Evaluation and Management of a Mobile Lump in the Suprasternal Notch

Clinical Evaluation

A thorough history should assess duration of the mass, associated symptoms, and risk factors for malignancy, according to the American Academy of Otolaryngology-Head and Neck Surgery 1
Physical examination should include visualization of the larynx, base of tongue, and pharynx if the mass is deemed at increased risk for malignancy, as recommended by the American Academy of Otolaryngology-Head and Neck Surgery 1
Key warning signs that increase risk for malignancy include a mass persisting longer than 2-3 weeks, voice changes, trouble or pain with swallowing, unexplained weight loss, and fever, as noted by the American Academy of Otolaryngology-Head and Neck Surgery 2

Ultrasound is the recommended first-line imaging modality for evaluation of a suprasternal mass, according to the American College of Radiology 4
The American College of Radiology recommends CT scan if ultrasound findings are inconclusive, there is suspicion of malignancy, or evaluation of deeper structures is needed 4
Image-guided core biopsy is preferred over fine-needle aspiration for tissue sampling when diagnosis remains uncertain, as recommended by the American College of Radiology 6

If a benign entity has been definitively identified on imaging, clinical follow-up is appropriate, according to the American College of Radiology 5
Prompt referral to a specialist is warranted for masses with concerning features, as recommended by the American Academy of Otolaryngology-Head and Neck Surgery 1

Most mobile masses in the suprasternal notch with benign imaging characteristics are likely to be non-malignant, according to the American College of Radiology 5
Physical examination alone is insufficient for diagnosis, as it correctly identifies only about 85% of soft tissue masses, as noted by Praxis Medical Insights 3