From the Guidelines
To properly assess a 41-year-old female with complaints of an anterior neck mass, begin with a thorough history and physical examination, and then proceed with imaging and fine-needle aspiration biopsy as necessary, as recommended by the clinical practice guideline for evaluation of the neck mass in adults 1. The initial assessment should include a complete neck examination, noting the size, consistency, mobility, and tenderness of the mass, as well as any lymphadenopathy. The patient's history should be evaluated to identify those at increased risk for malignancy, including a lack of infectious etiology, duration of the mass ≥2 weeks, and physical examination characteristics such as fixation to adjacent tissues, firm consistency, size >1.5 cm, and/or ulceration of overlying skin 1.
Key Components of the Assessment
- A thorough history to identify patients at increased risk for malignancy, including duration of the mass, associated symptoms, and physical examination characteristics 1
- A complete neck examination to evaluate the size, consistency, mobility, and tenderness of the mass, as well as any lymphadenopathy 1
- Imaging studies, such as neck computed tomography (CT) or magnetic resonance imaging (MRI) with contrast, to characterize the mass and assess for additional nonpalpable masses or invasion of surrounding structures 1
- Fine-needle aspiration (FNA) biopsy for cytological examination, which is recommended instead of open biopsy for patients with a neck mass deemed at increased risk for malignancy when the diagnosis remains uncertain 1
Additional Considerations
- Targeted physical examination, including visualizing the mucosa of the larynx, base of tongue, and pharynx, for patients with a neck mass deemed at increased risk for malignancy 1
- Patient education on the significance of being at increased risk for malignancy and the recommended diagnostic tests 1
- Consideration of additional ancillary tests, such as thyroid antibodies or calcitonin levels, based on the patient's history and physical examination 1 By following this systematic approach, clinicians can efficiently and effectively diagnose and manage neck masses in adults, reducing delays in diagnosis and promoting optimal outcomes 1.
From the Research
Assessment of Anterior Neck Mass
The proper assessment for a 41-year-old female with complaints of an anterior neck mass involves several steps, including:
- Clinical evaluation to identify any worrisome features such as rapid growth, attachment to adjacent tissues, new hoarseness, or palpable lymphadenopathy 2
- Ultrasonographic examination to identify suspicious features such as microcalcifications, rounded shape, or predominantly solid composition 2, 3
- Fine-needle aspiration (FNA) biopsy for nodules with suspicious features or for nodules that are firm, palpable, and solitary 4, 2, 3
- Consideration of patient's medical history, including any history of head and neck malignancy, radiation to the head and neck, or family history of thyroid cancer 2
Role of Ultrasound
Ultrasound can play a useful role in the initial evaluation and management of adults presenting with a neck mass, allowing for the identification of benign features and potentially avoiding the need for cross-sectional imaging or tissue sampling 5
- Ultrasound can help identify features consistent with benign pathology, such as low echodensity, regular borders, and lack of intense vascularization 3
- Ultrasound can also guide FNA biopsy for nodules with suspicious features 4, 2, 3
Differential Diagnosis
The differential diagnosis for an anterior neck mass includes:
- Thyroid nodules, which are common and often benign, but may require FNA biopsy to rule out malignancy 4, 2, 3
- Thyroglossal duct cysts, which may occur after an upper respiratory tract infection and require complete removal to prevent recurrence 6
- Other benign or malignant lesions, such as lymphadenopathy or salivary gland lesions, which may require further evaluation and management 5