Fine needle aspiration: an atraumatic method to diagnose head and neck masses

Distribution of non-thyroid neck swellings and their clinicopathological correlation

Background

Neck swellings are frequently found and can present the vast pathological spectrum from simple benign to highly malignant, which sometimes can pose a diagnostic dilemma. They are broadly classified as developmental, inflammatory, and neoplastic on the basis of etiology. The aim of the study is to assess the distribution of neck swelling according to etiology and its relation to age groups, as well as to assess their clinicopathological correlation as benign and malignant.

Materials and Methods

The study was conducted from January 2020 to February 2023 on the basis of retrospective and prospective sampling. All the patients with neck swellings, except thyroid, who had undergone an excisional or incisional biopsy, were included in this study. Data was collected from in-patient records for retrospective sampling, and fine-needle aspiration cytology (FNAC), radiological investigation, and excisional or incisional biopsy were performed for prospective sampling after proper history and examination. Cytological and pathological correlation was analyzed as benign and malignant. Sensitivity and specificity were calculated. (P value <0.001 considered significant).

Results

Out of the 74 patients, 16% were categorized as developmental, 31% as inflammatory, and 53% as neoplastic (benign 64%, malignant 36%). The most common cause was an epidermoid cyst (50%) among developmental swellings, reactive lymphadenitis (48%), and tuberculosis (35%) among inflammatory, pleomorphic adenoma among benign neoplasm and metastasis to lymph node among malignant swelling. Malignant lesions mainly occur in the older age group, more than 40 years of age. The overall sensitivity, specificity, and accuracy of FNAC, to differentiate from benign to malignant, is very similar to histopathological examination.

Conclusion

Different age groups breed different etiology, so age needs to be the prime demographic factor to be established. Pediatric and younger generations of neck swelling are usually inflammatory and developmental, in contrast to the older category, in which malignancy is far more prevalent, hence demanding more caution in evaluation. FNAC is a diagnostic tool that has become highly sensitive for malignant lesions; though in no sense can it replace histopathology, it can still be valuable in diagnostic and screening dilemmas of neck swelling.

Distribution of Non-thyroid Neck Swellings according to Tissue of Origin and Their Radio-pathological Correlation

Introduction:

Neck swellings are commonly found and can be presented as simple benign to malignant. Due to extensive differential diagnosis and similar presentation, the evaluation of neck swellings is more challenging. Most of the cases can be diagnosed after a detailed history and clinical examination of the head and neck, but the final diagnosis will be achieved by histopathological examination.

Materials and Methods:

The study was conducted from February 2020 to February 2023 on the basis of retrospective and prospective sampling. This study included all the patients with neck swellings, excluding thyroid, who had undergone excisional or incisional biopsy. The present study was carried out on 74 patients with non-thyroid neck swellings, which were classified five into main headings, i.e. lymph node swelling, salivary gland swellings, adipose tissue, neural tissue and skin and soft-tissue swellings as miscellaneous. Data were collected from patient records for retrospective sampling and radiological investigation, and ultrasonography (USG) and excisional or incisional biopsy were done for prospective sampling. A radiological and pathological correlation was analysed as benign and malignant.

Results:

Out of the 74 patients, n = 60, 81% were benign and n = 14, 19% were malignant. The most common swelling according to the tissue of origin was lymph node (n = 31, 41.9%) followed by salivary gland n = 15 (20.3%), adipose tissue (n = 7, 9.5%) and neural tissue (n = 6, 8.1%) origin. Other soft-tissue swellings were 20.3%. The overall sensitivity, specificity, positive predictive value, negative predictive value and radiological (USG) diagnosis accuracy to differentiate between benign and malignant are very similar to gold standard histopathological examination.

Conclusion:

Lymph node swellings were the most common swelling involving the neck region. USG diagnosis is highly sensitive for diagnosing malignant swellings but less good at confirming benign swellings. Radiological diagnosis is not a substitute for conventional surgical histopathology but is regarded as a precious complement in diagnosis. Newer diagnostic techniques are required to be infallible and accurate for further management.

Efficiency of Fine-Needle Aspiration (FNA) in Relation to Tru-Cut Biopsy of Lateral Neck Swellings

Background Lateral neck masses have always been difficult to diagnose without proposing a differential diagnosis. Fine-needle aspiration (FNA) was proposed to be a cost-effective method and less invasive than a tru-cut biopsy and may provide a provisional diagnosis in relation to cytopathology. FNA has also been shown to improve the diagnosis of neck masses such as cervical lymphadenopathy, neck cysts, and parotid masses, whether malignant or benign. This study aims to evaluate the accuracy of FNA cytopathology versus a tru-cut biopsy histopathological examination. Materials and methods This study was conducted retrospectively in King Hussein Medical Hospital, Royal Medical Services, Hashemite Kingdom of Jordan, from January 2019 to January 2024. Ethical approval was taken to conduct this study with reference number 06/2024. All patients included in this study have given verbal and written consent to perform FNA and surgical tru-cut biopsy. The inclusion of patients was based on any person above the age of 16 who underwent an FNA followed by a surgical biopsy to correlate with the primary diagnosis. Exclusion criteria involved any patient who missed one of the above criteria. Statistical analysis was performed using IBM SPSS v29 (IBM Corp., Armonk, NY, US) with significant results considered with a p-value <0.05. Results A total of 107 patients were included in this study. A correlation between FNA results and final histopathological biopsy was done with an accuracy of 90.6%, specificity of 94.3, predictive positive value of 73.6%, and negative predictive value of 94.3%. There was a statistical significance between FNA and tru-cut biopsy with a p-value of <0.001. Conclusion FNA is a great tool to consider when diagnosing lateral neck swellings. Since it was statistically significant, FNA should be considered for any lateral neck swelling before any surgical tru-cut biopsy for a definitive diagnosis.

Mapping the Potential of Microfluidics in Early Diagnosis and Personalized Treatment of Head and Neck Cancers

Head and neck cancers (HNCs) account for ~4% of all cancers in North America and encompass cancers affecting the oral cavity, pharynx, larynx, sinuses, nasal cavity, and salivary glands. The anatomical complexity of the head and neck region, characterized by highly perfused and innervated structures, presents challenges in the early diagnosis and treatment of these cancers. The utilization of sub-microliter volumes and the unique phenomenon associated with microscale fluid dynamics have facilitated the development of microfluidic platforms for studying complex biological systems. The advent of on-chip microfluidics has significantly impacted the diagnosis and treatment strategies of HNC. Sensor-based microfluidics and point-of-care devices have improved the detection and monitoring of cancer biomarkers using biological specimens like saliva, urine, blood, and serum. Additionally, tumor-on-a-chip platforms have allowed the creation of patient-specific cancer models on a chip, enabling the development of personalized treatments through high-throughput screening of drugs. In this review, we first focus on how microfluidics enable the development of an enhanced, functional drug screening process for targeted treatment in HNCs. We then discuss current advances in microfluidic platforms for biomarker sensing and early detection, followed by on-chip modeling of HNC to evaluate treatment response. Finally, we address the practical challenges that hinder the clinical translation of these microfluidic advances.

Real-Time Ultrasound Image Fusion with FDG-PET/CT to Perform Fused Image-Guided Fine-Needle Aspiration in Neck Nodes: Feasibility and Diagnostic Value

BACKGROUND AND PURPOSE

New imaging techniques such as hybrid imaging of ultrasound and FDG-PET/CT are available but not yet investigated for node staging. The aim of the study was to evaluate the feasibility and added diagnostic value of real-time image-fused ultrasound-guided fine-needle aspiration with FDG-PET/CT data for node staging.

MATERIALS AND METHODS

Ninety-six patients who were referred for cervical lymph node staging with FDG-PET/CT before ultrasound were prospectively included. After routine ultrasound-guided fine-needle aspiration, all FDG-PET-positive nodes were marked on FDG-PET/CT, and real-time image fusing of ultrasound and FDG-PET/CT was performed using the electromagnetic navigation system PercuNav. Already-punctured nodes were confirmed to be PET-positive, and additional fused-ultrasound-guided fine-needle aspiration was performed in previously missed PET-positive nodes.

RESULTS

Of 96 patients, 87 (91%) patients had suspicious nodes requiring fine-needle aspiration cytology. Ultrasound-guided fine-needle aspiration was performed in 175 nodes. Cytology was inconclusive in 9/175 (5%) nodes, and 85/166 (51%) nodes were malignant. Target planning was performed in 201 PET-positive nodes; 195/201 (97%) of those nodes were fused successfully. Twenty of 175 ultrasound-guided fine-needle aspiration nodes turned out to be FDG-PET-negative, and 149/175 (85%) of the fused ultrasound-guided fine-needle aspiration nodes were confirmed to be FDG-PET-positive. Of 201 PET-positive nodes, 46 (23%) were additionally identified, and fused ultrasound-guided fine-needle aspiration was performed. Cytology was inconclusive in 4/46 nodes (9%), and 13/42 (31%) nodes were malignant.

CONCLUSIONS

Real-time ultrasound image fusion with FDG-PET-positive nodes is feasible in cervical lymph nodes, and fused ultrasound-guided fine-needle aspiration increases the number of malignant nodes detected.

Accuracy of preoperative fine needle aspiration in diagnosis of malignant parotid tumors

Objectives:

To determine the diagnostic accuracy of fine needle aspiration (FNA) for detecting malignant parotid tumors.

Methods:

We conducted a retrospective study of all patients diagnosed with benign or malignant parotid gland tumors in King Abdulaziz University Hospital, Jeddah, Saudi Arabia, between January 2004 and May 2015. The records of 65 subjects were obtained. Histopathological findings and data from FNA examinations were obtained from medical records. Twenty-three subjects were excluded due to missing FNA, histopathology results or both. The sensitivity, specificity, negative predictive value, and positive predictive value of FNA for detecting malignant lesions were estimated and compared with the gold standard, histopathology.

Results:

The specimens of 5 cases were insufficient for diagnosis; therefore, 38 cases were diagnosed by FNA and had histopathological reports. Three cases were diagnosed positive for cancer using histopathology and missed by FNA, 3 were diagnosed as malignant lesions using both FNA and histopathology, and 32 cases were determined benign based on histopathology and FNA analysis. The total prevalence of parotid malignancies was 15.8%. The sensitivity of FNA for detecting malignancy was 50%, and the specificity was 100%; with a positive predictive value of 100% and negative predictive value of 91.4%.

Conclusion:

Fine needle aspiration is a highly specific, but only moderately sensitive test. We support the use of this method as an initial tool for diagnosing parotid gland malignancies, as it is a safe, rapid, and painless procedure, compared to histopathology.

Effectiveness of fine-needle aspiration cytology in the diagnosis of lateral cervical nonthyroid tumors

Given that the clinical and radiological examinations of lateral cervical masses are not always sufficient for deciding on appropriate management, the cytological examination of the material obtained by fine-needle aspiration might be an efficient tool in the preoperative investigation of these lesions.In this prospective cross-sectional study we evaluated the efficacy and diagnostic accuracy of fine-needle aspiration cytology in the assessment of lateral cervical nonthyroid tumors, by comparing its results with those of histopathology.A total of 58 patients with lateral cervical masses were included. Preoperative cytological results were compared with the histopathologic examination of surgical specimens.Both cytology and histology indicated that malignant tumors outnumbered benign lesions (62% vs 38%), with 88.9% of malignancies presenting in patients aged >50 years, but cytology was less effective at differentiating between benign and nontumor lesions. Cytology had 76.5% specificity and 78.1% sensitivity for identifying malignant lateral cervical lesions, and there was a concordance between the two diagnostic tests (McNemar test, P = 0.17, κ = 0.50, P <0.001).Fine-needle aspiration cytology is a simple, quick, and effective procedure that can aid in the preoperative evaluation of lateral cervical masses by differentiating benign tumors and inflammatory processes from malignancies and thus help in determining a subsequent therapeutic strategy.