Lateral cervical cysts: an Australian perspective

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.