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

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.