Effectiveness of differential diagnosis of primary neck masses in children

Aim. To assess the diagnostic features and accuracy of differential diagnosis of primary neck masses in pediatric patients, emphasizing the role of a reference center.

Materials and methods. A retrospective analysis was conducted patients (aged 1 month to 17 years) who underwent surgical treatment at the Dmitry Rogachev National Research Center (Moscow, Russia) between 2012 and 2022. Inclusion criteria were as follows: age under 18 years, presence of a primary non-visceral neck mass, and confirmed histopathological diagnosis.

Results. This study was performed using data collected from 153 patients. The study cohort included malignant neoplasms in 34.6% (53/153), benign neoplasms in 29.4% (45/153), and lymphatic malformations in 36.0% (55/153) of cases. The median age at disease onset was 1.40 years (0.01; 5.12), and at hospital admission – 2.58 years (1.02; 7.86). Lymphatic malformations were most commonly diagnosed in the prenatal and neonatal periods (52.7%, 29/55), malignant neoplasms typically presented before the age of 3 years (56.6%, 30/53), while benign neoplasms were more common in children older than 3 years (80.0%, 36/45). In 55.5% of cases, the initial outpatient diagnosis was revised upon hospitalization. Diagnostic biopsy performed outside of reference centers proved insufficiently informative: an accurate initial diagnosis was made in 23.5% (36/153) of patients in non-specialized facilities. Initial histopathological examination was carried out at the Dmitry Rogachev National Research Center in 54.9% (84/153) of cases and remained unchanged in 98.7% (151/153) following internal review.

Conclusion. Non-visceral neck masses in children are frequently misdiagnosed at the outpatient stage. This study highlights the importance of a multidisciplinary approach – including imaging, biopsy, and slide review in reference centers – to improve diagnostic accuracy and guide optimal treatment strategy.

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