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Evaluation of Neck Masses in Adults

This article was corrected on March 2, 2026.

Jason Wilbur, MD
Valery L. Tran, MD
Marc F. Doobay, MPAS, PA-C

American Family Physician. 2026;113(2):156-165.

Author disclosure: No relevant financial relationships.

This clinical content conforms to AAFP criteria for CME.

Neck masses are common in the outpatient setting. Although the differential diagnosis is broad, 95% of neck masses are benign. Efficiently identifying malignant masses is a priority. An investigatory framework allows for accurate diagnosis without delays in care. Human papillomavirus–related oropharyngeal squamous cell carcinoma constitutes approximately 70% of new head and neck cancer diagnoses. The differential diagnosis of a neck mass can be divided into three categories based on acuity: acute (eg, infection), subacute (eg, malignancy), and chronic (eg, congenital, thyroid). When a diagnosis cannot be made by history, risk factors, and physical examination alone, imaging or biopsy is indicated. Contrast-enhanced computed tomography is recommended for most nonpulsatile, nonthyroid masses. For thyroid masses, ultrasonography is the imaging modality of choice. Contrast-enhanced magnetic resonance imaging, computed tomography angiography, and positron emission tomography are preferred in cases of cranial nerve involvement, pulsatile masses, and potential metastases, respectively. When biopsy is indicated, fine-needle aspiration is recommended. In the detection of malignancy, fine-needle aspiration has an accuracy of 93%, sensitivity of 90%, and specificity of 97%, regardless of anatomic site.

JASON WILBUR, MD, FAAFP, is a clinical professor and vice chair for education, Department of Family and Community Medicine, University of Iowa Roy J. and Lucille A. Carver College of Medicine, Iowa City.

VALERY L. TRAN, MD, is a clinical assistant professor, Department of Family and Community Medicine, University of Iowa Roy J. and Lucille A. Carver College of Medicine, Iowa City.

MARC F. DOOBAY, MPAS, PA-C, is a clinical assistant professor, Department of Family and Community Medicine, University of Iowa Roy J. and Lucille A. Carver College of Medicine, Iowa City.

Address correspondence to Jason Wilbur, MD, FAAFP, at jason-wilbur@uiowa.edu.

Author disclosure: No relevant financial relationships.

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