D. Veivers MBBS, FRACS; J. Dent MBBS.
Lateral cervical cysts: an Australian perspective
Article first published online: 24 AUG 2012
© 2012 The Authors. ANZ Journal of Surgery © 2012 Royal Australasian College of Surgeons
ANZ Journal of Surgery
Volume 82, Issue 11, pages 799–802, November 2012
How to Cite
Veivers, D. and Dent, J. (2012), Lateral cervical cysts: an Australian perspective. ANZ Journal of Surgery, 82: 799–802. doi: 10.1111/j.1445-2197.2012.06187.x
- Issue published online: 4 NOV 2012
- Article first published online: 24 AUG 2012
- Manuscript Accepted: 5 JAN 2012
- branchial cyst;
- oropharynx neoplasm;
- squamous cell carcinoma
Correctly identifying the aetiology of lateral cervical cysts poses a diagnostic challenge commonly encountered by head and neck surgeons. The aim of this study was to ascertain the effectiveness of current investigatory techniques used in the diagnosis of these masses.
A retrospective analysis of all patients presenting to a single Sydney Head and Neck Unit between 2000 and 2010 with the diagnosis of a lateral cervical cyst was performed. Patients with a clinically evident primary malignancy were excluded from the study. Results of their clinical assessment and any investigations performed were compared with pathology after surgical excision.
Forty-seven patients met the inclusion criteria. Twelve of the 47 masses showed squamous cell carcinoma on histology post-operatively. The remainder of the masses (35 out of 47) were histologically diagnosed as branchial cleft cysts. Of the malignant tumours, 4 of 12 (33%) were correctly identified before cyst removal. Fine-needle aspiration (FNA) was performed in 37 of the 47 patients, with a sensitivity of 25% and a specificity of 96.6%. Notably, a false-positive result was obtained from FNA in a patient who had a final diagnosis of branchial cyst after modified radical neck dissection. The rate of malignancy in patients aged over 40 years (44%) was higher than that of the total group (25.5%) and significantly higher than that of patients aged below 40 years (0%).
Current techniques in the investigation of cystic neck masses are suboptimal in their accuracy. Clinical evaluation and, in particular, thorough examination of the oropharynx directly and by fibre-optic nasendoscopy will often reveal the presence of a primary cancer when present. Care must always be taken in the evaluation of such lesions to maximize the likelihood of making the correct diagnosis.