Ultrasonography in the treatment of a pediatric midline neck mass.

OBJECTIVE To assess the effectiveness of ultrasonography for determining which pediatric midline neck masses should be treated surgically. DESIGN Retrospective study. SETTING Tertiary care pediatric hospital. PATIENTS Pediatric patients with a midline neck mass who underwent ultrasonography from 2003 to 2011. MAIN OUTCOME MEASURES Demographics, ultrasonography, and surgical and pathology reports were studied. The ultrasonography findings and pathological analyses were compared. RESULTS One hundred twenty-two patients met the inclusion criteria. The most common diagnosis obtained by ultrasonography was thyroglossal duct cyst (48.4%), followed by reactive lymph node (27.9%). Ninety-five of 122 patients (77.9%) underwent surgery. Twenty-seven patients (22.1%) were treated nonsurgically. The diagnosis and characteristics obtained from ultrasonography were confirmed by surgical pathologic analysis in 84.2% of the surgical cases. Of the 95 patients who underwent surgery, 85 (89.5%) had a non-lymph node lesion diagnosed by ultrasonography and confirmed by pathologic analysis. Ultrasonography was only 66.1% accurate in specifically diagnosing thyroglossal duct cyst and 30.0% accurate in specifically diagnosing reactive lymph node when compared with surgical specimens. CONCLUSIONS Ultrasonography is helpful in determining the pediatric midline neck masses that need to be removed surgically. It is less helpful in determining the exact pathologic characteristics of the lesion.