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