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Clinical Review Regular review

Management of lateral neck masses in adults

BMJ 2000; 320 doi: (Published 03 June 2000) Cite this as: BMJ 2000;320:1521
  1. Michael Gleeson, professor (,
  2. Amanda Herbert, consultantb,
  3. Aurelia Richardsa
  1. a Department of Otolaryngology and Skull Base Surgery, Guy's Hospital, London SE1 9RT
  2. b Department of Cytopathology, St Thomas's Hospital, London SE1 7EH
  1. Correspondence to: M Gleeson

    One of the most important considerations in an adult presenting with a lump in the neck is that the mass may represent a metastatic deposit from a primary cancer, often but not always in the upper respiratory or alimentary tract (fig 1). This is particularly so for middle aged or elderly patients, especially those who have smoked. In these groups of patients it is important that the primary tumour is found quickly—preferably without open biopsy—so that correct management of the disease can be instituted.1 Often, however, there are avoidable delays in making the diagnosis and obtaining the complete clinical picture. Therefore, an appropriate initial referral must be made for examination of the upper aerodigestive tract, and all those who play a part in the management of neck masses should be aware of the role of fine needle aspiration cytology.

    Summary points

    75% of lateral neck masses in patients over 40 years are caused by malignant tumours

    In the absence of overt signs of infection, a lateral neck mass is metastatic squamous cell carcinoma or lymphoma until proved otherwise

    The primary tumour can be detected in 50% of patients by clinical examination alone and in a further 10-15% by panendoscopy of the upper aerodigestive tract

    Fine needle aspiration biopsy is an accurate, sensitive, inexpensive, and rapid technique that can be performed in the clinic

    Excisional and incisional biopsy of cervical metastases results in a 2-3 times increased incidence of local treatment failure when compared with fine needle aspiration cytology

    Excisional biopsy of parotid tumours risks damage to the facial nerve and seeding of the wound, and recurrence may develop up to 20 years after the first attempt at resection

    Fig 1.

    Location of cervical lymph nodes most frequently affected by metastasis from named primary sites in head and neck


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