Cytological-Pathologic Correlation
Fine needle aspiration of non-thyroidal head and neck masses: Correlation of the cyto-histopathological diagnoses, causes of inconsistency and traps

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Highlights

  • FNAC has been applied as a useful method in comparison to more expensive surgical excisional biopsies in our clinique.

  • Excisional biopsy for diagnosis and subtyping is recommended for cases with cytopathologically suspicious for malignant LN.

  • Cytodiagnosis of H&N masses should always be considered in clinical findings, correlated with histopathological findings.

Introduction

Fine needle aspiration cytopathology (FNAC) has become a well-liked modality in the diagnosis, staging and follow-up of head and neck (H&N) masses [1,2]. Good patient acceptability, repeatability and avoidance of unnecessary surgical procedure make FNAC as the first line investigation in H&N masses [3].

This technique has a high degree of accuracy for diagnosis of both primary and metastatic diseases [4]. Correlation with subsequent tissue samples is an essential part of quality control and assurance programs in all cytopathology laboratories [5].

Since over one half of asymmetrical H&N masses in adults have been reported to be either primary or secondary malignant, an accurate diagnosis of neck swelling is of paramount importance [6]. Preoperative diagnosis of H&N lesions by FNAC offers opportunity for planning the surgical time and type of surgery, therefore a surgery for non-neoplastic entities can be avoided [7].

Clinical diagnosis of a mass in H&N region encompasses a wide spectrum of differential diagnosis. The mass may originate from salivary glands (SGs) or adjacent lymph nodes (LNs), skin appendages, soft tissues or developmental abnormalities like branchial clefts. It is particularly useful in histologically uniform neoplasms of SGs, and confirmation of LN metastases in patients with a known history of malignant tumors [7]. Most of metastatic carcinomas can be identified by their cytomorphological characteristics alone, and ancillary techniques, like immunocytochemistry, are used to overcome diagnostic difficulties [8].

It is well documented that FNAC is of value in diagnosing relapsed lymphoma [9]. FNAC has also been advocated as a useful method in comparison to more expensive surgical excisional biopsies in developing countries with limited financial and health care resources. However, the exact diagnostic accuracy of FNAC of H&N masses in comparison with the histopathological findings in three locations, namely SGs, LNs and other tissues of H&N has not been determined clearly yet.

The aim of the current work was to report the results of FNAC of SGs, LNs and other tissues of H&N in comparison to the results of histopathology, and to highlight the diagnostic accuracy and reliability of FNAC that depends solely on the cytomorphological features in H&N tissues with an emphasis on discordant cases.

Section snippets

Patients

During a 10-year period in between October 2005 and October 2015, fine needle aspiration cytologies (FNAC) were performed in a total of 570 patients ranging from the age of 6 years to 94 years. The sex of patients was distributed as 250 female and 320 male. All patients with H&N masses undergone FNAC as the primary diagnostic modality and then underwent surgical biopsies were enrolled for the study. After a clinical and radiological diagnosis, FNA procedure was applied under an ultrasound

Results

The study comprised 570 patients, separately 310 (54.4%) men and 260 (45.6%) women. As shown in Fig. 1, 5.9% of specimens did not allow an adequate cyto-diagnosis and excluded from the study. Out of 536 cases, 21.1% had non-tumoral lesions, 28.7% had benign lesions. Almost half of all H&N lumps were (50.2%) malignant.

Among 232 studied cases with cytopathology of SGs, the most frequent diagnosis was benign lesion (53.8%) and the least one was inadequate samples (6.9%). Histopathological

Discussion

Assessing the effectiveness of FNAC in investigation of H&N masses, we carried a comprehensive 10-year retrospective review of our FNAC experiences in our institution. The quality control measurements in our overall FNAC experience for non-thyroidal H&N masses are in line with the literature. FNAC of SG cases revealed the highest intra-class significance, sensitivity and NPV. FNAC of other H&N cases showed the highest specificity, accuracy and PPV.

It becomes a general opinion that FNAC is

Sources of funding

None.

Declarations of interest

None.

Acknowledgements

None.

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