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Approach to Neck Masses &Thyroid NoduleBy: Amir Reza Honarmand (Chief Stager of Surgery )

Shariati Hospital Tehran

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Inflammatory Lesions

InfectiousBacterial strep/staph, cat scratch (bartonella), TB

Fungal actinomycosis

Viral (HIV, EBV, mumps)

Parasitic toxoplasmosis

Inflammatory

Granulomatous disease sarcoid

Reactive

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Lymphadenopathy

Normal nodes

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Drainage Patterns and NeckLevels

Level I (Submandibular / Submental)drain lip, oral cavity and submandibular gland

Level II (Upper jugular)

drain nasopharynx, oropharynx, parotid, and

supraglottic larynx

Level III (Mid jugular)

drain oropharynx, hypopharynx, and supraglottic

larynx

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Drainage Patterns and NeckLevels

Level IV (Lower jugular)

drain subglottic larynx, hypopharynx,esophagus,

and thyroid

Level V (Posterior triangle)drain nasopharynx and oropharynx

Level VI (Paratracheal)

drain thyroid and larynx

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Clinical Evaluation of NeckMass History

age (kids 80% benign, adults over 40

80% malignant), duration, growth,

fluctuation, tenderness, B symptoms,

oral/nasal/ear, skin, voice change, cough,

weight loss, SOB, dysphagia

Smoking Hx, Personal Ca History,

Previous irradiation, Family Ca Hx

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Fine Needle Aspiration ofNeck Masses

Sensitivity of 85 97% for tumours

Specificity of 88 98%

Non diagnostic 8 16%

Useful even for salivary lesions

to rule out

non-salivary pathology

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Laboratory Investigations

Base on suspicion from Hx and Px

CBC, LDH PPD

CXR for lower neck mass or lymphoma

Serology (toxoplasma, cat scratch, EBV)

US node character lucency, shape, hilar fat

Other imaging function of FNA result, eg CT with

SCC, or MRI if unlocalized primary

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Treatment of Metastatic

Squamous Cervical Cancer of

Unknown Primary

Indication for primary radiotherapy

Radical neck dissection may be

indicated when open biopsy proven

metastatic squamous carcinoma