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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Recommendation Grading

Overview

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

October 15, 2024

Document Type

Guideline

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. 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. 

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

Scope

Diagnosis

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
  
 

Supplemental Methodology Resources

Data Supplement, Data Supplement

Methodology

Number of Source Documents
117
Literature Search Start Date
December 1, 2015
Literature Search End Date
February 1, 2016