The true malignancy rate in 135 patients with preoperative diagnosis of a lateral neck cyst

Abstract

ObjectiveIn this study, the true malignancy rate in 135 patients with a preoperative tentative diagnosis of a lateral neck cyst (LNC) was assessed. Furthermore, the sensitivity and specificity of fine needle aspiration of suspected LNC were evaluated and the diagnostic delay was analyzed.Study DesignThis study was retrospective in design and included all patients who had undergone surgery for a suspected LNC in four secondary hospitals in the eastern regions of Denmark during the period of 2009 to 2012.MethodsOne hundred thirty‐five patients were identified and included by means of a search strategy for NOMECO surgical procedure codes KENB40A+B in the electronic surgical booking systems. Because the procedure codes also include median neck cysts and fistulas, the latter were excluded manually.ResultsOf the 135 patients preoperatively diagnosed with LNC, a malignant postoperative histopathological diagnosis was revealed in 19 patients (14.4%). Of these, three individuals were between 35 to 40 years of age. In 17 cases, preoperative fine‐needle aspiration biopsy showed benign cytology, whereas histopathology postoperatively proved to be malignant. This renders a sensitivity of 88.8% and a specificity of 60.0% for fine needle aspiration biopsy with regard to LNC diagnostics.ConclusionThis study suggests that, for patients older than 35 years, a cystic lateral neck mass should be considered potentially malignant; by contrast, LNC is a diagnosis of exclusion. Any delay in treatment should be avoided until final histopathological diagnosis has been obtained. Arguably, all patients older than 35 years with a cystic lesion laterally on the neck should be included in the fast‐track cancer referral program.Level of Evidence2b.

Branchial cyst: a diagnosis of exclusion

“…Our incidence of 14% cancer in lateral neck cysts is in keeping with other such reports (6.9% -22%) [1,2,3] . This study was initiated in 2003-4 after two 'near misses' in such lateral cysts in whom the cancer was picked up by the senior author who had not long since joined the team in Northamptonshire.…”

Clinical and ultrasound characteristics of pediatric lateral neck masses

“…Authors Riva et al reported a monocentric study with 190 pediatric patients with neck masses localized in all regions of the neck [ 15 ]. The three largest studies investigating LNM in adult population included data from 135 patients and were monocentric [ 16 , 17 ], and multicentric [ 18 ]. Therefore, this study presents the largest monocentric patient cohort to date, involving 250 children who underwent surgical treatment or sclerotherapy for a LNM.…”

Multiple simple cystic metastases in the lateral neck at presentation with papillary thyroid microcarcinoma

“…The false-negative range of FNAB is 33% to 83% in the diagnosis of cervical cystic metastasis. [ 8 ] However, this may be attributed to sampling errors, and specimens can be obtained from the wall or solid part of the capsule to improve diagnostic accuracy. Moreover, the level of thyroglobulin (TG) can be measured to evaluate a metastatic cystic lesion of the thyroid.…”