Image-guided fine-needle aspiration of the head and neck: Five year's experience

Objective: To evaluate the diagnostic utility of image-guided fine- needle aspiration (FNA) in the head and neck. Design: All image-guided FNAs of the head and neck performed January 1992 through June 1997 were included. All cytohistopathologic data were reviewed and collated. A slide review was performed in all cases with cytohistologic discrepancies. Setting: The Department of Radiology, University of Pennsylvania Medical Center, Philadelphia. Patients: Patients with deep-seated or poorly localized masses in the head and neck, representing both primary or recurrent/metastatic lesions, were referred. Results: There were 111 computed tomography-guided FNAs performed in 109 patients. Sites sampled included parapharyngeal (n = 20), parotid or submandibular (n = 25), thyroid (34), and neck, paratracheal/paraesophageal, skull base, and paraspinal (n = 32). Diagnostic samples were obtained in 93 cases (83.8%). The procedures were well tolerated, without long-term complications. Cytologic examination detected a total of 39 malignancies, 24 of which were confirmed histologically. Eleven of the remaining malignant FNA cases reflected recurrent tumor; there were 3 false-positive FNA cases (2.7%), 2 in the setting of previous surgery and/or radiation therapy. There were 2 false-negative aspirates from sites deep in the neck (1.8%) among 7 of the 35 patients with benign aspirates who underwent surgery. Twenty six patients underwent ultrasound-guided FNA (thyroid gland only), revealing 1 papillary carcinoma and 1 intrathyroidal parathyroid gland, both of which were confirmed histologically. The findings in the aspirates from the rest of the patients were benign (n = 18), Hurthle cell neoplasm (n = 1), and nondiagnostic (n = 5). Conclusions: (1) The cytologic findings were supported clinically and/or histologically in 86 (92%) of the 93 diagnostic computed tomography-guided FNA cases. (2) Unnecessary surgery was a avoided in 37% of the patients with recurrent tumor or benign diagnoses by cytologic assessment. (3) Potential pitfalls include false-positive diagnoses after radiation therapy and procedural or sampling limitations for deep neck and paraspinal lesions.