Cystic form of cervical lymphadenopathy. Guidelines of the French Society of Otorhinolaryngology - Head and Neck Surgery (SFORL). Part 1: Diagnostic procedures for lymphadenopathy in case of cervical mass with cystic aspect

Eur Ann Otorhinolaryngol Head Neck Dis. 2019 Nov;136(6):489-496. doi: 10.1016/j.anorl.2019.05.015. Epub 2019 Jun 9.


Objectives: The authors present the guidelines of the French Society of Otorhinolaryngology - Head and Neck Surgery Society on diagnostic procedures for lymphadenopathy in case of a cervical mass with cystic aspect.

Methods: A multidisciplinary work-group was entrusted with a review of the scientific literature on the topic. Guidelines were drawn up, then read over by an editorial group independent of the work-group, and the final version was drawn up. Guidelines were graded as A, B, C or expert opinion, by decreasing level of evidence.

Results: In adults presenting a cystic cervical mass, it is recommended to suspect cervical lymphadenopathy: in order of decreasing frequency, cystic metastasis of head and neck squamous cell carcinoma, of undifferentiated nasopharyngeal carcinoma, and of thyroid papillary carcinoma (Grade C). On discovery of a cystic cervical mass on ultrasound, architectural elements indicating a lymph node and a thyroid nodule with signs of malignancy should be screened for, especially if the mass is located in levels III, IV or VI (Grade A). Malignant lymphadenopathy should be suspected in case of cervical mass with cystic component on CT (Grade B), but benign or malignant status cannot be diagnosed only on radiological data (CT or MRI) (Grade A), and 18-FDG PET-CT should be performed, particularly in case of inconclusive ultrasound-guided fine needle aspiration biopsy (Grade C).

Keywords: 18-FDG PET-CT; Cystic adenopathy; Nasopharyngeal cancer; Oropharyngeal cancer; Thyroid papillary carcinoma.

Publication types

  • Practice Guideline

MeSH terms

  • Adult
  • Biopsy, Fine-Needle
  • Diagnosis, Differential
  • Fluorodeoxyglucose F18
  • Head and Neck Neoplasms / diagnosis*
  • Head and Neck Neoplasms / pathology
  • Head and Neck Neoplasms / surgery
  • Humans
  • Image-Guided Biopsy
  • Lymphadenopathy / diagnosis*
  • Lymphadenopathy / pathology
  • Lymphadenopathy / surgery
  • Magnetic Resonance Imaging
  • Nasopharyngeal Neoplasms / diagnosis
  • Nasopharyngeal Neoplasms / pathology
  • Nasopharyngeal Neoplasms / surgery
  • Oropharyngeal Neoplasms / diagnosis
  • Oropharyngeal Neoplasms / pathology
  • Oropharyngeal Neoplasms / surgery
  • Positron Emission Tomography Computed Tomography
  • Sensitivity and Specificity
  • Thyroid Cancer, Papillary / diagnosis
  • Thyroid Cancer, Papillary / pathology
  • Thyroid Cancer, Papillary / surgery
  • Thyroid Neoplasms / diagnosis
  • Thyroid Neoplasms / pathology
  • Thyroid Neoplasms / surgery
  • Tomography, X-Ray Computed
  • Ultrasonography


  • Fluorodeoxyglucose F18