From the Guidelines
The algorithm for managing neck adenoma begins with a thorough clinical evaluation, including history and physical examination, followed by imaging studies such as CT or MRI with contrast for patients at increased risk for malignancy, as recommended by 1 and 1. The initial assessment aims to identify patients at increased risk for malignancy based on factors such as the lack of infectious etiology, mass characteristics, and patient history. Key steps in the algorithm include:
- Clinical evaluation to identify suspicious history or physical examination findings, as outlined in 1.
- Imaging with CT or MRI with contrast for patients at increased risk, as strongly recommended by 1 and 1.
- 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 1. The management approach depends on the gland involved (thyroid, parathyroid, or salivary glands), with specific considerations for each type of adenoma, including the size of the adenoma, symptoms, and the presence of hyperparathyroidism. For example, thyroid adenomas may be observed with periodic ultrasound monitoring if benign, while symptomatic or large adenomas may require surgical excision. Parathyroid adenomas causing hyperparathyroidism typically require surgical removal, and salivary gland adenomas usually necessitate complete surgical excision. Postoperative care includes pain management, wound care, and follow-up to monitor for recurrence, balancing the need to rule out malignancy with the avoidance of unnecessary surgery for benign lesions.
From the Research
Diagnostic Approach for Neck Adenoma
The diagnostic approach for neck adenoma involves a combination of physical examination, imaging studies, and tissue sampling.
- A thorough medical history and physical examination are crucial in developing a differential diagnosis for patients with a neck mass 2, 3.
- Imaging studies, such as computed tomography (CT) scanning with contrast, can help determine the nature of the mass and guide further management 2, 4.
- Fine-needle aspiration biopsy (FNAB) can provide diagnostic information and has a high sensitivity and specificity for detecting malignancy 4, 5.
- Ultrasound (US) combined with FNAB has been shown to be a useful diagnostic tool for evaluating head and neck lesions, with high accuracy and specificity 5, 6.
Imaging Modalities
Different imaging modalities can be used to evaluate neck masses, including:
- Computed tomography (CT) scanning with contrast, which is often the initial diagnostic test of choice in adults 4.
- Ultrasound (US), which can be used in combination with FNAB to evaluate head and neck lesions 5, 6.
- CT angiography, which is recommended over magnetic resonance angiography for the evaluation of pulsatile neck masses 4.
Tissue Sampling
Tissue sampling is an important part of the diagnostic workup for neck adenoma.