Fine Needle Aspiration Cytology of Head & Neck Lesions- Single Centre study in a Rural Medical College

Abstract

Introduction:

 Diagnosis of swelling in the head and neck region is challenging due to the diversity of entities. Introduction of FNAC in diagnostic protocol of Space Occupying Lesion (SOL) of head and neck region has reduced the number of unnecessary surgery and excision biopsy. Existing Literature review indicates that clinical history and anatomical site of the lesion are valuable in terms of narrowing down the differential diagnosis of a SOL in head & neck region. FNAC has contributed a great deal to transform cytology from a primarily screening tool to a powerful diagnostic technique.

With this background knowledge, the present study was performed to evaluate the wide spectrum of lesions diagnosed on Fine needle aspiration cytology (FNAC) in patients with head and neck swellings and to know the efficacy of FNAC in diagnosing head and neck lesions

Materials and methods:

The present prospective, observational single hospital based study was conducted in a tertiary care centre and medical college in eastern India, catering mainly rural population. Eighty (80) patients were included in the study, after obtaining written consent, presenting with superficially palpable swellings of head and neck area. After explanation of procedure and taking informed consent of patient, FNAC was done using 10 cc disposable syringe and 22 gauge needle maintain appropriate procedure. Three or four smears were prepared following standard guidelines. Smears were stained with Papanicolaou and Leishman-Giemsa stain. Ziehl- Neelsen staining for acid fast bacilli was done in suspected tubercular lesions. Cytomorphological diagnosis was given.

 For statistical analysis data were entered into a Microsoft excel spreadsheet. Data had been summarized as percentages for categorical variables.

Results:

In our study, maximum number of patient are in the age group of 16-45 years (65%) with a female preponderance. Lymph node (45%) is the most common site of FNAC followed by thyroid gland (24 %) and salivary gland (16%). Among the lymph node swellings, tubercular lymphadenitis is the commonest diagnosis. Among malignant cases of lymph nodes, metastatic carcinoma was seen in 8.3%. In these cases FNAC not only confirmed the malignancy but also gave a vital information regarding type of carcinoma (adeno or squamous) and so about the primary site of the malignancy. In salivary gland lesions, Pleomorphic adenoma appears to be the commonest cytological diagnosis followed by sialadenitis cases. Regarding cytopathology of thyroid aspirates, in our study, 50% cases appeared as nodular colloid goiter.16.6% cases were lymphocytic thyroiditis and 12.5% cases were papillary carcinoma. Cytopathology of other   miscellaneous lesion of head and neck area aspirates show that inflammatory lesions constitute 25% of the cases.

Conclusion:

Due to technical ease, considerable accuracy and cost effectiveness, FNAC is an excellent screening test in the diagnosis of head and neck swelling and it is used as first-line investigation in diagnosing head and neck swellings nowadays. However, as seen in our study and in comparison to other similar studies, it is important to note that the diagnostic accuracy of FNA is variable for different conditions. Ultra- sound guidance (USG guided) and sampling from representative sites are sometimes necessary to improve the yield and diagnostic accuracy of FNAC. Introduction of FNAC in diagnostic protocol of head and neck area space occupying lesion (SOL) has reduced the rate of open tissue biopsy as well as unnecessary surgery.