Does a joint ultrasound guided cytology clinic optimize the cytological evaluation of head and neck masses?
OBJECTIVE
To compare the results of fine-needle aspiration (FNA) of head and neck masses performed in an ultrasound-guided cytology clinic (USGCC) staffed by a radiologist and pathologist to those obtained with specimens sent from other sources.


METHODS
Comparison of broad-category FNA diagnoses (malignant, uncertain, benign or inadequate) with the patient's ultimate clinical or pathological outcome. Because FNA outcomes are semi-quantitative, accuracy of the procedure (the proportion of all tests resulting in a true- positive or negative fine-needle aspirate) is a better measure than sensitivity or specificity. Specimens (n = 292) from the first 2 years of the USGCC are compared with 600 specimens received from other sources over the previous 4 years.


RESULTS
Accuracy was 23.4% better for specimens from the USGCC compared with those obtained by clinician guided aspiration (83.9%, 95% CI 79.7-88.1%, vs 60.5%, 95% CI 56.6-64.4%). There was an 84% reduction in inadequate specimens (from 21.5% to 3.4%). The proportion resulting in an uncertain result did not alter; 12.0% for USGCC and 11.9% for clinician-derived specimens. Improvement in accurate identification of salivary gland, lymph node, soft tissue and thyroid pathology was 27.0%, 21.2%, 18.3% and 15.8% respectively.


CONCLUSIONS
The common practice of FNA performed by clinicians produces sub-optimal results in head and neck masses. A combined approach of ultrasound-guided fine-needle aspiration of head and neck masses, with immediate assessment of the material by a pathologist, is more accurate than with specimens obtained in other ways. If the results of FNA are to be incorporated into clinical decision making, the samples are best obtained using the USGCC model.
Robinson
I A
IA
Department of Histopathology, Derbyshire Royal Infirmary, Derby, UK.
Cozens
N J
NJ
D001707:Biopsy, Needle / Q000379:methods / Q000706:statistics & numerical data; D003951:Diagnostic Errors; D004739:England; D006258:Head and Neck Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology*; D006801:Humans; D010044:Outpatient Clinics, Hospital; D018084:Ultrasonography, Interventional