Diagnosis

Document Overview

Design and created by Guideline Central in participation with the American Academy of Otolaryngology - Head and Neck Surgery Foundation.

Evaluation of the Neck Mass in Adults

American Academy of Otolaryngology - Head and Neck Surgery Foundation

Publication Date: Sep 10, 2017

Page Last Updated: May 5, 2026

Evidence Quality and Recommendation Grades

Evidence Quality and Recommendation Grades^a
Evidence Quality			Recommendation
Treatment and Harm	Diagnosis	Strength
A	High-quality RCTs	Systematic review of consistent cross-sectional studies	S	Strong recommendation
B	Consistent RCTs	Consistent individual cross-sectional studies	R	Recommendation
C	Observational studies	Nonconsecutive studies, case-control studies, or other studies of poor quality	O	Option
D	Case reports, consensus opinions		N	None
X	Exceptional situations with clear benefit		X

^a See full text guidelines for details.

Document Overview

Document Title: Evaluation of the Neck Mass in Adults

Authoring Society: American Academy of Otolaryngology - Head and Neck Surgery Foundation

Endorsing Societies

American Academy of Emergency Medicine

American Association of Oral and Maxillofacial Surgeons

American College of Radiology

American Society for Clinical Pathology

Society of Otorhinolaryngology and Head-Neck Nurses

Document Publication Date: Sep 10, 2017

Page Last Reviewed/Updated: May 5, 2026

Document Type: Guideline

Country of Publication: United States

Full Text Freely Available: Yes

Full Text Guideline: aao-hnsfjournals.onlinelibrary.wiley.com/doi/10.1177/0194599817722550

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

Supplemental Implementation Resources

Document Scope, Criteria, and Use Cases

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. Specific goals include reducing delays in diagnosis of HNSCC; promoting appropriate testing, including imaging, pathologic evaluation, and empiric medical therapies; reducing inappropriate testing; and promoting appropriate physical examination when cancer is suspected.

Scope: Diagnosis

Keywords: Head and Neck Squamous Cell Carcinoma, head and neck cancer, neck cancer, neck mass, squamous cell carcinoma

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, Operating and Recovery Room, Radiology Services

Intended Users: Dentist, Nurse, Nurse Practitioner, Physician, Physician Assistant, Radiology Technologist

Recommendation Development Processes & Methodology

PICO Questions

What is the overall incidence of neck masses as a presenting symptom, for all diagnoses (including inflammatory masses)?
What is the incidence of persistent neck masses (noninflammatory)?
How is the incidence of persistent neck masses expected to change as a result of increased incidence of HPV-positive HNSCC?
What is the overall cost burden of evaluation and diagnosis of neck masses?
What is the current length of delay in diagnosis of HNSCC presenting as a neck mass, and what is the impact of delay on outcomes?
How long is too long in terms of the duration of a neck mass before workup is indicated?
Does an FNA performed before CT scan interfere with appropriate radiology read of the neck mass?
For cystic masses, are there any radiologic findings that can be identified that would lead to a higher suspicion for malignancy?
What is the incidence of open biopsy, and what is the long-term impact on outcomes?

Supplemental Methodology Resources: Data Supplement Data Supplement

Number of Source Documents: 117

Literature Search Start Date: Tuesday, December 1, 2015

Literature Search End Date: Monday, February 1, 2016

Includes peer/external review process?: Yes

Includes public comment process?: Yes

Methodologist involvement?: Yes

Patient involvement?: No

Includes multi-disciplinary group?: Yes

Includes systematic review?: Yes

Grades quality of strength of evidence?: Yes

Grades quality of strength of recommendation?: Yes

Discloses funding source?: Yes

Discloses conflicts of interest?: Yes

Includes benefits/harms analysis with recommendations?: Yes

Evaluation of the Neck Mass in Adults

Diagnosis

Avoidance Of Antibiotic Therapy

Standalone Suspicious History

Standalone Suspicious Physical Examination

Additional Suspicious Signs and Symptoms

Follow Up of Patient Not At Increased Risk

Patient Education

Targeted Physical Examination

Imaging

Fine Needle Aspiration

Cystic Masses

Ancillary Tests

Examination Under Anesthesia of the Upper Aerodigestive Tract Before Open Biopsy

Evidence Quality and Recommendation Grades

Document Overview

Supplemental Implementation Resources

Document Scope, Criteria, and Use Cases

Recommendation Development Processes & Methodology