IMAGE-GUIDED FINE-NEEDLE ASPIRATION OF THE HEAD AND NECK - 5 YEARS EXPERIENCE

Objective: To evaluate the diagnostic utility of image-guided fine-nee dle aspiration (FNA) in the head and neck. Design: All image-guided FN As of the head and neck performed January 1992 through June 1997 were included. All cytohistopathologic data were reviewed and collated. A s lide review was performed in all cases with cytohistologic discrepanci es. Setting: The Department of Radiology, University of Pennsylvania M edical Center, Philadelphia. Patients: Patients with deep-seated or po orly localized masses in the head and neck, representing both primary or recurrent/metastatic lesions, were referred. Results: There were 11 1 computed tomography-guided FNAs performed in 109 patients. Sites sam pled included parapharyngeal (n = 20), parotid or submandibular (n = 2 5), thyroid (34), and neck, paratracheal/paraesophageal, skull base, a nd paraspinal (n = 32). Diagnostic samples were obtained in 93 cases ( 83.8%). The procedures were well tolerated, without long-term complica tions. Cytologic examination detected a total of 39 malignancies, 24 o f which were confirmed histologically. Eleven of the remaining maligna nt FNA cases reflected recurrent tumor; there were 3 false-positive FN A 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 under went surgery. Twenty six patients underwent ultrasound-guided FNA (thy roid gland only), revealing 1 papillary carcinoma and 1 intrathyroidal parathyroid gland, both of which were confirmed histologically. The f indings in the aspirates from the rest of the patients were benign (n = 18), Hurthle cell neoplasm (n = 1), and nondiagnostic (n = 5). Concl usions: (1) The cytologic findings were supported clinically and/or hi stologically in 86 (92%) of the 93 diagnostic computed tomography-guid ed FNA cases. (2) Unnecessary surgery was avoided in 37% of the patien ts 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 para spinal lesions.