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2004, Number 3

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Cir Gen 2004; 26 (3)

Fine needle aspiration biopsy in head and neck lesions: Usefulness and limitations

Duarte TRM, Hurtado LLM

Language: Spanish
References: 86
Page: 184-191
PDF size: 112.08 Kb.


ABSTRACT

Objective: To assess the usefulness, sensitivity, specificity, and limitations of FNAB in the head and neck region (87 references).
Method: Review of the literature on the head and neck region.
Results: For oral and laryngeal lesions, FNAB has a diagnostic certainty of 77.8%, with a specificity of 80.6%, and a positive predictive value of up to 100%. The main benefit of FNAB for lymphatic ganglia is to confirm the presence of a metastatic tumor, with a diagnostic certainty of 99.1%. Morphological recognition of a malignant lymphoma in a cytological sample is inherently more difficult than the recognition of other malignant neoplasms, therefore, this diagnostic technique must be complemented with other appropriate specialized studies. Another limitation in the diagnosis of lymphomas is the complexity and sophistication of their classification, and many cytopathologists lack a profound knowledge of this complex field. The informed diagnostic certainty of non-Hodgkin lymphomas is of 71-80%, being the low grade follicular lymphomas the greatest limitation for cytological diagnosis, mainly all the small cleaved cells and mixed cells subtypes that can produce false negative results, its diagnostic certainty varies from 37 to 66%. T-type cells lymphoma and those of the marginal zone can pose a diagnostic problem due to the heterogeneous population. In Hodgkin lymphomas, the Reed-Sternberg cells or their variants are easily recognizable; however, occasionally these cells are scarce or absent, therefore the diagnostic certainty of this type of lymphoma varies from 30 to 70%.
Sensitivy of FNAB in the thyroid varies from 57 to 95%, and the most common causes for false negatives are errors in obtaining and preparing the samples. The cystic changes occurring in papillary carcinomas produce diagnostic difficulties due to the degenerative changes, and 21.6% of cystic nodules originate false negative results. The lesions constituted by Hürthle cells are also causes of diagnostic errors, mainly of false positives; hence, other diagnostic methods must be used, such as the 99Technetium-MIBI gammagram, to discard a neoplasic process in this type of lesions. Another limitation of this procedure is the difficulty to differentiate among adenomatoid nodules (goiter, adenomas, and follicular carcinomas) due to the overlapping of morphological criteria among these lesions, which decreases the specificity of the method. Therefore, in this type of lesions, the diagnosis of follicular tumor can only be made by the presence, in a definitive section, of capsular or vascular invasion.
The FNAB of salivary glands yields 90% sensitivity and 95% specificity, with a diagnostic certainty of 95%; however, this depends largely on the experience of the pathologist because of the overlapping of morphological criteria among different neoplasic and non-neoplasic lesions. The most frequent cause of false negatives is sampling error mainly with cystic lesions, which, in this site, frequently correspond to neoplasms, both malignant and benign ones.
Conclusion: This technique is particularly useful to differentiate between malignant and benign lesions, with a sensitivity of 89% and a specificity of 94%, allowing to reach a definitive diagnosis in most cases, avoiding biopsies that might originate sowing of neoplasic cells in avascular planes that become resistant to radio- or chemo-therapies.


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