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Neck mass

Key sources
The following summarized guidelines for the evaluation and management of neck mass are prepared by our editorial team based on guidelines from the American Academy of Otolaryngology-Head and Neck Surgery Foundation (AAO-HNSF 2017).
1

Guidelines

1.Classification and risk stratification

Risk of malignancy
Classify patients with a neck mass as being at increased risk for malignancy if the patient lacks a history of infectious etiology and the mass has been present for ≥ 2 weeks without significant fluctuation, or if the mass is of uncertain duration.
B
Classify patients with a neck mass as being at increased risk for malignancy based if the mass is fixed to adjacent tissues, displays a firm consistency, has a size > 1.5 cm, and/or there is ulceration of overlying skin.
B
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2.Diagnostic investigations

Clinical assessment: conduct a history and physical examination for adults with a neck mass to identify those patients with other suspicious findings that represent an increased risk for malignancy.
B
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More topics in this section

  • Diagnostic imaging

  • Ancillary tests

3.Diagnostic procedures

Fine-needle aspiration
Perform FNA rather than open biopsy as the first-line method to obtain a tissue sample in patients with a neck mass deemed at increased risk for malignancy.
B
Complete a thorough and appropriate evaluation until a diagnosis is obtained in patients with a cystic neck mass who are deemed at high risk of malignancy. Avoid assuming prematurely that the mass is benign.
B

4.Medical management

Antibiotics: avoid routine antibiotic therapy for patients with a neck mass unless there are signs and symptoms of bacterial infection.
D

5.Therapeutic procedures

Examination under anesthesia: perform an examination of the upper aerodigestive tract under anesthesia prior to open biopsy for patients with a neck mass who are at increased risk for malignancy and in whom a primary site has not been identified via FNA, imaging, and/or ancillary tests.
B

6.Patient education

General counseling: counsel patients who are found to be at increased risk for malignancy regarding the significance of this finding, and any recommended diagnostic tests.
B

7.Follow-up and surveillance

General principles: advise patients with a neck mass who are not at increased risk for malignancy of criteria that would trigger the need for additional evaluation. Document a follow-up plan to discuss final diagnosis and/or assess resolution.
B