Guidelines Issued on Evaluating Neck Masses — Physician’s First Watch

Medical News |
September 11, 2017

Guidelines Issued on Evaluating Neck Masses

By Kelly Young

Edited by Susan Sadoughi, MD, and André Sofair, MD, MPH

The American Academy of Otolaryngology—Head and Neck Surgery has provided new guidelines for clinicians evaluating adults presenting with a neck mass.

Among the recommendations, published in Otolaryngology—Head and Neck Surgery and presented at the group's annual meeting:

  • Antibiotics shouldn't be prescribed for neck masses in the absence of signs and symptoms of a bacterial infection.

  • Patients are at elevated malignancy risk if they don't have a history of infectious etiology and the mass has been present for at least 2 weeks without major changes or if they don't know how long the mass has been present. Risk is also increased if a physical exam finds fixation to adjacent tissue, firm consistency, mass greater than 1.5 cm, or ulceration of overlying skin.

  • Patients with increased malignancy risk should undergo a targeted physical exam and either neck computed tomography or magnetic resonance imaging. When the diagnosis is uncertain in high-risk patients, fine needle aspiration is recommended.

  • If imaging or fine needle aspiration don't provide a diagnosis, clinicians should order ancillary tests.

Reader Comments (4)

nas rad

Excisional bipsy is needed if lymphoma is suspected

William Prince, MD, FRCSC Physician, Urology, Ontario, Canada

I wish that I had read these guidelines a year ago as my brother had a neck mass and was treated by his family doc with antibiotics three times before he saw an ENT guy. Now post chemo and RADS he is slowly improving. He also had a PEG tube and has lost about forty pounds in weight because of the inability to eat

BRIAN ZACK Physician, Pediatrics/Adolescent Medicine, Princeton University - retired

"Antibiotics shouldn't be prescribed for neck masses in the absence of signs and symptoms of a bacterial infection." - Really? This is now an official recommendation of American Academy of Otolaryngology? I am embarrassed for our profession.

James wallman Physician, Radiology, California

Recognizing the limitations, I would assume ultrasound is the 1st diagnostic test to be utilized in the usual clinically setting.

Your Comment

(will not be published)

Filtered HTML

  • Allowed HTML tags: <a> <em> <strong> <cite> <blockquote> <code> <ul> <ol> <li> <dl> <dt> <dd>
  • Web page addresses and e-mail addresses turn into links automatically.
  • Lines and paragraphs break automatically.

Plain text

  • No HTML tags allowed.
  • Web page addresses and e-mail addresses turn into links automatically.
  • Lines and paragraphs break automatically.
Do you have any conflict of interest to disclose?
CAPTCHA
This question is for testing whether you are a human visitor and to prevent automated spam submissions.

Vertical Tabs

* Required

Reader comments are intended to encourage lively discussion of clinical topics with your peers in the medical community. We ask that you keep your remarks to a reasonable length, and we reserve the right to withhold publication of remarks that do not meet this standard.

PRIVACY: We will not use your email address, submitted for a comment, for any other purpose nor sell, rent, or share your e-mail address with any third parties. Please see our Privacy Policy.