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Clinical Practice Guideline: Evaluation of the Neck Mass in Adults

Clinical Practice Guideline: Evaluation of the Neck Mass in Adults

This guideline was published as a supplement in the September 2017 issue of Otolaryngology—Head and Neck Surgery.

The primary purpose of this guideline is to promote the efficient, effective, and accurate diagnostic workup of neck masses to ensure that adults with potentially malignant disease receive prompt diagnosis and intervention to optimize outcomes. Specific goals include reducing delays in diagnosis of HNSCC; promoting appropriate testing, including imaging, pathologic evaluation, and empiric medical therapies; reducing inappropriate testing; and promoting appropriate physical examination when cancer is suspected. The target patient for this guideline is anyone >18 years old with a neck mass. The target clinician for this guideline is anyone who may be the first clinician whom a patient with a neck mass encounters. This includes clinicians in primary care, dentistry, and emergency medicine, as well as pathologists and radiologists who have a role in diagnosing neck masses. This guideline does not apply to children. This guideline addresses the initial broad differential diagnosis of a neck mass in an adult. However, the intention is only to assist the clinician with a basic understanding of the broad array of possible entities. The intention is not to direct management of a neck mass known to originate from thyroid, salivary gland, mandibular, or dental pathology as management recommendations for these etiologies already exist. This guideline also does not address the subsequent management of specific pathologic entities, as treatment recommendations for benign and malignant neck masses can be found elsewhere. Instead, this guideline is restricted to addressing the appropriate work-up of an adult patient with a neck mass that may be malignant in order to expedite diagnosis and referral to a head and neck cancer specialist. The Guideline Development Group sought to craft a set of actionable statements relevant to diagnostic decisions made by a clinician in the workup of an adult patient with a neck mass. Furthermore, where possible, the Guideline Development Group incorporated evidence to promote high-quality and cost-effective care.

Leadership: Melissa A. Pynnonen, MD (Chair), M. Boyd Gillespie, MD, MSc (Assistant Chair), Benjamin Roman, MD, MSHP (Assistant Chair), Richard M. Rosenfeld, MD, MPH (Methodologist), David Tunkel, MD (Methodologist-in-Training)

Guideline Development Group: Laura Bontempo, MD, MEd, Itzhak Brook, MD, MSc, Davoren Ann Chick, MD, FACP, Maria Colandrea, DNP, NP-C, CORLN, CCRN, Sandra A. Finestone, PsyD, Jason C. Fowler, PA-C, Christopher C. Griffith, MD, Zeb Henson, MD, Corinna Levine, MD, MPH, Vikas Mehta, MD, Andrew Salama, DDS, MD, Joseph Scharpf, MD, Deborah R. Shatzkes, MD, Wendy B. Stern, MD, Jay S. Youngerman, MD

This guideline is endorsed by: 

American Academy of Physician Assistants (AAPA)
American Association of Oral and Maxillofacial Surgeons (AAOMS)
American Head and Neck Society (AHNS)
American Society for Clinical Pathology (ASCP)
American College of Radiology (ACR)
Head and Neck Cancer Alliance (HNCA)
American Academy of Emergency Medicine (AAEM)
Society of Otorhinolaryngology Head-Neck Nurses (SOHN)
The Triological Society