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Image-Guided Fine-Needle Aspiration of the Head and Neck
Five Years' Experience
Martha J. Sack, MD;
Randal S. Weber, MD;
Gregory S. Weinstein, MD;
Ara A. Chalian, MD;
Harvey L. Nisenbaum, MD;
David M. Yousem, MD
Arch Otolaryngol Head Neck Surg. 1998;124:1155-1161.
Objective To evaluate the diagnostic utility of image-guided fine-needle aspiration (FNA) in the head and neck.
Design All image-guided FNAs of the head and neck performed January 1992 through June 1997 were included. All cytohistopathologic data were reviewed and collated. A slide review was performed in all cases with cytohistologic discrepancies.
Setting The Department of Radiology, University of Pennsylvania Medical Center, Philadelphia.
Patients Patients with deep-seated or poorly localized masses in the head and neck, representing both primary or recurrent/metastatic lesions, were referred.
Results There were 111 computed tomography–guided FNAs performed in 109 patients. Sites sampled included parapharyngeal (n=20), parotid or submandibular (n=25), thyroid (34), and neck, paratracheal/paraesophageal, skull base, and paraspinal (n=32). Diagnostic samples were obtained in 93 cases (83.8%). The procedures were well tolerated, without long-term complications. Cytologic examination detected a total of 39 malignancies, 24 of which were confirmed histologically. Eleven of the remaining malignant FNA cases reflected recurrent tumor; there were 3 false-positive FNA cases (2.7%), 2 in the setting of previous surgery and/or radiation therapy. There were 2 false-negative aspirates from sites deep in the neck (1.8%) among 7 of the 35 patients with benign aspirates who underwent surgery. Twenty six patients underwent ultrasound-guided FNA (thyroid gland only), revealing 1 papillary carcinoma and 1 intrathyroidal parathyroid gland, both of which were confirmed histologically. The findings in the aspirates from the rest of the patients were benign (n=18), Hürthle cell neoplasm (n=1), and nondiagnostic (n=5).
Conclusions (1) The cytologic findings were supported clinically and/or histologically in 86 (92%) of the 93 diagnostic computed tomography–guided FNA cases. (2) Unnecessary surgery was avoided in 37% of the patients with recurrent tumor or benign diagnoses by cytologic assessment. (3) Potential pitfalls include false-positive diagnoses after radiation therapy and procedural or sampling limitations for deep neck and paraspinal lesions.
From the Departments of Pathology (Cytopathology Section) (Dr Sack), Otorhinolaryngology–Head & Neck Surgery (Drs Weber, Weinstein, Chalian, and Yousem), and Radiology (Drs Nisenbaum and Yousem), University of Pennsylvania Medical Center, Philadelphia. Dr Sack is now with the Department of Pathology, Abington Memorial Hospital, Abington, Pa.
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