The Adult Neck Mass: Predictors of Malignancy

Abstract

Objective Distinguishing benign from malignant adult neck masses can be challenging because data to guide risk assessment are lacking. We examined patients with neck masses from an integrated health system to identify patient and mass factors associated with malignancy. Study Design Retrospective cohort. Setting Kaiser Permanente Northern California. Methods The medical records of adults referred to otolaryngology in 2017 for a neck mass were evaluated. Bivariate and multivariable logistic regression analyses were performed. Results Malignancy was found in 205 (5.0%) of the cohort’s 4103 patients. Patient factors associated with malignancy included sex, age, and race/ethnicity. Males had more than twice the odds of malignancy compared with females (adjusted odds ratio [aOR] = 2.38). Malignancy rates increased with age, ranging from 2.1% for patients younger than 40 years to 8.4% for patients 70 years or older. White non-Hispanic patients had 1.75 times the risk of malignancy compared with patients of other race/ethnicities. The percentage of patients with malignancy increased with increasing minimum mass dimension, from 3.0% in patients with mass size <1 cm to over 31% in patients with mass sizes 2 cm or larger ( P < .0001). Imaging-based mass factors most highly predictive of malignancy included larger minimum mass dimension (≥1.5 cm vs <1.5 cm: aOR = 3.87), multiple masses (2 or more vs 1: aOR = 5.07), and heterogeneous/ill-defined quality (aOR = 2.57). Conclusion Most neck masses referred to otolaryngology were not malignant. Increasing age, male sex, white non-Hispanic ethnicity, increasing minimum mass dimension, multiple neck masses, or heterogeneous architecture/ill-defined borders were associated with malignancy.

Aprendizaje radiológico basado en problema clínico específico: linfadenopatía cervical, tips clínicos y de imagen para facilitar su tipificación

“…Un riesgo del 5-10% de malignidad para masas en el cuello de adultos es significativo y amerita una cuidadosa evaluación. El estudio de Kshirsagar et al 22 confirma los factores conocidos del paciente para la malignidad (sexo y edad: los hombres tenían más del doble de probabilidades de malignidad en comparación con las mujeres (odds ratio ajustado: 2.38). Las tasas de malignidad aumentaron con la edad, desde el 2.1% para pacientes menores de 40 años hasta el 8.4% para pacientes de 70 años o más.…”