Implantation metastasis of head and neck cancer after fine needle aspiration biopsy

One possible complication of the aspiration biopsy of malignant tumors is dissemination of tumor cells along the needle track. However, a search of the literature revealed few definite reports of implantation metastases of head and neck tumors after fine needle aspiration biopsy (FNAB). Here we report two cases of skin metastasis of head and neck cancer after FNAB, including a patient with papillary adenocarcinoma of the thyroid and one with adenoid cystic carcinoma of the submandibular gland. Surgical treatment prevented the spread of the tumor in both cases and there have been no evidence of recurrence to date. This report should alert head and neck surgeons to the possibility of implantation metastasis after FNAB.     

Accuracy of fine needle aspiration biopsy in neck masses

One hundred thirty-eight fine needle aspirations (FNA) of neck masses were performed during a four-year period (1979-1982). The pre-existing literature was reviewed. An accuracy rate of 85% in FNA of neck masses was found, and a 100% accuracy rate in cases of benign tumors of the neck and developmental cysts of the neck was found.     

Role of repeat fine needle aspiration cytology in head and neck lesions: preliminary study

In this preliminary prospective study the value of repeating fine needle aspiration cytology (FNAC) in patients with head and neck lesions was investigated. Few reports exist on the significance of repeating the procedure in head and neck patients. Fifty-seven patients have been sampled twice for the first and second (repeat) FNAC. The second aspirate was performed in the operating theatre under general anaesthesia prior to a surgical procedure. The cytological results were compared with the histology of the 57 resected lesions. It was found that the overall diagnostic results improved after repeating the FNAC. It can be concluded that repeating FNAC is useful and should be considered under some circumstances, especially in the case of non-diagnostic cervical lymph node aspirates.     

Fine needle aspiration biopsy of pediatric head and neck masses

OBJECTIVE: To determine if fine needle aspiration (FNA) can preclude the requirement for diagnostic open biopsy in suspicious pediatric head and neck masses. METHODS: The records of 40 children presenting to an inner city tertiary care hospital who underwent a total of 50 FNA biopsies during the years 1988-1999 were reviewed. From these 40 patients, 17 children, aged 3 months to 18 years, underwent both clinically indicated FNA biopsy and subsequent open surgical biopsy or excision. Outcome measurements included clinical resolution or surgical pathologic diagnosis. RESULTS: The 17 patients who underwent open surgical biopsy subsequent to the FNA had a total of 21 FNAs performed. Three of these patients had more than one needle biopsy prior to surgery. The histologic diagnosis of the surgical excision confirmed the FNA biopsy cytologic diagnosis in all but two cases. FNA cytologic diagnostic categories included reactive lymph node/non-specific inflammation (25 biopsies), benign cystic process (four), granulomatous disease (eight), malignant neoplasm (three), and benign neoplasm (one). Eight of nine FNAs initially non-diagnostic had either complete resolution of the mass or a diagnosis obtained by subsequent FNA or open biopsy. CONCLUSIONS: FNA is a valuable diagnostic tool in the management of children with the clinical presentation of a suspicious neck mass. The technique reduces the need for more invasive and costly procedures. Early surgical biopsy, however, should be considered in rapidly enlarging masses, in the presence of persistent systemic symptoms, and when repeated FNA cytology is non-diagnostic.     

Utility of immediate on-site cytopathological procurement and evaluation in fine needle aspiration biopsy of head and neck masses

The utility of on-site microscopic evaluation of fine needle aspirates (FNAs) of the head and neck was assessed by comparing the diagnostic yield in 336 specimens obtained with immediate on-site cytopathological procurement and evaluation to that achieved in 548 cases performed without immediate on-site evaluation. Three hundred six (91%) of 336 immediate evaluation specimens were adequate for cytopathologic diagnosis, compared to 391 (71%) of 548 specimens not evaluated immediately (P < .001, chi-squared test). The higher satisfactory rate in immediate evaluation cases was related primarily to 1. immediate reaspiration of the masses until sufficient cytopathologic material was obtained for diagnosis; and 2. optimal specimen preparation. It is concluded that immediate on-site cytopathological procurement and evaluation of fine needle aspirates of head and neck masses is a valuable practice which assures a higher yield of adequate specimens compared to biopsies taken without immediate evaluation. The technique of immediate on-site evaluation of FNAs is discussed and a cost-benefit analysis of immediate on-site evaluation of FNAs is presented.     

CT-directed fine needle aspiration biopsies of masses in the head and neck

Fine needle aspiration (FNA) biopsy is a safe, reliable, and cost-effective technique available for the evaluation of head and neck masses. Its utility is enhanced by the use of CT-directed aspiration. Candidates for CT-directed FNA include patients with: 1. deep-seated lesions; 2. distorted anatomy as a result of surgery or irradiation; 3. medical problems which contraindicate general anesthesia. The initial UCLA experience with this modality is reviewed. In certain clinical settings, CT-directed FNA can be a highly productive source of clinical information.     

Parotid tumours: correlation between fine needle aspiration biopsy and histological findings

ObjectivesTo evaluate the role of the fine needle aspiration biopsy (FNAB) in the study of parotid masses.MethodsRetrospective review of FNAB results compared with final histological diagnosis in 148 patients with a parotid mass from 1993 to 2003.ResultsFNAB was performed in 93.92% of parotid masses. Eleven of these were not conclusive. The FNAB diagnosis of malignant o suspicious lesion had 81.25% of sensibility, 96.87% of specificity and positive and negative predictive values of 89.65% and 93.94%, respectively. The FNAB specific histopathologic diagnosis in the benign parotid masses were 92%, and 57.69% in the malign masses.ConclusionsFNAB is a diagnostic tool with a high negative predictive value, very usotul in the study of suspicious malignant parotid masses and whenever surgery is not possible.     

Evaluation of fine needle aspiration cytology in the management of head and neck masses

In the present study 80 cases of head and neck masses were subjected to FNA and simultaneously biopsy was also sent for histopathological examination. Though the histopathological report was considered to be confirmatory in diagnosis but comparison was done with FNA cytology report & the accuracy of the FNA was calculated. The Overall accuracy was 90.42 percent with 9.58 percent false negative cases and no false positive case was reported. Thus the Clinical experience achieved in this study concludes that properly executed FNAB is of great importance and should be used as primary diagnostic modality in the surgical practice for masses in the head and neck.     

Fine needle aspiration biopsy in salivary gland tumours

Of 105 tumours of the major salivary glands, 90 were benign and 15 malignant. In benign tumours a correct preoperative diagnosis was made by fine needle aspiration biopsy in 84%, and none were falsely classed as malignant. In the malignant tumours, only 8 out of 15 (53%) were correctly diagnosed as malignant while 7 were misdiagnosed as benign. It is concluded that in benign salivary gland tumours there is good accordance between fine needle aspiration biopsy and the final histological report, in contrast to the malignant tumours where this is less convincing. Fine needle aspiration biopsy is a valuable diagnostic tool, but the result should be carefully evaluated, regarded as only part of the clinical picture and not solely relied on.     

Fine needle aspiration biopsy: role in diagnosis of pediatric head and neck masses

OBJECTIVE: To assess the feasibility and role of fine needle aspiration biopsy (FNAB) as a diagnostic tool in children with neck masses. DESIGN: Retrospective chart review. SETTING: Tertiary care children's hospital. PATIENTS: Consecutive series of 71 children with a head and neck mass who underwent FNAB as the primary diagnostic modality. INTERVENTIONS: FNAB was performed and interpreted by a pediatric cytopathologist. Rapid on-site analysis was performed to allow immediate assessment of specimen adequacy and to attain a preliminary diagnosis, after which routine cytologic staining was performed. Flow cytometry was performed on cytological specimens when malignancy was suspected, and open biopsy was performed when the cytologic diagnosis was in question. MAIN OUTCOME MEASURES: Technical feasibility of FNAB in children, complications, cytopathological diagnoses, accuracy of rapid on-site analysis, need for subsequent diagnostic evaluations, clinical outcomes and follow-up. RESULTS: Mean age was 8.4 years (S.D. 5.3 years), with mean follow-up of 4.1 months (S.D. 9.6 months). FNAB was performed under general anesthesia in 54 cases (76%). There were no technical complications. On-site rapid interpretation was completed in 55 cases, 18/55 confirmed adequacy of specimen only, 37/55 yielded a preliminary diagnosis, and in 34/37 cases, was same as final cytopathologic result. Overall, FNAB biopsy demonstrated 64 benign lesions, 3 malignant diagnoses, 2 follicular thyroid neoplasms, and 2 non-diagnostic specimens. FNAB was the only pathological test performed in 54 (76%) cases. The most common diagnosis was reactive lymphoid hyperplasia (n=39), followed by benign granulomatous disease (n=8). Flow cytometry was performed on 7 specimens (non-diagnostic in 5, negative for malignancy in 2). Of the 15 cases with surgical specimens, 3 revealed a pathologic diagnosis different from initial FNAB. There were no cases in which FNAB missed a malignancy, and there were 2 cases where FNAB suggested malignancy, with benign disease subsequently found on open biopsy. CONCLUSIONS: Fine needle aspiration biopsy is developing into a feasible option in diagnosing pediatric neck masses, with its main advantage being its minimally-invasive nature and avoidance of an open surgical procedure for benign persistent lymphadenitis. On-site rapid interpretation can be used successfully to confirm specimen adequacy and to give an accurate preliminary diagnosis for concerned parents. Issues to consider include the need for a specialized pediatric cytopathologist familiar with pediatric differential diagnoses, the need for general anesthesia in many cases, and the possibility of inaccurate diagnosis requiring an open procedure.     

Ultrasound-controlled fine needle biopsy of pathologic space occupying lesions in the head and neck area

We report 121 fine-needle aspiration biopsies of tumours and lymph nodes of the head and neck guided by ultrasound. The average minimal diameter of the lesions was 1.2 cm; the smallest lymph node was adjacent to the carotid artery and had a diameter of 0.4 cm. There were no complications. Of the cytological results 96% were confirmed by histology or by the subsequent clinical course.     

Biopsy cannula as diagnostic alternative to puncture-aspiration biopsy with fine needle in head and neck tumors

Biopsy cannula is a diagnostic tool allowing anatomopathological examination of tissue samples, achieved through a percutaneous perforation. Unlike puncture-aspiration with fine needle method that only permits a cytologic study, this technique eases the removal of pieces big enough to provide the knowledge of the whole architecture of the lesion. At length in other specialities in our has been forgotten perhaps for the great efficiency of PAFN on neck masses or as complement of traditional surgery. We present one case in which the biopsy-cannula showed its diagnostic usefulness. We also discuss on the technique and made a bibliographic perusal about the published literature.     

Computed tomography--guided needle biopsy of head and neck lesions

OBJECTIVE: To evaluate the diagnostic efficacy of computed tomography (CT)-guided needle biopsies of head and neck lesions. DESIGN: All CT-guided needle biopsies of head and neck lesions performed between September 1994 and February 1999 were included. Cytopathologic and histologic records, along with patient clinical records, were reviewed. SETTING: A tertiary care medical center. PATIENTS: Patients referred for evaluation of lesions inaccessible to routine methods of needle biopsy. RESULTS: Thirty-seven patients underwent 42 CT-guided biopsies. There were included 12 lesions in or adjacent to the skull base and 9 lesions around the pharyngoesophageal or laryngotracheal complex; the other lesions were located in the deep lobe of the parotid gland (n = 7), deep neck area (n = 12), and thyroid gland (n = 2). Diagnostic cytologic biopsy specimens were obtained in 38 (91%) of 42 needle biopsy procedures. The results were supported histologically and/or clinically in 36 cases (95%). Eighteen patients underwent open surgical procedures. Histologic confirmation was found in 86% of cases. Nineteen patients (51%) avoided an open surgical procedure: 11 with benign disease and 8 with recurrent malignancy. There were no false-positive or false-negative results, and no complications were identified. CONCLUSIONS: Computed tomography-guided needle biopsy is a safe and reliable minimally invasive technique for the diagnosis of poorly accessible or deep-seated lesions of the head and neck. Diagnostic needle biopsies allow improved preoperative planning and patient counseling in surgical patients and avoidance of open surgical procedures in patients with benign disease or recurrent malignant neoplasms.     

Image-guided needle biopsy of inaccessible head and neck lesions

Fine-needle biopsy and large-needle core biopsy of inaccessible and deep-space lesions of the head and neck are difficult and sometimes hazardous to perform. Patients subsequently may have to undergo a major surgical procedure with exploration of the neck and open biopsy. We describe our experience with computed tomography and ultrasound-guided fine-needle and core-needle biopsy for 11 patients with inaccessible lesions in the head and neck. Carcinoma was diagnosed in three patients and nonmalignant pathologic findings in eight patients. Three of the needle biopsy findings were confirmed by surgical excision. The initial diagnoses made from the cytopathologic findings have remained unchanged in all patients. Compared with the alternative of open biopsy, we have found this method to be technically easy, diagnostically expeditious, and safe. Head and neck surgical oncologists should be familiar with image-guided biopsy techniques, since many of their patients may benefit from these diagnostic procedures.     

Fine needle aspiration biopsy of neck lumps in a district hospital

This paper examines the results of 117 fine needle aspiration biopsies performed on head and neck lumps over the first 3 years of its use in a district general hospital. The cytological diagnosis has corresponded exactly with the histological diagnosis in 51% of cases and the concurrence rate has been 84%. Fifty-seven (49%) of the 117 masses proved to be malignant and 79% of these were correctly diagnosed by needle biopsy. A further 12% of the aspirations were highly suspicious of malignancy. There were no false positive aspirations (specificity 100%) and 4 false negative results (sensitivity 93%). No complications were encountered.     

Correlation of fine needle aspiration biopsy and CT scanning of parotid masses

Preoperative evaluation of parotid tumors still poses difficult problems for the head and neck surgeon. The complex anatomy of the parotid space leads to difficulty in localizing these tumors. In addition, physical examination will rarely determine whether a parotid lesion is benign or malignant. High resolution CT scanning with contrast and fine needle aspiration can provide enough preoperative information to enable the surgeon to counsel his patient concerning possible risks and the extent of surgery that may be indicated. We are able to determine tumor location, multiple or bilateral masses, associated adenopathy, and often specific tumor histology. Forty-two parotid aspirates and 26 CT scans were reviewed and correlated with their postoperative pathology specimen. Parotid aspiration cytology was found to be a highly accurate and safe procedure for preoperative determination of parotid pathology. However, the CT scan was specific only in defining the anatomic localization and extent of a parotid mass.