Purpose or Case Report: The presence of abnormal masses in the neck of children always represents a diagnostic challenge. Ultrasound can provide useful information about the origin of an inflammatory mass in the neck and is effective in differentiating solid from cystic lesions. The aim of this study was to evaluate the diagnostic performance of ultrasound in the characterization of abnormal neck masses of the pediatric population.
Methods & Materials: In this observational, cross-sectional study neck ultrasound was performed in 56 children presenting with abnormal neck mass. In 33 patients computed tomography (CT) was also obtained. Patients were categorized into three diagnostic groups: lymphadenopathy, abscess, and miscellaneous masses. The gold standard was a combination of histopathological findings collected during surgery and clinical evolution during medical treatment.
Results: The median age was 6.35 years, and 57.1% were girls. The final diagnosis was lymphadenopathy in 26 (46.4%) patients, abscess in 10 (17.8%) and miscellaneous masses in 19 (33.9%). In one patient it was not possible to reach the final diagnosis. The first clinical diagnostic impression was correct in 32 (57.1%) cases, while ultrasound examination hit in 48 (85.7%) cases. For the correct diagnosis of adenopathies, ultrasound showed sensitivity (Sn), specificity (Sp), positive (PPV) and negative (NPV) predictive value of 98%, 94%, 95%, and 98%; respectively. For abscess, ultrasound exhibited Sn, Sp, PPV and NPV of 95%, 93%, 75%, and 99%; respectively. For miscellaneous neck masses Sn, Sp, PPV and NPV were 79%, 97%, 94%, and 90%; respectively. Notably, ultrasound showed a higher accuracy than CT (as shown by the ROC curve) in the correct identification of adenopathies (90% vs 82% respectively), abscess (93% vs 63% respectively) and miscellaneous masses (83% vs 67% respectively).
Conclusions: Our findings suggest that ultrasound should be the initial imaging approach in assessing abnormal neck masses in children.