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Aulino JM, Kirsch CFE, Burns J, Busse PM, Chakraborty S, Choudhri AF, Conley DB, Jones CU, Lee RK, Luttrull MD, Moritani T, Policeni B, Ryan ME, Shah LM, Sharma A, Shih RY, Subramaniam RM, Symko SC, Bykowski J. ACR Appropriateness Criteria ® Neck Mass-Adenopathy. J Am Coll Radiol 2020; 16:S150-S160. [PMID: 31054741 DOI: 10.1016/j.jacr.2019.02.025] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 02/08/2019] [Indexed: 11/26/2022]
Abstract
A palpable neck mass may be the result of neoplastic, congenital, or inflammatory disease. Older age suggests neoplasia, and a congenital etiology is more prevalent in the pediatric population. The imaging approach is based on the patient age, mass location, and clinical pulsatility. Underlying human papillomavirus-related malignancy should be considered in all age groups. Although the imaging appearance of some processes in the head and neck overlap, choosing the appropriate imaging examination may allow a specific diagnosis, or a limited differential diagnosis. Tissue sampling is indicated to confirm suspected malignancy. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
| | | | - Claudia F E Kirsch
- Panel Chair, Northwell Health, Zucker Hofstra School of Medicine at Northwell, Manhasset, New York
| | | | - Paul M Busse
- Massachusetts General Hospital, Boston, Massachusetts
| | - Santanu Chakraborty
- Ottawa Hospital Research Institute and the Department of Radiology, The University of Ottawa, Ottawa, Ontario, Canada, Canadian Association of Radiologists
| | - Asim F Choudhri
- Le Bonheur Children's Hospital, University of Tennessee Health Science Center, Memphis, Tennessee
| | - David B Conley
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, American Academy of Otolaryngology-Head and Neck Surgery
| | | | - Ryan K Lee
- Einstein Healthcare Network, Philadelphia, Pennsylvania
| | | | | | - Bruno Policeni
- University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Maura E Ryan
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | | | - Aseem Sharma
- Mallinckrodt Institute of Radiology, Saint Louis, Missouri
| | - Robert Y Shih
- Walter Reed National Military Medical Center, Bethesda, Maryland
| | | | | | - Julie Bykowski
- Specialty Chair, UC San Diego Health Center, San Diego, California
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Akkina SR, Kim RY, Stucken CL, Pynnonen MA, Bradford CR. The current practice of open neck mass biopsy in the diagnosis of head and neck cancer: A retrospective cohort study. Laryngoscope Investig Otolaryngol 2019; 4:57-61. [PMID: 30847391 PMCID: PMC6383295 DOI: 10.1002/lio2.240] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 11/08/2018] [Accepted: 11/29/2018] [Indexed: 11/08/2022] Open
Abstract
Objective To characterize current use of open neck mass biopsy for diagnosis of squamous cell carcinoma in patients presenting with a neck mass. Methods Using the University of Michigan Specialized Program of Research Excellence in Head and Neck Cancer patient database (2008-2014), we reviewed patients' referral documentation to identify those who received open neck mass biopsies as part of their squamous cell carcinoma diagnosis. We compared subsequent treatment between patients who did and did not receive an open neck mass biopsy. Results Of 940 patients, 50 patients had received open neck mass biopsy leading to squamous cell carcinoma diagnosis. Only 19 of 50 patients (38%) had undergone fine-needle aspiration prior to open neck mass biopsy. There were no statistically significant differences in treatment or outcomes between patients who did and those who did not receive open neck mass biopsy. Conclusion Optimal care for patients who present with a neck mass is fine-needle aspiration. Unfortunately, these data show that many patients undergo open neck mass biopsy for diagnosis, often without prior fine-needle aspirate. Compared to fine-needle aspiration, open biopsy incurs additional risks of general anesthesia and greater surgical risks. While our data did not find statistically significant differences between treatment offered and outcomes, this small study was not expected to demonstrate a difference in outcomes. Further work is needed to promote the utility of fine-needle aspiration for diagnosis of neck mass and to discourage use of open neck mass biopsy as a primary diagnostic intervention. Level of Evidence 2c (Outcomes Research).
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Affiliation(s)
- Sarah R Akkina
- Department of Otolaryngology-Head and Neck Surgery University of Washington Seattle Washington
| | - Roderick Y Kim
- the Section of Oral and Maxillofacial Surgery University of Michigan Health System Ann Arbor Michigan
| | - Chaz L Stucken
- Department of Surgery; and the Department of Otolaryngology-Head and Neck Surgery University of Michigan Health System Ann Arbor Michigan
| | - Melissa A Pynnonen
- Department of Surgery; and the Department of Otolaryngology-Head and Neck Surgery University of Michigan Health System Ann Arbor Michigan
| | - Carol R Bradford
- Department of Surgery; and the Department of Otolaryngology-Head and Neck Surgery University of Michigan Health System Ann Arbor Michigan
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Moshtaghi O, Haidar YM, Mahmoodi A, Tjoa T, Armstrong WB. The Role of In-Office Ultrasound in the Diagnosis of Neck Masses. Otolaryngol Head Neck Surg 2017; 157:58-61. [PMID: 28669308 DOI: 10.1177/0194599817696288] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
To evaluate the efficacy of otolaryngologist-performed in-office ultrasound (US) in the clinical assessment of lateral neck masses, we performed a retrospective review of patients with lateral neck masses who had both a surgeon-performed US and US-guided fine-needle aspiration (USGFNA) at our tertiary academic center from 2012 to 2015. Fifty-nine patients were included. USGFNA results included 32 (54%) malignant lesions, 23 (39%) benign lesions, and 4 (6%) nondiagnostic lesions. USGFNA demonstrated 85% accuracy. In 22 (37%) patients, in-office US revealed additional findings that were not identified on physical examination (eg, nonpalpable lymph nodes or elucidated anatomical structures), which either assisted in surgical planning or altered treatment. In-office US and USGFNA on initial evaluation by the otolaryngologist augment physical examination and have potential value as the primary imaging and diagnostic modality in the workup of lateral neck masses.
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Affiliation(s)
- Omid Moshtaghi
- 1 Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine Medical Center, Orange, California, USA
| | - Yarah M Haidar
- 1 Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine Medical Center, Orange, California, USA
| | - Amin Mahmoodi
- 2 Department of Biomedical Engineering, University of California, Irvine, Orange, California
| | - Tjoson Tjoa
- 1 Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine Medical Center, Orange, California, USA
| | - William B Armstrong
- 1 Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine Medical Center, Orange, California, USA
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