Correlation of fine needle aspiration cytology and histopathology of neck swellings
Keywords:FNAC, Histopathology, Specificity, Sensitivity, Accuracy
Background: Neck swellings are a common clinical finding affecting all age groups. FNAC is a minimally invasive procedure helpful in the diagnosis of various neck swellings. The purpose of this study is to determine the accuracy of FNAC in the diagnosis of neck swellings by comparing it with the histopathology which is taken as the gold standard.
Methods: A prospective study which included 90 patients who attended ENT and surgery departments of Government Medical College, Trivandrum with neck swellings from July 2006-2007. FNAC of the swelling was done and the FNAC results were compared with the histopathology results. The specificity, sensitivity, positive and negative predictive values and accuracy of FNAC were calculated.
Results: Of the 90 patients, thyroid swelling formed the major group followed by lymph node, salivary gland and miscellaneous swellings. Thyroid swellings had a female predominance while the other three groups namely lymph node, salivary gland and miscellaneous groups showed a male preponderance. When the neck swellings namely thyroid, salivary gland, lymph node and miscellaneous group were taken into consideration as a whole, the sensitivity of FNAC for detecting malignancy was 64.3%. The specificity, positive predictive value, negative predictive value and accuracy were 97.4%, 81.8%, 93.7% and 92% respectively.
Conclusions: FNAC can be rated as a safe, simple, reliable, cost effective and rapid diagnostic tool with high specificity and sensitivity for the initial evaluation of neck swellings.
Russ JE, Sacnion EF, Christ AM. Aspiration cytology of head and neck masses. Am J Surg. 1978;136:342–7.
Mahbod G, Koasri F, Tafreshi MA. Fine needle aspiration cytology in diagnosing non thyroidal neck masses. Acta Med Iran. 2002;40:49–51.
Klijanienko J. Head and Neck and Salivary gland. In: Layfield LJ, editor. Atlas of Fine Needle Aspiration Cytology. 1st ed. New Delhi: Jaypee Publishers; 2014: 11.
El Hag IA, Chiedozi LC, Reyees FA, Kollur SM. Fine needle aspiration cytology of head and neck masses. Seven years’ experience in a secondary care hospital. Acta Cytol. 2003;47:387–92.
Gallagher J, Oertel YC, Oertel JE. Follicular variant of papillary carcinoma of the thyroid: fine-needle aspirates with histologic correlation. Diagn Cytopathol. 1997;16:207-13.
Goodell WM, Saboorian MH, Ashfaq R. Fine-needle aspiration diagnosis of the follicular variant of papillary carcinoma. Cancer Cytopathol. 1998;84:349-54.
Mesonero CE, Jugle JE, Wilbur DC, Nayar R. Fine-needle aspiration of the macrofollicular and microfollicular subtypes of the follicular variant of papillary carcinoma of the thyroid. Cancer Cytopathol. 1998;84:235-44.
Zacks JF, de lasMorenas A, Beazley RM, O’Brien MJ. Fine-needle aspiration cytologydiagnosis of colloid nodule versus follicular variant of papillary carcinoma of the thyroid. Diagn Cytopathol. 1998;18:87-90.
De Micco C, Vassko V, Henry JF. The value of thyroid peroxidase immunohistochemistry for preoperative fine-needle aspiration diagnosis of the follicular variant of papillary thyroid cancer. Surgery. 1999;126:1200-4.
Kumar PV, Tali AR, Malekhusseini SA. Follicular variant of papillary carcinoma of the thyroid. A cytologic study of 15 cases. Acta Cytol. 1999;43:139-42.
Logani S, Gupta PK, Li Volsi VA. Thyroid nodules with FNA cytology suspicious for follicular variant of papillary thyroid carcinoma: follow up and management. Diagny Cytopathol. 2000;23:380-5.
Fulcinite F, Benincasa G, Vetrani A, Palombini L. Follicular variant of papillary carcinoma: cytologic findings on FNAB samples-experience with 16 cases. Diagn Cytopathol. 2001;25:86-93.
Jain M, Khan A, Patwardhan N. Follicular variant of papillary thyroid carcinoma: a comparative study of histopathologic features and cytology results in 141 patients. Endocr Pract. 2001;7:79:84.
Nasi M, Kapila K, Karak AK, Verma K. Papillary carcinoma of the thyroid and its variants: a cytohistological correlation. Diagn Cytopathol. 2001;24:167-73.
Yang GCH, Liebeskind D, Messina AV. Should cytopathologists stop reporting follicular neoplasms on fine-needle aspiration of the thyroid? Diagnosis and histologic follow up of 147 cases. Cancer Cytopathol. 2003;99:69-74.
Baloch ZW, Fleisher S, Li Volsi VA, Gupta PK. Diagnosis of follicular neoplasm: a gray zone in thyroid fine-needle aspiration cytology. Diagn Cytopathol. 2002;26:41-4.
Lowhagen T, Granberg PO, Lundell G. Aspiration Biopsy Cytology (ABC) in nodules of thyroid gland suspected to be malignant. Surg Clin North Am. 1979;59:3-18.
Kini SR. Thyroid. In: Kline TS, ed. Guides to clinical aspiration biopsy. 2nded. New York: Iga Ku-Shoin; 1996.
Droese M. Cytological aspiration biopsy of the thyroid gland. 2nd ed. Stuttgart: Schattauer; 1995.
Harach HR. Usefulness of fine-needle aspiration of the thyroid in a endemic goitre region. Acta Cytol. 1989;33:31-5.
Howlett DC, Harper B, Quante M, Berresford A, Morley M, Grant JL. Diagnostic adequacy and accuracy of fine-needle aspiration cytology in neck lump assessment: results from a regional cancer network over a one year period. J Laryngol Otol. 2007;121:571-9.
Cheung YS, Poon CM, Mak SM, Suen MWM, Leong HT. Fine-needle aspiration cytology. Hong Kong Med J. 2007;13(1):12-5.
Bajaj Y, De M, Thompson A. Fine-needle aspiration cytology in diagnosis and management of thyroid disease. J Laryngol Otol. 2006;120:467-9.
Javaid M, Niamaltullah, Anwar K, Said M. Diagnostic value of fine-needle aspiration cytology in cervical lymphadenopathy. J Postgrad Med Inst. 2006;20(2):117-20.
Fernandes GC, Pandit AA. Diagnosis of salivary gland tumours by FNAC. Bombay Hosp J. 2002;4:201–6.
Stow N, Veivers D, Poole A. Fine-needle aspiration cytology in the management of salivary gland tumours: an Australian experience. Ear, Nose, Throat J. 2004;83(2):128-31.