Brass will flow from the head of the case to the neck. Depending on the cartridge, and the load this can happen rather quickly, or very slowly. One sure way to tell is to take a fired case and see if a bullet will fit in the case before sizing the case. If the bullet won't go, or goes tight, then the neck needs to be relieved some. If the neck thickens, and you seat a bullet in it, then it can be difficult to chamber the round, and because of the pressure from the thick neck being squeezed into the chamber higher than normal pressure can result, even if using a load well below max. If you have a cast of the chamber, then you can play with the neck thickness a little using the chamber dimensions minus the clearance, usually .003".
When the neck thickens, you can either outside turn the neck, or inside ream the case. The benefits of one over the other has been debated for some time now.
I see no reason that a hand held unit, for all practical purposes, can't be just as accurate as a fixture provided you take your time.
You could always check the runout with a v block and a dial indicator.
Pauls is right, if the neck is not turned cocentricly (did I spell that right?) then accuracy can suffer.
Wilson makes a real nice hand held inside reamer that uses a die to support the case. If you have time and can afford it, you might want to give reaming a try as well. Some get good results with reaming and it might be a little easier. JMO.......