Differenzierung von benignen und malignen Halszysten – eine diagnostische Herausforderung

Zusammenfassung

Hintergrund

Die Differenzierung von benignen und malignen Halszysten stellt für den HNO-Arzt eine Herausforderung dar. Die Inzidenz von Karzinomen in initial benigne eingestuften Halszysten liegt bei bis zu 24%. Das Ziel dieser Studie war es, über die Malignitätsrate von zystischen zervikalen Läsionen zu berichten und mittels aktueller Leitlinien eine Differenzierung von zervikalen Metastasen im Vergleich zu benignen Halszysten zu erleichtern.

Material und Methoden

Zwischen 2013 und 2023 wurden insgesamt 155 Patienten mit der Verdachtsdiagnose einer lateralen Halszyste in der Abteilung für Hals-, Nasen- und Ohrenheilkunde des Universitätsklinikums Heidelberg behandelt. Bei allen Patienten wurde eine Zystenexstirpation mit oder ohne Panendoskopie durchgeführt.

Ergebnisse

Bei 21,9% der Patienten zeigte sich histologisch eine Lymphknotenmetastase ipsilateral zum Primarius. Das Durchschnittsalter dieser Patienten lag statistisch signifikant höher als das der Patienten mit benignen Läsionen (64,0±12,8 versus 41,0±15,8; p<0,001). Während die Wahrscheinlichkeit einer Malignität bei Patienten unter 54 Jahren selten war (11%), stieg sie in der Altersgruppe von 60–69 Jahren auf 80% an. Die klinische Sensitivität bei Initialverdacht einer benignen Halszyste lag bei 60,3%, die Spezifität bei 48,7%.

Schlussfolgerungen

Zur frühzeitigen Diagnose und Therapie einer unilateralen Halszyste gehört eine individuelle Vorgehensweise, welche durch multiple Faktoren (Anamnese, klinische Befunde, Bildgebung sowie klinikeigene Kompetenzen) getroffen werden muss. Unabhängig davon empfehlen wir bei Patienten über 40 Jahren ein bildmorphologisches Staging, eine „No-touch“-Panendoskopie und eine histologische Sicherung.

Abstract

Objective

A cystic lateral neck mass in adults represents a major challenge, as it can be difficult to distinguish between benign and malignant lesions. The incidence of carcinoma in initially benign treated neck cysts is estimated to be as high as 24%. The objective of this study was to ascertain the malignancy rate of cystic cervical masses and to provide a differentiation of cervical metastases in comparison to benign cervical cysts, utilising current guidelines.

Material and Methods

Between 2013 and 2023, a total of 155 patients with a suspected diagnosis of lateral neck cyst were recruited at the Department of Otorhinolaryngology at our University Hospital. All patients underwent cyst removal, either alone or in conjunction with panendoscopy.

Results

A histologically confirmed ipsilateral lymph node metastasis was identified in 21.9% of patients. The mean age of patients with malignant neck masses was significantly higher than that of patients with benign neck masses (64.0±12.8 versus 41.0±15.8; p<0.001). The probability of malignancy was low in patients younger than 54 years (11%), but increased markedly to 80% in the age group of 60–69 years. The clinical sensitivity for initial suspicion of a benign neck cyst was 60.3%, while the specificity was 48.7%.

Conclusions

An individualized approach is necessary for the early diagnosis and treatment of unilateral neck cysts, as this condition requires a multifaceted assessment based on the patient’s medical history, clinical findings, imaging, and clinical expertise. We advise that patients over the age of 40 years undergo image morphological staging, a “no-touch” panendoscopy, and histological confirmation.

Schlüsselwörter

Laterale Halszyste - CUP-Syndrom - Kopf-Hals-Karzinom - Risikofaktoren - Halszysten

Keywords

branchial cleft cysts - CUP syndrome - head and neck cancer - risk factors - neck cysts

Publication History

Received: 24 September 2024

Accepted after revision: 03 December 2024

Article published online:
09 January 2025

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