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Eur Ann Otorhinolaryngol Head Neck Dis. 2019 Jun 8. pii: S1879-7296(19)30107-3. doi: 10.1016/j.anorl.2019.05.015. [Epub ahead of print]

Cystic form of cervical lymphadenopathy. Guidelines of the French Society of Otorhinolaryngology - Head and Neck Surgery (SFORL). Part 1: Diagnostic procedures for lymphadenopathy in case of cervical mass with cystic aspect.

Author information

1
Service d'ORL et chirurgie cervico-faciale, hôpital Claude Huriez, université de Lille, CHU de Lille, rue Michel Polonovski, 59000 Lille, France. Electronic address: francois.mouawad@chru-lille.fr.
2
Service d'ORL et chirurgie cervico-faciale, hôpital Claude Huriez, université de Lille, CHU de Lille, rue Michel Polonovski, 59000 Lille, France.
3
Centre de pathologie et d'imagerie, Paris 14(ème) et unité thyroïde et tumeurs endocrines, hôpital La Pitié-Salpêtrière, 75013 Paris, France.
4
Service d'imagerie médicale, hôpital Bicêtre, Assistance publique Hôpitaux de Paris, Kremlin Bicêtre, 94270 Paris, France.
5
Service d'imagerie médicale, Gustave Roussy, 94800 Villejuif, France.
6
Service de médecine nucléaire et Biophysique, hôpital Augustin Morvan, centre hospitalier régional universitaire, 29609 Brest, France.
7
Service de médecine nucléaire, institut universitaire du cancer de Toulouse Oncopole, 31100 Toulouse, France.
8
Société française d'ORL et chirurgie cervico-faciale, 75000 Paris, France.
9
Service d'ORL pédiatrique, centre hospitalier universitaire, 37000 Tours, France.
10
Service d'ORL et chirurgie cervico-faciale, centre hospitalier universitaire, 33000 Bordeaux, France.
11
Service d'ORL et chirurgie cervico-faciale, centre hospitalier universitaire, 34295 Montpellier, France.

Abstract

OBJECTIVES:

The authors present the guidelines of the French Society of Otorhinolaryngology - Head and Neck Surgery Society on diagnostic procedures for lymphadenopathy in case of a cervical mass with cystic aspect.

METHODS:

A multidisciplinary work-group was entrusted with a review of the scientific literature on the topic. Guidelines were drawn up, then read over by an editorial group independent of the work-group, and the final version was drawn up. Guidelines were graded as A, B, C or expert opinion, by decreasing level of evidence.

RESULTS:

In adults presenting a cystic cervical mass, it is recommended to suspect cervical lymphadenopathy: in order of decreasing frequency, cystic metastasis of head and neck squamous cell carcinoma, of undifferentiated nasopharyngeal carcinoma, and of thyroid papillary carcinoma (Grade C). On discovery of a cystic cervical mass on ultrasound, architectural elements indicating a lymph node and a thyroid nodule with signs of malignancy should be screened for, especially if the mass is located in levels III, IV or VI (Grade A). Malignant lymphadenopathy should be suspected in case of cervical mass with cystic component on CT (Grade B), but benign or malignant status cannot be diagnosed only on radiological data (CT or MRI) (Grade A), and 18-FDG PET-CT should be performed, particularly in case of inconclusive ultrasound-guided fine needle aspiration biopsy (Grade C).

KEYWORDS:

18-FDG PET-CT; Cystic adenopathy; Nasopharyngeal cancer; Oropharyngeal cancer; Thyroid papillary carcinoma

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