Efficacy and cost-effectiveness of multihole fine-needle aspiration of head and neck masses

Verification bias in diagnostic accuracy studies for fine- and core needle biopsy of salivary gland lesions in otolaryngology journals: a systematic review and analysis

BACKGROUND

Diagnostic test accuracy (DTA) studies for needle biopsy are frequently published in otolaryngology journals, but this body of literature has not been assessed for verification bias.

METHODS

We conducted a systematic review of DTA studies on needle biopsy of salivary gland lesions appearing in otolaryngology journals. Studies were assessed by 2 reviewers for verification bias.

RESULTS

We identified 95 DTA studies for needle biopsy of salivary gland lesions. Eighty-one studies (84%) had verification bias. Five of the biased studies provided sufficient data to estimate the extent of bias. Verification bias was associated with an overestimate of sensitivity and an underestimate of specificity. Studies on core needle biopsy (CNB) had a lower rate of verification bias than fine-needle aspiration (FNA) studies.

CONCLUSION

Verification bias is common in DTA studies of needle biopsy for salivary gland lesions published in ear, nose, and throat (ENT) journals. Such studies overestimated sensitivity and underestimated specificity.

Basics of cytology

This overview is intended to give a general outline about the basics of Cytopathology. This is a field that is gaining tremendous momentum all over the world due to its speed, accuracy and cost effectiveness. This review will include a brief description about the history of cytology from its inception followed by recent developments. Discussion about the different types of specimens, whether exfoliative or aspiration will be presented with explanation of its rule as a screening and diagnostic test. A brief description of the indications, utilization, sensitivity, specificity, cost effectiveness, speed and accuracy will be carried out. The role that cytopathology plays in early detection of cancer will be emphasized. The ability to provide all types of ancillary studies necessary to make specific diagnosis that will dictate treatment protocols will be demonstrated. A brief description of the general rules of cytomorphology differentiating benign from malignant will be presented. Emphasis on communication between clinicians and pathologist will be underscored. The limitations and potential problems in the form of false positive and false negative will be briefly discussed. Few representative examples will be shown. A brief description of the different techniques in performing fine needle aspirations will be presented. General recommendation for the safest methods and hints to enhance the sensitivity of different sample procurement will be given. It is hoped that this review will benefit all practicing clinicians that may face certain diagnostic challenges requiring the use of cytological material.

Efficacy of 'two-man' FNAB technique in the assessment of patients with non-thyroid neck masses

OBJECTIVE

To show the superiority of 'two-man' FNAB technique comparing to the standard FNAB technique, in order to identify the cause of non-thyroid neck masses.

METHODS

Over an 18 months period, a consecutive paired study was conducted in the tertiary referral Venizelion General Hospital. Forty-four cytologic examinations were performed in patients with non-thyroid head and neck masses. The samples were taken from the same side using both techniques the standard FNAB technique and the 'two-man' FNAB technique (for which two persons carried out the procedure). The slides were seen by the pathologist and were defined as diagnostic, suggestive or inconclusive. The diagnosis was confirmed in any case by definite histology after surgical treatment or open biopsy.

RESULTS

From 44 samples taken with the 'two-man' technique, 34 were diagnostic (all true) verified by histopathology, seven suggestive (five true and two false) and three inconclusive (6.82%). The correct diagnosis was confirmed in 39 cases (88.64%). From 44 samples of standard technique, 22 were diagnostic (all true), 12 suggestive (five true and seven false) and 10 inconclusive (22.72%). The correct diagnosis was confirmed in 27 cases (61.36%). The accuracy of diagnosis with the standard FNAB technique was 0.79 (SE=0.07), while with the 'two-man' FNAB technique was 0.95 (SE=0.03), a significant statistical difference (Fischer exact test, P=0.041).

CONCLUSIONS

'Two-man' FNAB technique proved to be as safe and patient friendly as the standard FNAB, but more accurate and may be easier to perform than this. The 'two-man' FNAB technique could become the preferred method for fine-needle cytology, particularly for difficult to reach areas of the head and neck.

Accuracy of terminology and methodology in economic analyses in otolaryngology

OBJECTIVE

Economic studies increasingly guide health care resource allocation decisions. Because rigorous adherence to accepted definitions and research techniques is critical to ensure accuracy, we evaluated the terminology and methods of otolaryngology economic analyses.

STUDY DESIGN

A total of 71 articles published from 1990 to 1999 in 6 peer-reviewed otolaryngology journals with terms such as "cost-effective" in their title or representing economic analyses were reviewed for terminology and use of established methodology guidelines.

RESULTS

Over half (35 of 66) of terms such as "cost-effective" were used incorrectly, and 60% of articles (39 of 64) confused "charge" and "cost" data. Eleven percent (7 of 64) of papers specified the perspective of their analysis. About half (17 of 30) reported a summary measure such as a cost-effectiveness ratio. Only one third (23 of 63) performed sensitivity analyses.

CONCLUSION

Adherence to accepted definitions and research methods is inconsistent, although we did note moderate improvements in making the distinction between costs and charges, defining of study perspective, and performing sensitivity analysis.

SIGNIFICANCE

Greater attention to both terminology and methodology can enhance the quality of economic analyses and ultimately improve certain resource allocation decisions.

Surfing prognostic factors in head and neck cancer at the millennium

The ability to reliably predict cancer outcome could tailor therapy to the aggressiveness of the tumour to achieve the best results in terms of loco-regional control, overall survival and quality of life. Retrospective and prospective clinical trials involving large series of patients have validated some predictive clinical and pathological factors, whereas the utility of many other prognostic factors has not been established. This has led to some confusion in clinical practice. In order to clarify the significance, role and cost of these prognostic factors we carried out a Medline search of all papers published between 1993 and 1998 concerning the reliability and cost of markers with prognostic significance, in head and neck squamous cell carcinoma, and assessed the results according to a number of criteria relating to reliability and cost. Regarding reliability we classified prognostic factors into: (1) those with a proven significance based on the fact that they were unanimously reported as having an independent statistical correlation with outcome and prognosis; and (2) those for which results were not unanimous, and which significance is still controversial. Cost analysis showed a substantial difference between validated tests which are of low cost and experimental tests which are expensive. Based on these data regarding both the reliability and cost of each prognostic factor, we propose guidelines for their use in clinical practice in the year 2000.