Utility of Fnac With Cytomorphological Pitfalls in Intraoral Lesions- A 6-Year Experience at a Tertiary Care Hospital

Abstract

BACKGROUND Intraoral region has a spectrum of distinct anatomical sites and there exists a wide variety of intraoral lesions. Fine Needle Aspiration Cytology (FNAC) is a simple tool and has gained importance, especially in cases with difficult intraoral accessibility and risk of bleeding obviating biopsy and thereby helping in the decision for surgical intervention. Aim: This study was carried out to evaluate the diagnostic utility and pitfalls of FNAC in the intraoral lesions with histopathological correlation. MATERIALS AND METHODS This is a retrospective descriptive study and the data was collected retrospectively of intraoral lesions diagnosed on FNAC over a period of 6 years (July 2011 to June 2017) from the cytology records. The histopathology correlation was done wherever available. RESULTS Out of 102 cases, 82 (80.39%) were adequate for cytological study. Different sites involved were tongue, gingival region, buccal mucosa, floor of mouth, soft palate, hard palate, tonsil, oropharynx and parapharyngeal/ posterior pharyngeal wall. Of these 82 cases, 40 (48.78%) were neoplastic and 42 (51.22%) were non-neoplastic. Twenty-nine cases (72.5%) out of 40 neoplastic cases were diagnosed as benign and 11 cases (27.5%) as malignant. Cytological diagnosis was compared with the histopathology diagnosis. Histological correlation was found in 44 cases with concordance rate of 68.2% (30 of 44 cases). However, in 9 cases there was discordance with histological findings. In rest 5 cases, the histology report was descriptive without a definitive diagnosis. A single false positive case was of dense inflammation with squamous cells misinterpreted as squamous cell carcinoma on cytology. CONCLUSION FNAC was found to be useful in the diagnosis of variety of lesions in the oral cavity, though few cases can pose diagnostic difficulties. Cytological diagnosis can save many non-neoplastic cases from undergoing surgery or excision biopsy and helps identify the malignant cases for early management.