What to do about a 1.1 cm mass in the neck found on ultrasound (US)?

From the Guidelines

For a 1.1 cm neck mass found on ultrasound, you should consult with a healthcare provider for proper evaluation and diagnosis, as the size of the mass warrants investigation, especially if you have risk factors such as smoking history, alcohol use, prior radiation exposure, or family history of head and neck cancer 1. The next step typically involves a complete head and neck examination by an otolaryngologist (ENT specialist) or primary care physician.

• Depending on the ultrasound characteristics and location of the mass, your doctor may recommend fine needle aspiration (FNA) biopsy to determine if the mass is benign or malignant 1.
• Additional imaging such as CT or MRI might be ordered to better characterize the mass and its relationship to surrounding structures 1. While waiting for your appointment, monitor the mass for any changes in size, pain, or associated symptoms like difficulty swallowing or breathing. Many neck masses are benign, such as reactive lymph nodes, thyroid nodules, or cysts, but proper evaluation is essential as some can represent more serious conditions including cancer. Do not attempt to drain or manipulate the mass yourself, as this could spread infection or complicate diagnosis. It is also important to note that the American Academy of Otolaryngology-Head and Neck Surgery recommends avoiding antibiotic therapy unless there are signs and symptoms of bacterial infection 1. Your healthcare provider will guide you through the diagnostic process and determine the best course of action based on your individual situation. In general, a strong recommendation is made for contrast-enhanced neck CT or contrast-enhanced neck MRI for patients with a neck mass deemed at risk for malignancy 1. Fine-needle aspiration (FNA) is also recommended instead of open biopsy for patients with a neck mass deemed at increased risk for malignancy when the diagnosis of the neck mass remains uncertain 1.

From the Research

Evaluation of a 1.1 cm Mass in the Neck

• A 1.1 cm mass in the neck found on ultrasound (US) requires further evaluation to determine its cause and appropriate treatment 2, 3, 4, 5, 6.
• The first step is to take a carefully taken history and perform a thorough physical examination to gather clues about the mass, including its location, size, consistency, and mobility 5.
• If the history and physical examination do not reveal an obvious cause, imaging studies such as contrast-enhanced computed tomography (CT) may be helpful in determining the etiology of the mass 4.
• A fine-needle aspiration biopsy can be performed to provide diagnostic information via cytology, Gram stain, and bacterial and acid-fast bacilli cultures, with a sensitivity and specificity of 77-97% and 93-100%, respectively, in detecting malignancy 4.
• The management of the mass depends on its cause, with antibiotic therapy sufficient for some inflammatory masses, and excision generally needed for congenital lesions and malignant neoplasms 2, 6.

Considerations for Biopsy and Excision

• Biopsy of a mass is considered for progressive growth, isolated nature or asymmetry of the mass, location (supraclavicular), development of symptoms associated with lymphoma, or static size (if > 3 cm) 2.
• Open biopsy of the mass should be accompanied by a frozen-section examination of the mass, and a concomitant definitive neck dissection should be performed if the mass proves to be metastatic carcinoma 2.
• Needle biopsy of the neck mass is the current standard of care if no cause of the mass is found on examination, and identified benign cystic lesions or lymphomas indicate a need for excision, either as definitive treatment or for diagnostic reasons 2.