Clinicopathological Spectrum and Diagnostic Utility of Ultrasonography and Fine Needle Aspiration Cytology in Neck Masses: A Prospective Observational Study in a North Indian Population

Background: Neck masses comprise a diverse group of lesions with inflammatory, congenital, benign, and malignant etiologies. Accurate diagnosis is essential for timely management. This study evaluated the clinicopathological spectrum of neck masses and assessed the diagnostic role of ultrasonography (USG) and fine needle aspiration cytology (FNAC). Material and Methods: This prospective observational study included 100 consecutive patients with palpable neck swellings attending the Department of Otorhinolaryngology, Baba Raghav Das Medical College, Gorakhpur, from December 2023 to January 2026. All patients underwent clinical evaluation, ultrasonography, and FNAC. Thyroid lesions were classified using the ACR TI-RADS and Bethesda systems. Histopathological examination was performed in surgically managed cases wherever available. Results: Females constituted 83% of cases, and the 31–40-year age group was most commonly affected (30%). The thyroid gland (44%) was the commonest site, followed by cervical lymph nodes (32%). Ultrasonography demonstrated predominantly solid lesions (74%), with TI-RADS III being the most frequent category (37.5%). FNAC showed benign lesions in 67%, inflammatory lesions in 26%, neoplastic lesions in 4%, suspicious lesions in 2%, and malignant lesions in 1%. Granulomatous/tubercular lymphadenitis (23%) was the most common final diagnosis, followed by inflammatory lesions (18%) and colloid goitre (16%). A significant association was observed between TI-RADS category and FNAC diagnosis (p = 0.018). Conclusion: Neck masses predominantly involved the thyroid gland and were mostly benign. The combined use of clinical examination, ultrasonography, and FNAC provides an accurate, minimally invasive, and cost-effective approach for evaluating neck masses.

Keywords: Neck masses, Fine-needle aspiration cytology, Ultrasonography, Clinicopathological correlation, Cervical lymphadenopathy, Thyroid lesions, Diagnostic accuracy, Prospective observational study.