Routine non-thyroid head and neck cytology in a large UK centre: clinical utility and pitfalls

Kaye, Philip; Pigera, Marian; Khan, Marium Mateen; Hollows, P.; Beasley, Nigel

doi:10.1017/s0022215115000092

Cited by 3 publications

(2 citation statements)

References 14 publications

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“…When FNAB is combined with ultrasound guidance, FNAB demonstrates a diagnostic accuracy between 95% and 100% 2,4,6,7,9‐12 . While overall diagnostic accuracy is well documented, less is known about node characteristics impacting the technique's sensitivity for identification of metastatic disease.…”

Section: Discussionmentioning

confidence: 99%

Axillary lymph node metastasis: Fine‐needle aspiration biopsy sensitivity as a function of node size, percent replacement of lymph node by tumor and tumor deposit size

Layfield

Zhang

Esebua

et al. 2020

Diagnostic Cytopathology

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BackgroundFine‐needle aspiration (FNA) is commonly used to investigate lymphadenopathy of suspected metastatic origin. While diagnostic accuracy of FNA for lymph node disease is well described, the relationship between node size, percent tumor replacement, and size of metastatic deposit with diagnostic accuracy is less well documented.MethodsAll axillary lymph nodes undergoing ultrasound‐guided FNA for suspected breast metastases were correlated with subsequent surgical excision specimens. FNAs were judged as positive or negative for malignancy and the percent of false negative FNAs was correlated with node size, percent tumor replacement and size of metastatic depositResultsSensitivities were calculated for nodes greater than 15 mm (92%), nodes 11 to 14.9 mm (83%), nodes 7 to 10.9 mm (61%), and for nodes less than 7 mm (60%). Sensitivity increases with increasing node size (P = .001). Percent tumor replacement correlated with sensitivity: 90% or greater replacement (85%) 60% to 89.9% replacement (75%), 40% to 59.9% replacement (75%) and less than 39.9% replacement (64%)(P < .001). Metastases size correlated with sensitivity: metastases greater than 10 mm (94%), 6 to 9.9 mm (70%), 4 to 5.9 mm (54%), and less than 4 mm (72%).ConclusionsPercentage of false negative FNAs associate with investigation of metastatic disease correlates with node size, size of metastatic deposit and percentage of nodes replaced by tumor. Lymph nodes smaller than 7 mm, deposit diameter less than 6 mm and percentage replacement of less than 40% have the highest percentage of false negative results.

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Section: Discussionmentioning

confidence: 99%

Axillary lymph node metastasis: Fine‐needle aspiration biopsy sensitivity as a function of node size, percent replacement of lymph node by tumor and tumor deposit size

Layfield

Zhang

Esebua

et al. 2020

Diagnostic Cytopathology

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“…Firat et al 21 identified 1 benign branchial cyst that was reported as highly suspicious of carcinoma. Kaye et al 22 reported that of 22 lesions confirmed to be a benign branchial cyst, 1 was suspicious of squamous cell carcinoma. Kadhim et al 23 reported that of 34 patients with a cytology aspirate from a benign branchial cleft cyst, 1 was reported as cytologically suspicious of squamous cell carcinoma.…”

Section: Lateral Neck Cystsmentioning

confidence: 99%

Should uncertainty concerning the risk of malignancy be included in diagnostic (nongynecologic) cytopathology reports?

Poller

Schmitt

2020

Cancer Cytopathology

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In diagnostic cytology, the known site‐specific false positive rates at various anatomical sites for the risk malignancy (ROM) when a confirmed malignant diagnosis is made are comparatively well documented. ROM figures for diagnostic cytology specimens may vary according to the anatomical site of the specimen, the exact nature of the specimen received, the staining method(s) used, and the use of additional laboratory techniques including molecular profiling; furthermore, they often differ to some extent from institution to institution, between differing cytologists within the same institution, and over time. A brief literature review for a selected group of routine diagnostic cytology specimens shows a published ROM for a confirmed malignant diagnosis as follows: bile duct brushings, ~99% (range, 97%‐100%); breast fine needle aspiration, 98.5% (range, 92%‐100%); serous effusion fluid, 98.9% (range, 90%‐100% although lower for squamous cell carcinoma, mesothelioma, and lymphoma), pulmonary endobronchial ultrasound cytology, ~99% (range, 86.6%‐100%); thyroid FNA, 98% (range, 97%‐99% if NIFTP tumors are excluded), salivary gland FNA, ~90%; (range 57%‐100%) and lateral neck cyst FNA, ~99% (range, 95.5%‐100%). Because most diagnostic cytology specimens have a small but accepted false‐positive rate, this information is vitally important for the clinical management of patients and for shared patient decision making. In our view, the known false‐positive rate for a given diagnostic cytology specimen could be included within the cytology report to assist in explaining the limitations of the diagnostic cytology interpretation and help facilitate the clinical decision‐making process.

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Reduced percentage of inconclusive reports and need for repeated fine needle aspirations in ultrasound versus free-hand parotid cytology

Prades

Garlea-Robu

Harris

et al. 2023

Egypt J Otolaryngol

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Background Fine needle aspiration cytology has been established as a minimally invasive, non-tumour seeding investigation of choice in the initial diagnostic pathway of parotid lesions. The purpose of this study was to compare the accuracy of fine needle aspiration cytology performed with and without ultrasound to determine whether one method should be preferred to the other. A retrospective review of all patients undergoing fine needle aspiration cytology with and without ultrasound for parotid masses in a large district general hospital between 2012 and 2016 was performed. Specificity, sensitivity, accuracy, positive and negative predictive value, percentage of inconclusive fine needle aspiration cytology and percentage of second fine needle aspiration cytology were determined for each group. Results A total of 397 fine needle aspiration cytology results were available for analysis. The numbers performed with ultrasound guidance and free-hand were roughly equal (208 (52.3%) versus 189 (47.7%)). The number of inconclusive fine needle aspiration cytology reports was significantly higher in the free-hand group (65/189 (34.4%)) than the ultrasound group (25/208 (12%)) (p < 0.0001). A significantly higher number of repeated fine needle aspiration cytology were undertaken in the free-hand group vs ultrasound group (43 vs 15, p < 0.0001); overall 7.2% of ultrasound-guided fine needle aspiration cytology required a second fine needle aspiration cytology, compared to 22.8% in the free-hand group. The sensitivity, specificity, positive and negative predictive values were all higher in the ultrasound group versus the free-hand group. Conclusions Ultrasound-guided fine needle aspiration cytology is superior to free-hand fine needle aspiration cytology in the investigation of parotid tumours. There is a significant benefit in reducing the number of inconclusive results and repeat fine needle aspiration cytology, and a potential benefit in improving the sensitivity and positive predictive value, when immediate cytology assessment of the sample quality is not performed.

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Routine non-thyroid head and neck cytology in a large UK centre: clinical utility and pitfalls

Abstract: Head and neck cytology is a robust technique at our institution, although there are certain problem areas. There is room for improvement in the technical quality of fine needle aspiration.

Cited by 3 publications

References 14 publications

Axillary lymph node metastasis: Fine‐needle aspiration biopsy sensitivity as a function of node size, percent replacement of lymph node by tumor and tumor deposit size

Axillary lymph node metastasis: Fine‐needle aspiration biopsy sensitivity as a function of node size, percent replacement of lymph node by tumor and tumor deposit size

Should uncertainty concerning the risk of malignancy be included in diagnostic (nongynecologic) cytopathology reports?

Reduced percentage of inconclusive reports and need for repeated fine needle aspirations in ultrasound versus free-hand parotid cytology

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