Controversies in the Workup and Management of Cervical Lymphadenopathy

PROGRAM DESCRIPTION: The focus of this session is to clarify the workup for an adult patient with a neck mass. We will review the clinical practice guidelines for the workup of cervical lymphadenopathy and identify common deviations from this workup that are seen as referrals in head and neck surgical oncology practice. Through case-based presentations, we will examine the nuance of obtaining a history and physical exam and identify how the information elicited from the history and physical impacts the decision-making in obtaining one imaging modality or tissue diagnostic over another. We will review the strengths and weaknesses of each imaging modality (US, CT, MRI) and tissue diagnostic (FNA, core needle biopsy, excisional vs incisional biopsy). Three cases will be presented with differential diagnoses including but not limited to thyroid pathology, salivary pathology, lymphoma, benign lymphadenopathy, and upper aerodigestive tract squamous cell carcinoma. We will work through each case and discuss the rationale for the chosen radiologic and tissue diagnostics with commentary and insight from our expert panel. This topic has been identified as a knowledge gap and this session aims to provide general practitioners and comprehensive otolaryngologists with further guidance on a common consult seen in general practice as well as to identify patients who may benefit from early referral to head and neck oncology.

OUTCOME OBJECTIVE 1: Identify core components of the clinical practice guideline for evaluation of a neck mass in adults and identify common deviations from the guideline.

OUTCOME OBJECTIVE 2: Review the most frequently used imaging modalities for the workup of a head and neck mass (including US, CT, MRI) and discuss the utility of each in obtaining a diagnosis depending on the differential (ex: thyroid vs salivary vs lymphoma).

OUTCOME OBJECTIVE 3: Review FNA, core needle biopsy and open biopsy to discuss the benefits and risks of each and the diagnostic yield of each method based on the differential diagnosis.

BACKGROUND STATEMENT: This panel was presented at last year's conference however it was disrupted due to fire alarm dysfunction and we would like the opportunity to present this to the eager audience who arrived for the talk last year.

Comprehensive Otolaryngology Track Statement : This panel provides expertise from head and neck surgeons regarding a pathology that is commonly managed in comprehensive otolaryngology clinics. The anticipated audience is comprehensive otolaryngologists and advanced practice providers.