Evaluation of Neck Masses in the Population of District Dir Lower, Pakistan; A Systematic Approach

Background: Neck masses whether benign or malignant are abnormal growths or lumps that develop in the neck area, and are a common clinical concern. Organized and accurate diagnostic methods are essential for their proper evaluation and management. Aim: This study was conducted to determine the types of neck masses and their association with multiple neck-related diseases using various diagnostic tools among patients belonging to District Lower Dir, Pakistan. Methodology: A comprehensive evaluation of neck masses was conducted in 242 patients including males and females of different ages by using physical examination, ultrasonography, fine needle aspiration cytology (FNAC), gene Xpert, and ultrasound-guided FNAC (USG-FNAC) analyses. Results: Among total patients, 50.41% were males while 49.58% were females. Furthermore, acute, sub-acute, and chronic neck masses were observed in patients 10-70 years old. The ages of 30.5% patients were 10-20 years old, 48.3% were 21-40 years and 21% were 41-70 years old, reported with neck masses. Abscesses and benign thyroid diseases were more common in the 21-40 years age group. However, metastatic squamous carcinoma was predominantly detected in patients from 41-70 years. Furthermore, malignancies were more frequent in patients over 50 years, whereas neck masses in younger patients were typically non-malignant. The patients diagnosed with neck mass through physical examination, ultrasonography, FNAC, Gene Xpert and USG-FNAC were 24.79, 28.09, 22.31, 14.87, and 9.92%, respectively. Among physically diagnosed patients, further neck mass-related diseases were detected as a dermoid cyst (25%), preauricular sinus (11.66%), cervical lymphadenitis (25%), hematoma pinna ear (11.66%), seroma pinna ear (5%), thyroiditis (10%) and lipoma (11.66%). In addition, diseases like thyroglossal duct cysts (14.70%), abscesses (70.58%), pharyngeal pouch (1.47%), bronchial cysts (10.29%) and Ludwig angina (2.94%) were identified with ultrasonography. The patients diagnosed with FNAC have benign thyroid diseases (42.22%), pleomorphic adenoma (16.66%), cystic hygroma (1.11%) and cervical tuberculosis (40%). Similarly, the patients diagnosed with USG-FNAC have medullary thyroid carcinoma (25%), metastatic squamous carcinoma (33.33%), papillary thyroid carcinoma (8.33%), lymphoma (29.16%) and adenoid cystic carcinoma (4.16%). Conclusion: Our findings highlight the age-related incidence of malignancies in neck masses in the local population of the Dir district. Additionally, ultrasound-guided FNAC emerged as the most sensitive diagnostic method for evaluating neck masses.