Research Gaps: Evaluation of the Neck Mass in Adults
During the process of guideline development, several important gaps in knowledge were identified regarding the epidemiology and appropriate management of adult neck masses. The guideline recommendations would be strengthened with research seeking to clarify this information. Several questions arose regarding the etiology and epidemiology of neck masses:
- What is the overall incidence of neck masses as a presenting symptom, for all diagnoses (including inflammatory masses)?
- What is the incidence of persistent neck masses (noninflammatory)?
- How is the incidence of persistent neck masses expected to change as a result of increased incidence of HPV-positive HNSCC?
- What is the overall cost burden of evaluation and diagnosis of neck masses?
- What is the current length of delay in diagnosis of HNSCC presenting as a neck mass, and what is the impact of delay on outcomes?
Other questions arose regarding management issues:
- How long is too long in terms of the duration of a neck mass before workup is indicated? (The GDG, citing other literature, states that the period should be 2 weeks.)
- Does an FNA performed before CT scan interfere with appropriate radiology read of the neck mass?
- For cystic masses, are there any radiologic findings that can be identified that would lead to a higher suspicion for malignancy?
- What is the incidence of open biopsy, and what is the long-term impact on outcomes?