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CT-guided aspirations in the head and neck: assessment of the first 216 cases
Paul M Sherman1, David M Yousem, Laurie A Loevner
1Russell H. Morgan Department of Radiology and Radiological Sciences, Division of Neuroradiology, Johns Hopkins Medical Institution, Baltimore, MD, USA.
Background And Purpose:
The growth of cross-sectional imaging has increased the detection of nonpalpable head and neck masses. We sought to determine the reliability of CT-guided fine-needle aspiration (FNA) over 216 consecutive cases.
Methods:
We retrospectively reviewed histopathologic findings and notes from 216 consecutive head and neck CT-guided FNA procedures performed between 1993 and 2003. Types of needles used, passes required, lesion location, initial cytologic diagnosis, and final histopathologic or clinical diagnosis were reviewed.
Results:
Diagnostic samples were obtained in 195 (90.3%) of the lesions, with 21 (9.7%) inadequate samples. A correct diagnosis was made in 191 cases (88.4%). Final FNA diagnosis was discordant in four (1.9%) specimens, with the parapharyngeal space and parotid gland having the highest rate of inaccuracy. The range in number of passes required for final diagnosis was one to six (mode, 2.0 passes per specimen; median, 2.0; mean, 2.6; standard deviation, 1.13). In 135 (63%) of 216 cases, definitive surgical pathologic results, including findings for the four discordant specimens, were obtained. Of the nondiagnostic specimens, six (29%) of 21 went to surgery, five (83%) of six were neoplastic, and one (17%) of six was fibrous tissue. The remainder underwent clinical and imaging follow-up.
Conclusion:
CT-guided FNA is a safe, well tolerated, and accurate for the diagnosis of head and neck lesions. In our series, the percentage of diagnostic samples obtained improved compared with prior reports. The low diagnostic error rate overall was possibly related to onsite evaluation by the cytopathologist and to improved FNA technique.