mass 5
Considerations for Referral
- Referral to an otolaryngologist is frequently warranted to obtain a definitive diagnosis and develop an appropriate treatment plan 3
- Surgical removal is often the treatment for congenital neck masses 4