Evaluation of the Neck Mass in Adults
Publication Date: September 1, 2017
Last Updated: December 16, 2022
Diagnosis
Avoidance Of Antibiotic Therapy
Clinicians should NOT routinely prescribe antibiotic therapy for patients with a neck mass unless there are signs and symptoms of bacterial infection. ( C , R )
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Standalone Suspicious History
Clinicians should identify patients with a neck mass who are at increased risk for malignancy when the patient lacks a history of infectious etiology and the mass has been present for ≥2 weeks without significant fluctuation, or the mass is of uncertain duration. ( C , R )
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Standalone Suspicious Physical Examination
Clinicians should identify patients with a neck mass who are at increased risk for malignancy based on one or more of these physical examination characteristics: fixation to adjacent tissues, firm consistency, size >1.5 cm, and/or ulceration of overlying skin. ( C , R )
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Additional Suspicious Signs and Symptoms
Clinicians should conduct an initial history and physical examination for all adults with a neck mass to identify those patients with an increased risk for malignancy. ( C , R )
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Follow Up of Patient Not At Increased Risk
For patients with a neck mass who are not at increased risk for malignancy, clinicians or their designees should advise patients of criteria that would trigger the need for additional evaluation. Clinicians or their designees should also document a plan for follow up to assess resolution or final diagnosis. (C, R)
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Patient Education
For patients with a neck mass who are deemed at increased risk for malignancy, clinicians or their designees should explain to the patient the significance of being at increased risk, and explain any recommended diagnostic tests. ( C , R )
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Targeted Physical Examination
Clinicians should perform, or refer the patient to a clinician who can perform, a targeted physical examination (including visualizing the mucosa of the larynx, base of tongue, and pharynx), for patients with a neck mass deemed at increased risk for malignancy. ( C , R )
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Imaging
Clinicians should order a neck CT (or MRI) with contrast for patients with a neck mass deemed at increased risk for malignancy. ( B , S )
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Fine Needle Aspiration
Clinicians should perform FNA instead of open biopsy, or refer the patient to someone who can perform FNA, for patients with a neck mass deemed at increased risk for malignancy when the diagnosis of the neck mass remains uncertain. ( A , S )
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Cystic Masses
For patients with a neck mass deemed at increased risk for malignancy, clinicians should continue evaluation of patients with a cystic neck mass, as determined by FNA or imaging studies, until a diagnosis is obtained and should not assume the mass is benign. ( B , R )
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Ancillary Tests
Clinicians should obtain additional ancillary tests based on the patient's history and physical examination when a patient with a neck mass is at increased risk for malignancy and/or does not have a diagnosis after FNA and imaging. ( C , R )
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Examination Under Anesthesia of the Upper Aerodigestive Tract Before Open Biopsy
Clinicians should recommend examination of the upper aerodigestive tract (under anesthesia and before open biopsy) for patients with a neck mass who are at increased risk for malignancy and without a diagnosis or primary site identified by FNA, imaging, and/or ancillary tests. ( B , R )
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Title
Evaluation of the Neck Mass in Adults
Authoring Organization
American Academy of Otolaryngology - Head and Neck Surgery Foundation
Endorsing Organizations
American Academy of Emergency Medicine
American Association of Oral and Maxillofacial Surgeons
American Society for Clinical Pathology
Society of Otorhinolaryngology and Head-Neck Nurses
Publication Month/Year
September 1, 2017
Last Updated Month/Year
March 19, 2024
External Publication Status
Published
Country of Publication
US
Document Objectives
The primary purpose of this guideline is to promote the efficient, effective, and accurate diagnostic workup of neck masses to ensure that adults with potentially malignant disease receive prompt diagnosis and intervention to optimize outcomes.
Target Patient Population
Anyone ≥18 years old with a neck mass
Target Provider Population
Anyone who may be the first clinician whom a patient with a neck mass encounters
Inclusion Criteria
Male, Female, Adult, Older adult
Health Care Settings
Ambulatory, Emergency care, Hospital, Radiology services, Operating and recovery room
Intended Users
Dentist, nurse, nurse practitioner, physician, physician assistant, radiology technologist
Keywords
head and neck cancer, head and neck squamous cell carcinoma (HNSCC), squamous cell carcinoma, neck mass, neck cancer
Source Citation
Pynnonen MA, Gillespie MB, Roman B, et al. Clinical Practice Guideline: Evaluation of the Neck Mass in Adults. Otolaryngology–Head and Neck Surgery. 2017;157(2_suppl):S1-S30. doi:10.1177/0194599817722550
Methodology
Number of Source Documents
117
Literature Search Start Date
December 1, 2015
Literature Search End Date
February 1, 2016