Pynnonnen et al evaluated adults with a neck mass. They developed an algorithm for evaluating the patient. The authors are from multiple institutions in the United States.
Patient selection: adult with a neck mass
Decision points:
(1) evidence of a bacterial (or other) infection?
(2) one or more reasons to suspect malignancy?
(3) diagnosis obtained?
(4) resolution?
If there is evidence of a bacterial infection, then antibiotics are given. Ideally the pathogen should be identified and therapy given accordingly.
If there is reason to suspect malignancy, then:
(1) inform and educate the patient
(2) perform history and ENT physical exam
(3) perform contrast-enhanced CT or MRI of neck
(4) perform sampling for pathology (FNA, biopsy, other)
If a diagnosis is obtained then manage according to guidelines.
If the diagnosis is not obtained then continue workup with expanded exam. Do not assume that a cystic lesion is benign.
If the lesion is not infectious or suspicious for malignancy, then:
(1) perform history and physical exam
(2) perform ancillary tests as appropriate
(3) develop a plan for follow-up
If there is resolution of the mass then algorithm ends.
If the mass does not resolve then continue work-up until diagnosis made.
