Fine needle aspiration biopsy of pediatric head and neck masses

Objective: To determine if fine needle aspiration (FNA) can preclude the re quirement for diagnostic open biopsy in suspicious pediatric head and neck masses. Methods: The records of 40 children presenting to an inner city ter tiary care hospital who underwent a total of 50 FNA biopsies during the yea rs 1988-1999 were reviewed. From these 40 patients, 17 children, aged 3 mon ths to 18 years, underwent both clinically indicated FNA biopsy and subsequ ent open surgical biopsy or excision. Outcome measurements included clinica l resolution or surgical pathologic diagnosis. Results: The 17 patients who underwent open surgical biopsy subsequent to the FNA had a total of 21 FNA s performed. Three of these patients had more than one needle biopsy prior to surgery. The histologic diagnosis of the surgical excision confirmed the FNA biopsy cytologic diagnosis in all but two cases. FNA cytologic diagnos tic categories included reactive lymph node/non-specific inflammation (25 b iopsies), benign cystic process (four), granulomatous disease (eight), mali gnant neoplasm (three), and benign neoplasm (one). Eight of nine FNAs initi ally non-diagnostic had either complete resolution of the mass or a diagnos is obtained by subsequent FNA or open biopsy. Conclusions: FNA is a valuabl e diagnostic tool in the management of children with the clinical presentat ion of a suspicious neck mass. The technique reduces the need for more inva sive and costly procedures. Early surgical biopsy, however, should be consi dered in rapidly enlarging masses, in the presence of persistent systemic s ymptoms, and when repeated FNA cytology is non-diagnostic. (C) 2001 Elsevie r Science Ireland Ltd. All rights reserved.