The American Academy of
Otolaryngology-Head and Neck Surgery Foundation has published the
"Clinical Practice Guideline: Evaluation of the Neck Mass in Adults."
These guidelines includes 12 recommendations how to reduce delays in diagnosis
of head and neck squamous cell carcinoma; promote appropriate testing,
including imaging, pathologic evaluation, and empiric medical therapies; reduce
inappropriate testing; and promote appropriate physical examination when cancer
is suspected.
The recommendations include these statements:
·
Clinicians should not
routinely prescribe antibiotic therapy for patients with a neck mass unless
there are signs and symptoms of bacterial infection.
·
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.
·
·
Clinicians should
identify patients with a neck mass who are at increased risk for malignancy
based on 1 of these physical examination characteristics: fixation to adjacent
tissues, firm consistency, size .1.5 cm, and/or ulceration of overlying skin.
·
·
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.
·
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.
·
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.
·
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.
·
Clinicians should
order neck computed tomography (CT; or magnetic resonance imaging
[MRI]) with contrast for patients with a neck mass deemed at increased risk for
malignancy.
·
Clinicians should
perform fine needle aspiration (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.
·
For patients with a neck
mass deemed at increased risk for malignancy, clinicians should continue
evaluation and perform additional ancillary tests of patients with a cystic neck
mass, as determined by FNA or imaging studies, until a diagnosis is obtained
and should not assume that the mass is benign.
Hopefully this guideline will 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.
Click here to read the executive summary of the guidelines, click here to read the guidelines and click here to read the plain language
summary.