Investigating Neck Masses
| TEST | PURPOSE / COMMENT |
| Endoscopy and biopsy | To identify primary tumor as source of metastatic node; used in all patients suspected of having neoplasia |
| Radionuclide scan | For lesions of anterior neck compartment; helpful in thyroid lesions and in localizing a lesion within a salivary gland |
| Ultrasonography | To differentiate solid from cystic masses; especially useful in congenital and developmental cysts; also a useful noninvasive technique for vascular lesions |
| Arteriography | For vascular lesions and tumors fixed to the carotid artery |
| Sialography | To diagnose diffuse sialadenopathies or to locate mass within or outside the gland |
| Computed tomography scan | Single most informative test; to differentiate cysts from solid lesions; to locate mass inside or outside a gland or nodal chain; cost limits its use |
| Magnetic resonance imaging | Provides similar information as computed tomography; T2-weighted images most useful for soft tissue involvement by tumor |
| Positron emission tomography scan | Currently used as a research tool for functional examination; useful for tumors and nodal identification; lacks anatomic detail |
| Radiography, plain | Rarely helpful in differentiating neck masses |
| Skin tests | Useful when chronic or granulomatous inflammatory lesions are suspected |
| Fine-needle biopsy | Most important as the initial invasive diagnostic procedure—current standard of care for initial biopsy; small-gauge aspiration needle used |
| Culture with sensitivity tests | For inflammatory tissue at open biopsy |
| Open biopsy | Done only after workup is complete and if diagnosis is still not evident; specimen for histologic frozen section; simultaneous, radical neck dissection may be necessary |
(Adapted from Otolaryngology - Head and Neck Surgery 3rd Ed. (1999), Cummings et al.)