2
Key Points
Table 1. Summary of Guideline Key Action Statements (KAS)
Statement Action Strength
1. Avoidance of
antibiotic therapy
Clinicians should NOT routinely prescribe
antibiotic therapy for patients with a neck mass
unless there are signs and symptoms of bacterial
infection.
R
2a. Standalone
suspicious history
Clinicians should identify patients with a neck
mass who are at increased risk for malignancy
because the patient lacks a history of infectious
etiolog y and the mass has been present for 2
weeks or longer without significant fluctuation, or
the mass is of uncertain duration.
R
2b. Standalone
suspicious
physical
examination
Clinicians should identify patients with a neck
mass who are at increased risk for malignancy
based on one or more of these physical
examination characteristics: fixation to adjacent
tissues, firm consistency, size greater than 1.5 cm,
and/or ulceration of overlying skin.
R
2c. Additional
suspicious signs
and symptoms
Clinicians should conduct an initial history and
physical examination for adults with a neck mass
to identify those patients with other suspicious
findings that represent an increased risk for
malignancy.
R
3. Follow up of the
patient not at
increased risk
For patients with a neck mass who are not at
increased risk for malignancy, clinicians or their
designees should advise patients of criteria that
would trigger the need for additional evaluation.
Clinicians or their designees should also
document a plan for follow up to assess resolution
or final diagnosis.
R
4. Patient education For patients with a neck mass who are deemed
at increased risk for malignancy, clinicians or
their designees should explain to the patient the
significance of being at increased risk, and explain
any recommended diagnostic tests.
R
5. Targeted physical
examination
Clinicians should perform, or refer the patient to
a clinician who can perform, a targeted physical
examination (including visualizing the mucosa
of the larynx, base of tongue, and pharynx) for
patients with a neck mass deemed at increased risk
for malignancy.
R
6. Imaging Clinicians should order a neck CT (or MRI) with
contrast for patients with a neck mass deemed at
increased risk for malignancy.
S
