FINE-NEEDLE ASPIRATION CYTOLOGY IN TUMORS AND TUMOR-LIKE CONDITIONS OF THE ORAL AND MAXILLOFACIAL REGION - DIAGNOSTIC RELIABILITY AND LIMITATIONS

BACKGROUND, Fine-needle aspiration cytology (FNAC) is a well establish ed diagnostic technique. The purpose of the current study was to evalu ate its diagnostic accuracy, sensitivity, and specificity in tumors an d tumor-like conditions in the oral and maxillofacial region. METHODS. The results of 1022 cases of FNAC performed over a 7-year period (199 0-1996) were retrospectively reviewed and analyzed. The material was c ollected from 228 major salivary glands, 67 perioral soft tissues and facial bones, 139 tumors of the oral cavity, 18 paranasal tumors, 41 o ropharyngeal lesions, and 21 nasopharyngeal lesions, whereas 508 cases represented cervical lymph nodes. RESULTS. In 804 cases FNAC establis hed or documented the initial diagnosis whereas in 198 cases it confir med suspected recurrences. Definitive histologic diagnosis was establi shed in 809 of the 1022 cases after surgical treatment and the histolo gic diagnoses were compared with preoperative FNAC results. In 20 case s the cytologic material was considered unsatisfactory and therefore t he cytologic diagnosis was impossible to establish. In 12 of these cas es diagnosis was made based on histologic examination after surgery. M alignancy was found in three of the latter cases. In the total number of 1022 cases there were 18 false-negative and 2 false-positive cytolo gic results. In another 19 cases a difference in the histologic type o f the lesion was found. The diagnostic accuracy of the method was 98.2 % with a sensitivity of 96.2% and a specificity of 99.4%. CONCLUSIONS. Four major causes of error were identified: material adequacy criteri a, sampling technique, cytologic interpretation, and limitations of th e procedure. FNAC proved to be a safe, accurate, inexpensive, and pati ent-friendly in the effort to establish preoperative diagnosis in tumo rs and tumor-like conditions of the oral and maxillofacial region. The authors have proposed modification in the mathematic computation of d iagnostic accuracy, adding the parameter of nonconcordance with histol ogic typing of FNAC. (C) 1997 American Cancer Society.