Assessment and management of presumed branchial cleft cysts: our experience

Assessment and management of presumed branchial cleft cysts: our experience. Objectives: The aim was to assess the accuracy of diagnosis and management of presumed branchial cleft cysts in our centre. Methodology: Retrospective review of patients with a clinical diagnosis of branchial cleft cyst at Barts Health NHS Trust from 2009 to 2015. Results: 67 patients underwent surgical excision for presumed branchial cysts. Ninety per cent were histologically confirmed, 7% demonstrated cystic metastatic squamous cell carcinoma, and 3% lymph node metastases from papillary thyroid cancer. No patient had pre-operative Multi-Disciplinary Team (MDT) discussion. Pre-operative FNA had a positive predictive value of 90% (95% CI 0.82-0.95). Age >40 years (p=0.02) and presence of lymph nodes (p=0.02) carried a higher risk of malignancy. Conclusions: Patients >40 years with or without multiple lymph nodes on imaging should be treated as presumed metastatic cancer. Consideration should be given to concurrent panendoscopy and intra-operative frozen section +/- selective neck dissection after discussion at the Head & Neck MDT.