Evaluation of a neck mass
- Daniel G Deschler, MD, FACS
Daniel G Deschler, MD, FACS
- Section Editor — Otorhinolaryngology
- Professor of Otology and Laryngology
- Harvard Medical School
A new neck mass is a relatively common head and neck problem in patients presenting to physicians. There often are no associated symptoms, other than the recognition of a "new lump" noted incidentally on palpation while grooming or noticed by another individual.
Evaluation of the neck mass must be approached in a thorough and disciplined manner. The mass may be the only manifestation of a serious and potentially malignant pathology, especially in the adult population.
The differential diagnosis in a patient presenting with a neck mass is often extensive and will vary with the age of the patient at presentation. A thorough history and physical examination are essential steps in the evaluation [1,2]. This will narrow the diagnostic possibilities and help determine the appropriate next diagnostic steps, as outlined in an algorithm (algorithm 1).
The diagnostic approach to evaluation of a neck mass will be reviewed here. The differential diagnosis is discussed separately. (See "Differential diagnosis of a neck mass".)
A thorough patient history will often narrow the differential diagnosis of a neck mass.
- Alvi A, Johnson JT. The neck mass. A challenging differential diagnosis. Postgrad Med 1995; 97:87.
- Weymuller EA Jr. Evaluation of neck masses. J Fam Pract 1980; 11:1099.
- Enepekides DJ. Management of congenital anomalies of the neck. Facial Plast Surg Clin North Am 2001; 9:131.
- Otto RA, Bowes AK. Neck masses: benign or malignant? Sorting out the causes by age-group. Postgrad Med 1990; 88:199.
- Turkington JR, Paterson A, Sweeney LE, Thornbury GD. Neck masses in children. Br J Radiol 2005; 78:75.
- Brown RL, Azizkhan RG. Pediatric head and neck lesions. Pediatr Clin North Am 1998; 45:889.
- Mendenhall WM, Mancuso AA, Amdur RJ, et al. Squamous cell carcinoma metastatic to the neck from an unknown head and neck primary site. Am J Otolaryngol 2001; 22:261.
- Ruhl C. Evaluation of the neck mass. Med Health R I 2004; 87:307.
- Weber AL, Rahemtullah A, Ferry JA. Hodgkin and non-Hodgkin lymphoma of the head and neck: clinical, pathologic, and imaging evaluation. Neuroimaging Clin N Am 2003; 13:371.
- Gourin CG, Johnson JT. Incidence of unsuspected metastases in lateral cervical cysts. Laryngoscope 2000; 110:1637.
- Kupferman ME, Patterson M, Mandel SJ, et al. Patterns of lateral neck metastasis in papillary thyroid carcinoma. Arch Otolaryngol Head Neck Surg 2004; 130:857.
- Wei WI, Sham JS. Nasopharyngeal carcinoma. Lancet 2005; 365:2041.
- Giridharan W, Hughes J, Fenton JE, Jones AS. Lymph node metastases in the lower neck. Clin Otolaryngol Allied Sci 2003; 28:221.
- Pellitteri PK, Rinaldo A, Myssiorek D, et al. Paragangliomas of the head and neck. Oral Oncol 2004; 40:563.
- Weber AL, Romo L, Hashmi S. Malignant tumors of the oral cavity and oropharynx: clinical, pathologic, and radiologic evaluation. Neuroimaging Clin N Am 2003; 13:443.
- Wetmore RF, Mahboubi S, Soyupak SK. Computed tomography in the evaluation of pediatric neck infections. Otolaryngol Head Neck Surg 1998; 119:624.
- Sakai O, Curtin HD, Romo LV, Som PM. Lymph node pathology. Benign proliferative, lymphoma, and metastatic disease. Radiol Clin North Am 2000; 38:979.
- Chang DB, Yang PC, Luh KT, et al. Ultrasonic evaluation of cervical lymphadenopathy. J Formos Med Assoc 1990; 89:286.
- Douglas SA, Jennings S, Owen VM, et al. Is ultrasound useful for evaluating paediatric inflammatory neck masses? Clin Otolaryngol 2005; 30:526.
- Gritzmann N, Hollerweger A, Macheiner P, Rettenbacher T. Sonography of soft tissue masses of the neck. J Clin Ultrasound 2002; 30:356.
- Ishikawa M, Anzai Y. MR imaging of lymph nodes in the head and neck. Neuroimaging Clin N Am 2004; 14:679.
- McGuirt WF, Greven K, Williams D 3rd, et al. PET scanning in head and neck oncology: a review. Head Neck 1998; 20:208.
- Amedee RG, Dhurandhar NR. Fine-needle aspiration biopsy. Laryngoscope 2001; 111:1551.
- Tatomirovic Z, Skuletic V, Bokun R, et al. Fine needle aspiration cytology in the diagnosis of head and neck masses: accuracy and diagnostic problems. J BUON 2009; 14:653.
- Layfield LJ. Fine-needle aspiration in the diagnosis of head and neck lesions: a review and discussion of problems in differential diagnosis. Diagn Cytopathol 2007; 35:798.
- Carroll CM, Nazeer U, Timon CI. The accuracy of fine-needle aspiration biopsy in the diagnosis of head and neck masses. Ir J Med Sci 1998; 167:149.
- Tryggvason G, Gailey MP, Hulstein SL, et al. Accuracy of fine-needle aspiration and imaging in the preoperative workup of salivary gland mass lesions treated surgically. Laryngoscope 2013; 123:158.
- Cho HW, Kim J, Choi J, et al. Sonographically guided fine-needle aspiration biopsy of major salivary gland masses: a review of 245 cases. AJR Am J Roentgenol 2011; 196:1160.
- PATIENT HISTORY
- Mass growth pattern
- Other history
- PHYSICAL EXAMINATION
- Anatomy of the neck
- Mass localization
- Characteristics of the mass
- Components of the general examination
- LABORATORY STUDIES
- IMAGING STUDIES
- DIAGNOSTIC STUDIES
- Fine-needle aspiration
- Core biopsy
- Excisional or incisional biopsy
- SUMMARY AND RECOMMENDATIONS