Histopathologic and cytopathologic diagnostic discrepancies in head and neck region: pitfalls, causes, and preventive strategies.
BACKGROUND
Clinicians commonly utilize fine needle aspiration biopsy (FNAB) for the primary investigation of head and neck masses. Correlation of these results with the surgical resection diagnosis is an essential part of quality control and assurance programs in all cytology laboratories.


METHODS
Of 610 cases, 20 (3.3%) had corresponding surgical resections performed within 3 months of the FNAB, with a discrepant diagnosis identified through a search that involved all FNABs performed on the head and neck region, excluding the thyroid gland, at Wayne State University between 1999 and 2004. Sites of discrepant samples included the parotid or submandibular gland (n = 5), lymph nodes (n = 8), and paratracheal/paraesophageal neck masses (n = 7).


RESULTS
The reasons of false-negative FNABs included sampling errors (n = 3), insufficient material for an adequate interpretation (n = 5), lack of triage necessary for ancillary studies (n = 4), and interpretation errors (n = 6). There were 2 false-positive FNABs, both reported as mucoepidermoid carcinoma and showed chronic sialadenitis in one and lymphoepithelial cyst in the other.


CONCLUSIONS
FNAB is an effective tool for the diagnosis and triage of patients with head and neck masses that can be further improved with an onsite immediate adequacy evaluation and triage performed by a pathologist.
Fathallah
Lamia
L
Department of Pathology, Detroit Medical Center, Wayne State University, Detroit, Michigan 48201, USA.
Tulunay
Ozlem E
OE
Feng
Jining
J
Husain
Mujtaba
M
Jacobs
John R
JR
Al-Abbadi
Mousa A
MA
D044963:Biopsy, Fine-Needle; D005434:Flow Cytometry; D006258:Head and Neck Neoplasms / Q000473:pathology*; D006801:Humans; D016130:Immunophenotyping; D010307:Parotid Neoplasms / Q000473:pathology; D011237:Predictive Value of Tests; D011786:Quality Control; D013365:Submandibular Gland Neoplasms / Q000473:pathology; D014218:Triage