Fine needle aspiration biopsy of intraoral and pharyngeal lesions

Fine needle aspiration biopsy (FNAB) of superficial and deep-seated lesions has been used extensively with high sensitivity and specificity. However, reports of intraoral FNABs are sparse. We present a series of 44 intraoral FNABs performed between September 1988 and January 1992 at Loyola University Medical Center (36 cases) and Hines Veterans Administration Hospital (8 cases). The age of the patients ranged from 29 to 90 years (mean, 61), with 25 males and 19 females. Biopsy sites included buccal mucosal lesions (13 cases), pharynx/nasopharynx (11), tongue (10), tonsils (6), soft palate and epiglottis (2 each). Of the 44 cases, 32 (72.7%) had follow-up surgical biopsy, and 11 (25%) (all with benign diagnosis) were followed clinically. One aspiration was unsatisfactory. Cytologic diagnosis correlated with tissue biopsy in 25 cases (80.6% sensitivity). In six cases the cytologic material did not reveal a neoplasm found in the tissue sections (19.4% false negative). In one case the cytologic diagnosis of malignancy did not correlate with the surgical biopsy (3.1% false positive; specificity, 96.9%). The results of our study suggest that FNAB of intraoral lesions is less sensitive and specific than that of superficial masses. This may be explained by the small size and superficial location of the lesions as well as by the limited space for maneuvering the needle, with difficulty in fixing the lesion for adequate aspiration.