Assessing the role of ultrasound for the evaluation of adult neck masses

Abstract

Objectives: The American Academy of Otolaryngology clinical practice guidelines recommend cross-sectional imaging or fine needle aspiration for any neck mass in an adult that persists beyond 2 weeks that is not convincingly related to a bacterial infection. We aimed to assess the role of ultrasound in the evaluation and management of neck masses.

Methods: A retrospective chart review was performed of adult patients evaluated in the Otolaryngology clinic at a single institution from December 2014 to December 2015 for a visible or palpable neck mass persistent beyond 2 weeks who had an ultrasound exam as part of their initial workup. Patients with a history of head and neck malignancy or those presenting wtih primary salivary or thyroid gland lesions were excluded. Sonographic features, demographics, imaging, and biopsy results were recorded.

Results: Of the 56 patients who met inclusion criteria, 36 (64.3%) received FNA or biopsy, of which 18 (50%) demonstrated malignant pathology. Twenty patients (35.7%) demonstrated benign features on ultrasound and did not undergo tissue sampling. Two of these 20 patients underwent subsequent cross-sectional imaging. Eight of these 20 patients were followed with serial ultrasound with an average of 3 exams over 14.7 months. The remaining 12 patients had spontaneous resolution of their adenopathy. None of these 20 patients was subsequently diagnosed with malignancy.

Conclusion: In this study, approximately one third of patients presenting with a visible or palpable neck mass were able to safely avoid cross-sectional imaging and/or tissue sampling when ultrasound demonstrated features consistent with benign pathology. Our results suggest that ultrasound can play a useful role in the initial evaluation and management of adults presenting with a neck mass.

Level of evidence: IV.

Keywords: cervical adenopathy; clinical practice guidelines; neck mass; ultrasound.