Utility of ultrasound-guided fine needle aspiration cytology in assessing malignancy in head and neck pathology
Gianluigi Petrone
Pathology, Fondazione Policlinico Universitario, A. Gemelli IRCCS, Rome, Italy
Search for more papers by this authorEsther Diana Rossi
Pathology, Fondazione Policlinico Universitario, A. Gemelli IRCCS, Rome, Italy
Search for more papers by this authorRoberto Gallus
Otolaryngology, Mater Olbia Hospital, Olbia, Italy
Search for more papers by this authorLivia Petrelli
Otolaryngology Division, Ospedale San Filippo Neri, Rome, Italy
Search for more papers by this authorSabino Marrone
Department of Head and Neck Surgery, Università Cattolica del Sacro Cuore, Roma, Italia
Search for more papers by this authorCorresponding Author
Davide Rizzo
Otolaryngology Division, Azienda Ospedaliera Universitaria, Sassari, Italy
Correspondence
Davide Rizzo, Otolaryngology Division, Azienda Ospedaliera Universitaria di Sassari, Viale San Pietro, Sassari 07100, Italy.
Email: [email protected]
Search for more papers by this authorAntonio Piras
Otolaryngology Division, Azienda Ospedaliera Universitaria, Sassari, Italy
Search for more papers by this authorGabriella Garofalo
Otolaryngology Division, Azienda Ospedaliera Universitaria, Sassari, Italy
Search for more papers by this authorGuido Rindi
Pathology, Fondazione Policlinico Universitario, A. Gemelli IRCCS, Rome, Italy
Institute of Pathology, Università Cattolica del Sacro Cuore, Rome, Italy
Search for more papers by this authorJacopo Galli
Department of Head and Neck Surgery, Università Cattolica del Sacro Cuore, Roma, Italia
ENT Division, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
Search for more papers by this authorGaetano Paludetti
Department of Head and Neck Surgery, Università Cattolica del Sacro Cuore, Roma, Italia
ENT Division, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
Search for more papers by this authorFrancesco Bussu
Otolaryngology Division, Azienda Ospedaliera Universitaria, Sassari, Italy
Dipartimento delle Scienze Mediche, Chirurgiche e Sperimentali, Università di Sassari, Sassari, Italy
Search for more papers by this authorGianluigi Petrone
Pathology, Fondazione Policlinico Universitario, A. Gemelli IRCCS, Rome, Italy
Search for more papers by this authorEsther Diana Rossi
Pathology, Fondazione Policlinico Universitario, A. Gemelli IRCCS, Rome, Italy
Search for more papers by this authorRoberto Gallus
Otolaryngology, Mater Olbia Hospital, Olbia, Italy
Search for more papers by this authorLivia Petrelli
Otolaryngology Division, Ospedale San Filippo Neri, Rome, Italy
Search for more papers by this authorSabino Marrone
Department of Head and Neck Surgery, Università Cattolica del Sacro Cuore, Roma, Italia
Search for more papers by this authorCorresponding Author
Davide Rizzo
Otolaryngology Division, Azienda Ospedaliera Universitaria, Sassari, Italy
Correspondence
Davide Rizzo, Otolaryngology Division, Azienda Ospedaliera Universitaria di Sassari, Viale San Pietro, Sassari 07100, Italy.
Email: [email protected]
Search for more papers by this authorAntonio Piras
Otolaryngology Division, Azienda Ospedaliera Universitaria, Sassari, Italy
Search for more papers by this authorGabriella Garofalo
Otolaryngology Division, Azienda Ospedaliera Universitaria, Sassari, Italy
Search for more papers by this authorGuido Rindi
Pathology, Fondazione Policlinico Universitario, A. Gemelli IRCCS, Rome, Italy
Institute of Pathology, Università Cattolica del Sacro Cuore, Rome, Italy
Search for more papers by this authorJacopo Galli
Department of Head and Neck Surgery, Università Cattolica del Sacro Cuore, Roma, Italia
ENT Division, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
Search for more papers by this authorGaetano Paludetti
Department of Head and Neck Surgery, Università Cattolica del Sacro Cuore, Roma, Italia
ENT Division, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
Search for more papers by this authorFrancesco Bussu
Otolaryngology Division, Azienda Ospedaliera Universitaria, Sassari, Italy
Dipartimento delle Scienze Mediche, Chirurgiche e Sperimentali, Università di Sassari, Sassari, Italy
Search for more papers by this authorGianluigi Petrone and Esther Diana Rossi contributed equally to this work.
Abstract
Objective
Fine needle aspiration cytology (FNAC) is a well-established diagnostic procedure for head and neck masses not clearly originating from mucosal or cutaneous surfaces. We analysed head and neck masses evaluated over a 2-year period, to assess the reliability of FNAC for the evaluation of malignancy.
Methods
We enrolled all patients undergoing FNAC, from April 2013 to July 2015, in a single service of a large Italian university hospital. Relevant clinical data and ultrasonographic parameters of the lesions were recorded. We performed both conventional and thin-prep smears. Clinical presentation, ultrasonographic features and final cytology diagnoses were analysed and correlated with histology.
Results
The series included 301 lesions in 285 patients, with a single (94.4%) or two (5.6%) lesions. Only eight samples were considered non-diagnostic/inadequate (2.6%). Among the cases, 139 FNAC (46.1%) underwent surgery. Cytological-histological correspondence was found in 89% of the cases. Concerning malignancy, we documented less than 4% false positives and less than 2.5% false negatives, with 92.7% sensitivity and 94.6% specificity.
Conclusion
FNAC diagnosis can be highly specific. Most importantly, it is highly reliable in assessing malignancy, thus defining the priority and guiding the management procedures.
Abstract
Fine needle aspiration cytology for non-thyroid head and neck masses, when performed with ultrasound guidance and rapid on-site evaluation, offers a high reliability in preliminarily assessing malignancy. Ultrasound-guided fine needle aspiration cytology is a powerful tool in the hands of clinicians to determine the priority and guide further diagnostic work-up.
CONFLICT OF INTEREST
The authors declare that they have no conflict of interest.
Open Research
DATA AVAILABILITY STATEMENT
The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.
REFERENCES
- 1Ganguly A, Burnside G, Nixon P. A systematic review of ultrasound-guided FNA of lesions in the head and neck—focusing on operator, sample inadequacy and presence of on-spot cytology service. Br J Radiol. 2014; 87(1044):e20130571. https://doi.org/10.1259/bjr.20130571
- 2Tandon S, Shahab R, Benton JI, Ghosh SK, Sheard J, Jones TM. Fine-needle aspiration cytology in a regional head and neck cancer center: comparison with a systematic review and meta-analysis. Head Neck. 2008; 30(9): 1246-1252. https://doi.org/10.1002/hed.20849
- 3Layfield LJ. Fine-needle aspiration in the diagnosis of head and neck lesions: a review and discussion of problems in differential diagnosis. Diagn Cytopathol. 2007; 35(12): 798-805. https://doi.org/10.1002/dc.20769
- 4Nasuti JF, Gupta PK, Baloch ZW. Diagnostic value and cost-effectiveness of on-site evaluation of fine-needle aspiration specimens: review of 5,688 cases. Diagn Cytopathol. 2002; 27(1): 1-4.
- 5Shah KSV, Ethunandan M. Tumour seeding after fine-needle aspiration and core biopsy of the head and neck–a systematic review. Br J Oral Maxillofac Surg. 2016; 54(3): 260-265.
- 6Barats R, Evrard S, Collin L, Vergez S, Gellée S, Courtade-Saïdi M. Ultrasound-guided fine-needle capillary cytology of parotid gland masses coupled with a rapid-on-site evaluation improves results. Morphologie. 2018; 102(336): 25-30.
- 7Can AS, Peker K. Comparison of palpation-versus ultrasound-guided fine-needle aspiration biopsies in the evaluation of thyroid nodules. BMC Res Notes. 2008; 1: 12.
- 8Baatenburg de Jong RJ, Rongen RJ, Verwoerd CD, van Overhagen H, Laméris JS, Knegt P. Ultrasound-guided fine-needle aspiration biopsy of neck nodes. Arch Otolaryngol Head Neck Surg. 1991; 117(4): 402-404.
- 9Robitschek J, Straub M, Wirtz E, Klem C, Sniezek J. Diagnostic efficacy of surgeon-performed ultrasound-guided fine needle aspiration: a randomized controlled trial. Otolaryngol Head Neck Surg. 2010; 142(3): 306-309.
- 10Carmeci C, Jeffrey RB, McDougall IR, Nowels KW, Weigel RJ. Ultrasound-guided fine-needle aspiration biopsy of thyroid masses. Thyroid. 1998; 8(4): 283-289.
- 11Izquierdo R, Arekat M, Knudson P, et al. Comparison of palpation-guided versus ultrasound-guided fine-needle aspiration biopsies of thyroid nodules in an outpatient endocrinology practice. Endocrine Practice. 2006; 12(6): 609-614. https://doi.org/10.4158/ep.12.6.609
- 12Addams-Williams J, Watkins D, Owen S, Williams N, Fielder C. Non-thyroid neck lumps: appraisal of the role of fine needle aspiration cytology. Eur Arch Otorhinolaryngol. 2009; 266(3): 411-415.
- 13Cesur M, Corapcioglu D, Bulut S, et al. Comparison of palpation-guided fine-needle aspiration biopsy to ultrasound-guided fine-needle aspiration biopsy in the evaluation of thyroid nodules. Thyroid. 2006; 16(6): 555-561.
- 14Danese D, Sciacchitano S, Farsetti A, Andreoli M, Pontecorvi A. Diagnostic accuracy of conventional versus sonography-guided fine-needle aspiration biopsy of thyroid nodules. Thyroid. 1998; 8(1): 15-21.
- 15Robinson IA, Cozens NJ. Does a joint ultrasound guided cytology clinic optimize the cytological evaluation of head and neck masses? Clin Radiol. 1999; 54(5): 312-316.
- 16Witcher TP, Williams MD, Howlett DC. “One-stop” clinics in the investigation and diagnosis of head and neck lumps. Br J Oral Maxillofac Surg. 2007; 45(1): 19-22.
- 17Kocjan G, Chandra A, Cross P, et al. BSCC Code of Practice—fine needle aspiration cytology. Cytopathology. 2009; 20(5): 283-296.
- 18Sharma SD, Kumar G, Horsburgh A, et al. Do immediate cytology and specialist radiologists improve the adequacy of ultrasound-guided fine-needle aspiration cytology? Otolaryngol Head Neck Surg. 2015; 152(2): 292-296.
- 19Witt RL, Sukumar VR, Gerges F. Surgeon-performed ultrasound-guided FNAC with on-site cytopathology improves adequacy and accuracy. Laryngoscope. 2015; 125(7): 1633-1636.
- 20Zhuang SM, Wu X-F, Li J-J, Zhang G-H. Management of lymph node metastases from an unknown primary site to the head and neck (Review). Mol Clin Oncol. 2014; 2(6): 917-922.
- 21Fitzhugh VA, McCash SI, Park E, Wiesenthal C, LaBombardi V, Chen H. Mycobacterium avium complex infection in a neck abscess: a diagnostic pitfall in fine-needle aspiration biopsy of head and neck lesions. Diagn Cytopathol. 2009; 37(7): 527-530. https://doi.org/10.1002/dc.21067
- 22Issing WJ, Taleban B, Tauber S. Diagnosis and management of carcinoma of unknown primary in the head and neck. Eur Arch Otorhinolaryngol. 2003; 260(8): 436-443.
- 23Bussu F, Parrilla C, Rizzo D, Almadori G, Paludetti G, Galli J. Clinical approach and treatment of benign and malignant parotid masses, personal experience. Acta Otorhinolaryngol Ital. 2011; 31(3): 135-143.
- 24Bussu F, Rigante M, Giglia V, et al. Clinical history, prognostic factors, and management of facial nerve in malignant tumors of the parotid gland. Clin Exp Otorhinolaryngol. 2014; 7(2): 126-132. https://doi.org/10.3342/ceo.2014.7.2.126
- 25Wu M. A comparative study of 200 head and neck FNAs performed by a cytopathologist with versus without ultrasound guidance: evidence for improved diagnostic value with ultrasound guidance. Diagn Cytopathol. 2011; 39(10): 743-751. https://doi.org/10.1002/dc.21460
- 26Göret CC, Göret NE, Özdemir ZT, et al. Diagnostic value of fine needle aspiration biopsy in non-thyroidal head and neck lesions: a retrospective study of 866 aspiration materials. Int J Clin Exp Pathol. 2015; 8(8): 8709-8716.
- 27Coghill SB, Brown LA. Why pathologists should take needle aspiration specimens. Cytopathology. 1995; 6(1): 1-4.
- 28Orell SR. Pitfalls in fine needle aspiration cytology. Cytopathology. 2003; 14(4): 173-182.
- 29Bussu F, Sali M, Gallus R, et al. HPV and EBV infections in neck metastases from occult primary squamous cell carcinoma: another virus-related neoplastic disease in the head and neck region. Ann Surg Oncol. 2015; 22(Suppl 3): S979-S984.
- 30Baldassarri R, Aronberg R, Levi AW, Yarbrough WG, Kowalski D, Chhieng D. Detection and genotype of high-risk human papillomavirus in fine-needle aspirates of patients with metastatic squamous cell carcinoma is helpful in determining tumor origin. Am J Clin Pathol. 2015; 143(5): 694-700.
- 31Hakima L, Adler E, Prystowsky M, et al. Hybrid Capture 2 human papillomavirus testing of fine needle aspiration cytology of head and neck squamous cell carcinomas. Diagn Cytopathol. 2015; 43(9): 683-687.
- 32Qureishi A, Mawby T, Fraser L, Shah KA, Møller H, Winter S. Current and future techniques for human papilloma virus (HPV) testing in oropharyngeal squamous cell carcinoma. Eur Arch Otorhinolaryngol. 2017; 274(7): 2675-2683.
- 33Russ JE, Scanlon EF, Christ MA. Aspiration cytology of head and neck masses. Am J Surg. 1978; 136(3): 342-347.
- 34Frable WJ, Frable MAS. Thin-needle aspiration biopsy. The diagnosis of head and neck tumors revisited. Cancer. 1979; 43(4): 1541-1548.
10.1002/1097-0142(197904)43:4<1541::AID-CNCR2820430448>3.0.CO;2-H CAS PubMed Web of Science® Google Scholar
- 35Sismanis A, Strong MS, Merriam J. Fine needle aspiration biopsy diagnosis of neck masses. Otolaryngol Clin North Am. 1980; 13(3): 421-429.
- 36Feldman PS, Kaplan MJ, Johns ME, Cantrell RW. Fine-needle aspiration in squamous cell carcinoma of the head and neck. Arch Otolaryngol. 1983; 109(11): 735-742.
- 37Slack RW, Croft CB, Crome LP. Fine needle aspiration cytology in the management of head and neck masses. Clin Otolaryngol Allied Sci. 1985; 10(2): 93-96.
- 38Matsuyama T, Fujii Y, Takeichi N, Dohi K. Aspiration biopsy cytology a highly diagnostic procedure for assessing neck masses, excluding thyroid tumors. Jpn J Surg. 1986; 16(4): 239-244.
- 39Raju G, Kakar PK, Das DK, Dhingra PL, Bhambhani S. Role of fine needle aspiration biopsy in head and neck tumours. J Laryngol Otol. 1988; 102(3): 248-251.
- 40Karayianis SL, Francisco GJ, Schumann GB. Clinical utility of head and neck aspiration cytology. Diagn Cytopathol. 1988; 4(3): 187-192.
- 41McLean NR, Harrop-Griffiths K, Shaw HJ, Trott PA. Fine needle aspiration cytology in the head and neck region. Br J Plast Surg. 1989; 42(4): 447-451.
- 42Stevenson DS, Allison RS, Robertson MS, Hamer JW. Aspiration cytology in the diagnosis of head and neck masses: the early Christchurch experience. N Z Med J. 1989; 102(881): 639-641.
- 43Morton KD. Fine needle aspiration cytology of lesions of the head and neck and factors affecting outcome. Scott Med J. 1989; 34(5): 523-525.
- 44Schwarz R, Chan NH, MacFarlane JK. Fine needle aspiration cytology in the evaluation of head and neck masses. Am J Surg. 1990; 159(5): 482-485.
- 45Dejmek A, Lindholm K. Fine needle aspiration biopsy of cystic lesions of the head and neck, excluding the thyroid. Acta Cytol. 1990; 34(3): 443-448.
- 46Flynn MB, Wolfson SE, Thomas S, Kuhns JG. Fine needle aspiration biopsy in clinical management of head and neck tumors. J Surg Oncol. 1990; 44(4): 214-217.
- 47Guyot J-P, Obradovic D, Krayenbuhl M, Zbaeren P, Lehmann W. Fine-needle aspiration in the diagnosis of head and neck growths: is it necessary? Otolaryngol Head Neck Surg. 1990; 103(5): 697-701. https://doi.org/10.1177/019459989010300506
- 48Schelkun PM, Grundy WG. Fine-needle aspiration biopsy of head and neck lesions. J Oral Maxillofac Surg. 1991; 49(3): 262-267.
- 49Lampe HB, Cramer HM. Advances in the use of fine-needle aspiration cytology in the diagnosis of palpable lesions of the head and neck. J Otolaryngol. 1991; 20(2): 108-116.
- 50Oyafuso MS, Filho AL, Ikeda MK. The role of Fine Needle aspiration cytology in the diagnosis of lesions of the head and neck excluding the thyroid and salivary glands. Tumori Journal. 1992; 78(2): 134-136. https://doi.org/10.1177/030089169207800214
- 51Guyot J-P, Auberson S, Obradovic D, Lehmann W. Fine-Needle aspiration in the diagnosis of head and neck growths: the pitfalls of false-positive diagnosis. ORL. 1993; 55(1): 41-44. https://doi.org/10.1159/000276351
- 52Roland NJ, Caslin AW, Smith PA, Turnbull LS, Panarese A, Jones AS. Fine needle aspiration cytology of salivary gland lesions reported immediately in a head and neck clinic. J Laryngol Otol. 1993; 107(11): 1025-1028. https://doi.org/10.1017/s0022215100125162
- 53Donahue BJ, Cruickshank JC, Bishop JW. The diagnostic value of fine needle aspiration biopsy of head and neck masses. Ear Nose Throat J. 1995; 74(7): 483-486.
- 54Murthy P, Laing MR, Palmer TJ. Fine needle aspiration cytology of head and neck lesions: an early experience. J R Coll Surg Edinb. 1997; 42(5): 341-346.
- 55Fulciniti F, Califano L, Zupi A, Vetrani A. Accuracy of fine needle aspiration biopsy in head and neck tumors. J Oral Maxillofac Surg. 1997; 55(10): 1094-1097.
- 56Allen SM, Boon AP, Brownridge DM, Chadwick CH, Buckley JG. Fine needle cytology of palpable head and neck lesions: a comparison of sampling methods with and without suction. Cytopathology. 1999; 10(2): 97-106.
- 57Bardales RH, Baker SJ, Mukunyadzi P. Fine-needle aspiration cytology findings in 214 cases of nonparotid lesions of the head. Diagn Cytopathol. 2000; 22(4): 211-217.
10.1002/(SICI)1097-0339(200004)22:4<211::AID-DC2>3.0.CO;2-M CAS PubMed Web of Science® Google Scholar
- 58Knappe M, Louw M, Gregor RT. Ultrasonography-guided fine-needle aspiration for the assessment of cervical metastases. Arch Otolaryngol Head Neck Surg. 2000; 126(9): 1091-1096.
- 59Zbären P, Schär C, Hotz MA, Loosli H. Value of fine-needle aspiration cytology of parotid gland masses. Laryngoscope. 2001; 111(11): 1989-1992. https://doi.org/10.1097/00005537-200111000-00023
- 60Postema RJ, van Velthuysen M-LF, van den Brekel MWM, Balm AJM, Peterse JL. Accuracy of fine-needle aspiration cytology of salivary gland lesions in the Netherlands Cancer Institute. Head Neck. 2004; 26(5): 418-424.
- 61Seethala RR, LiVolsi VA, Baloch ZW. Relative accuracy of fine-needle aspiration and frozen section in the diagnosis of lesions of the parotid gland. Head Neck. 2005; 27(3): 217-223. https://doi.org/10.1002/hed.20142
- 62Inohara H, Akahani S, Yamamoto Y, et al. The role of fine-needle aspiration cytology and magnetic resonance imaging in the management of parotid mass lesions. Acta Otolaryngol. 2008; 128(10): 1152-1158.
- 63Gudmundsson JK, Ajan A, Abtahi J. The accuracy of fine-needle aspiration cytology for diagnosis of parotid gland masses: a clinicopathological study of 114 patients. J Appl Oral Sci. 2016; 24(6): 561-567.
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