(0309) Diagnostic Yield of Neck Mass Imaging: Impact of Clinician Specialty

Introduction: While the American Academy of Otolaryngology Clinical Practice Guidelines for adult neck masses recommends a physical exam including the pharynx, base of tongue and larynx before formal imaging, it is unclear if the patient should be evaluated by an otolaryngologist (HNS) prior to obtaining formal imaging. The objective of this study is to investigate the diagnostic yield of formal neck imaging based on the specialty of the ordering clinician.

Methods: A retrospective chart review was conducted on a randomized cohort of patients within a multilocation HMO system who underwent neck imaging (CT, MRI, or US) for neck mass evaluation between January 1, 2021 and December 31, 2022. Imaging studies for suspected thyroid masses, surveillance of known masses, or incidental findings were excluded. A positive finding was defined as a relevant imaging finding corresponding to the area of suspicion noted by the ordering clinician or the skin marker placed by the radiology technician. Workup prior to imaging, including physical exam, flexible nasolaryngoscopy (FNL), and point-of-care ultrasound (POCUS), was also assessed.

Results: A total of 213 patients were included, with an average age of 54.5, and 64.3% were female. Imaging was ordered by OHNS and non-OHNS clinicians in 62 and 151 cases, respectively. CT was the most common study ordered (61.5%), followed by US (21.6%), and MRI (15%). Regarding workup prior to imaging, 172 patients (80.8%) had a physical exam, 15 (7%) had FNL, and 12 (5.6%) underwent POCUS. OHNS-ordered imaging had a higher diagnostic yield of 74.2% compared to non-OHNS diagnostic yield of 50.5% (p < 0.001). Diagnostic yield increased to 80% and 83.3% when FNL or POCUS was performed, respectively, and decreased to 42.4% without a physical exam. The most common diagnosis were normal anatomy, normal benign lymph nodes, and thyroid nodules. The overall rate of incidental findings was 17.8% with no significant difference based on specialty, and most commonly included thyroid and lung nodules.

Conclusions: In the workup of adult neck mass, the majority of imaging was ordered by non-OHNS and associated with a lower diagnostic yield compared to tests ordered by OHNS.