From the Guidelines
The workup for a tongue mass should begin with a thorough history and physical examination, focusing on risk factors like tobacco and alcohol use, duration of symptoms, and associated pain or functional impairment, as recommended by the clinical practice guideline for evaluation of the neck mass in adults 1.
Key Components of the Workup
- Direct visualization and palpation of the mass are essential, including a targeted physical examination to visualize the mucosa of the larynx, base of tongue, and pharynx for patients with a neck mass deemed at increased risk for malignancy 1.
- Initial diagnostic steps include complete blood count, comprehensive metabolic panel, and imaging studies such as CT scan with contrast or MRI to assess the extent of the lesion and potential lymph node involvement 1.
- Biopsy is the gold standard for diagnosis and should be performed promptly, typically as an incisional biopsy for larger lesions or excisional biopsy for smaller ones, with fine needle aspiration used for initial assessment but often requiring follow-up with a more definitive biopsy 1.
Additional Considerations
- Depending on biopsy results, additional workup may include PET/CT scan for suspected malignancy to evaluate for metastatic disease 1.
- Prompt referral to otolaryngology or oral surgery is recommended, ideally within 1-2 weeks of identifying the mass, as early diagnosis significantly improves outcomes, particularly for malignancies 1.
- The patient should be educated on the significance of being at increased risk for malignancy and the recommended diagnostic tests, with a plan for follow-up to assess resolution or final diagnosis 1.
From the Research
Tongue Mass Workup
- A systematic approach is recommended for the diagnosis of a posterior tongue mass, considering neoplastic, infectious, and congenital categories 2
- Intraoral ultrasonography (IOUS) can be a useful technique for evaluating tongue mass lesions, providing information on the border, size, location, depth, and internal structure of the mass 3
- The most common diagnoses for mass lesions of the tongue include fibroma, mucous cyst, papilloma, hemangioma, and granuloma, with a low recurrence rate and potential surgical complications such as lingual nerve paralysis 4
Diagnostic Techniques
- Ultrasound tongue is a reliable imaging modality for pre-operative T staging by assessing tumor depth of invasion in carcinoma tongue patients, with good internal consistency according to the 8th AJCC staging system 5
- Diagnostic tests such as vital staining, oral cytology, and light-based detection can be used as adjuncts to conventional oral examination for detecting oral cancer and potentially malignant disorders, but their accuracy varies and none can replace surgical biopsy and histological assessment 6
- Oral cytology appears to offer the most potential as an adjunctive test, with relatively high values of sensitivity and specificity, and combined adjunctive tests involving cytology warrant further investigation 6
Considerations
- The risk of lingual nerve paralysis is higher at the ventral tongue, regardless of tumor size, and surgical complications can occur in a significant proportion of patients 4
- The choice of diagnostic technique and treatment approach should be individualized based on the specific characteristics of the tongue mass and the patient's overall health status 2, 3, 4, 5, 6