Fine-needle aspiration biopsy of intraosseous jaw lesions

Purpose: This study assessed diagnostic accuracy, determined reasons for er ror, and evaluated modifications to improve the reliability of fine-needle aspiration biopsy (FNAB) of primary jaw lesions. Patients and Methods: This was a retrospective review of 32 FNABs of intrao sseous jaw lesions performed at the Massachusetts General and Children's Ho spital between 1933 and 1998. A consistent, standardized technique was used , and each case was evaluated for 1) adequacy of cells to allow diagnosis, 2) presence of malignant cells, and 3) correlation between FNAB diagnosis a nd the final histopathology. Results: Material obtained by FNAB was adequate for evaluation in 30 of 32 cases. No complications were reported. Malignant cells were found in 5 of 3 0 cases. FNAB diagnosis was confirmed by histopathology in all 5 of these s pecimens (100% accuracy). The FNAB diagnosis of benign lesions was confirme d in 17 of 25 cases (68%). The most common benign lesions were odontogenic cysts, ameloblastomas, and fibro-osseous and giant cell lesions. Incorrect diagnosis was related to lack of architectural context of the FNAB material , sampling of a nonrepresentative part of a large lesion, and inadequate qu antity or quality of the aspirate. Conclusions: FNAB is a useful technique to distinguish between malignant an d benign intraosseous jaw lesions. Its simplicity, suitability as an outpat ient procedure, rapidity of interpretation, and minimal. morbidity potentia lly make it the diagnostic tool of choice in the hospital setting.