Neck mass in adults: Guideline for evaluation provides framework for timely diagnosis

With the development of the Clinical Practice Guideline: Evaluation of the Neck Mass in Adults, published today in Otolaryngology-Head and Neck Surgery and presented at the AAO-HNSF 2017 Annual Meeting & OTO Experience in Chicago, IL, the appropriate testing and physical examination of an adult with a neck mass is addressed, with a specific goal to reduce delays in diagnosis of malignant disease and to optimize outcomes.

"Neck masses are common in adults, but the underlying cause is not always easily identified. This guideline is an important instrument for the early diagnosis and treatment of potentially malignant growths, especially with the rise of HPV-related head and neck cancer. A neck mass may indicate a serious medical problem. It does not mean the patient has cancer, but it does mean they need more medical evaluation to make a diagnosis," said M. Boyd Gillespie, MD, MSc, guideline development group assistant chair.

Most persistent neck masses in adults are neoplasms, new and abnormal growths, and malignant growths far exceed any other. While the traditional patient profile for neck mass was an older adult, younger people infected with HPV are changing that expectation. If current trends continue, the incidence of HPV oropharyngeal (tonsil and base of tongue) head and neck squamous cell carcinoma will surpass HPV-positive cancer of the uterine cervix by 2020.

Forty years ago, patients with a neck mass experienced an average of a five- to six-month delay from the time of initial presentation to the diagnosis of malignancy. Today, studies continue to report delays as long as three to six months. The information in this guideline is targeted at anyone who may be the first clinician a patient with a neck mass encounters. This includes clinicians in primary care, dentistry, and emergency medicine, as well as pathologists and radiologists.

"In addition to crafting a set of actionable statements relevant to diagnostic decisions in the workup of an adult patient with a neck mass, the guideline also seeks to promote high quality and cost-effective care as well as educate patients about seeking medical attention when a neck mass presents," said Dr. Gillespie. The accompanying materials provide and patient information for adults with a neck mass.

The American Academy of Otolaryngology—Head and Neck Surgery Foundation (AAO-HNSF) guideline is endorsed to date by American Academy of Physician Assistants (AAPA), American Academy of Emergency Medicine (AAEM), American Association of Oral and Maxillofacial Surgeons (AAOMS), American College of Radiology (ACR), American Head and Neck Society (AHNS), American Society for Clinical Pathology (ASCP), Head and Neck Cancer Alliance, Society of Otorhinolaryngology Head-Neck Nurses (SOHN), and Triological Society.

The guideline was chaired by Melissa A. Pynnonen, MD, with M. Boyd Gillespie, MD, MSc, and Benjamin R. Roman, MD, MSHP, serving as assistant Chair, and Richard M. Rosenfeld, MD, MPH, as the methodologist, and David E. Tunkel, MD, as methodologist-in-training.