What is the recommended first step in the workup of an anterior neck mass?

The recommended first step in the workup of an anterior neck mass is fine needle aspiration (FNA) because it allows for a rapid, minimally invasive method of obtaining cytological samples. This procedure can help in diagnosing the nature of the mass—such as distinguishing between benign and malignant lesions. FNA provides valuable information regarding the cellular composition of the mass, which can significantly guide further diagnostic and therapeutic approaches.

In many cases, especially when evaluating thyroid nodules or lymphadenopathy, FNA can confirm the presence of cancer or other pathology, allowing for prompt management. It is also a relatively safe procedure with minimal complications, making it an ideal first step compared to more invasive options.

While imaging modalities like CT scans and ultrasound can provide helpful anatomical information and assess the characteristics of the mass, they do not provide definitive diagnosis. Ultrasound can be beneficial in guiding FNA and assessing the mass's characteristics, while CT can help evaluate the extent of disease and surrounding structures, but neither can replace the need for cytological confirmation provided by FNA or biopsy. Additionally, performing a biopsy as an initial step may be more invasive and could lead to complications or alter the tissue’s characteristics if further management is required.