title: FNA biopsy of pediatric cervicofacial masses and validation of clinical characteristics of malignancy.
abstract: BACKGROUND
  Pediatric head and neck masses can pose a diagnostic challenge due to their ubiquitous nature. The vast majority of masses are inflammatory, however malignancies do occur. This study is a review of fine needle aspiration biopsy (FNA-B) as a diagnostic technique at a single institution over a 13 year period. The objectives were to examine the sensitivity and specificity of FNA-B, correlate these results with clinical characteristics of each mass and determine if such characteristics are associated with malignancy.
  
  
  METHODS
  This was a retrospective case series of 143 consecutive pediatric patients who underwent FNA-B of 146 head and neck masses with subsequent follow up examinations from 2000 to 2012 (inclusive). We expected FNA-B to be a sensitive and specific method for determining malignancy. FNA-B diagnoses were confirmed with open biopsy pathology results and clinical follow up greater than 1 year. Physical exam characteristics of each mass including location, tenderness, firmness, and mobility were documented. Chi square and Fisher exact tests were used to determine statistical significance.
  
  
  RESULTS
  The sensitivity and specificity of FNA-B in determining malignancy were 87.5% and 100% respectively. Positive and negative predictive values were 100% and 99.1%, respectively. On univariate analysis of clinical descriptors associated with malignancy, non-mobile masses significantly correlated (p=0.0025), while the firmness and tenderness of a mass did not reach statistical significance. Of mass locations, the lateral neck had the strongest association with malignancy, but this relationship only demonstrated statistical significance when lymphomas were considered independently (p=0.0428).
  
  
  CONCLUSIONS
  Results demonstrate FNA-B to be an effective method for the diagnosis of pediatric head and neck masses. It maintained a high sensitivity and specificity with a large sample size, to date one of the largest in the pediatric otolaryngology literature. Also, the data offered statistical validation of classical signs of malignancy and showed fixed masses to have the highest correlation. Finally, the findings support lateral neck masses to warrant a higher degree of suspicion for malignancy compared to other compartments.
authors.affiliation: Geisinger Medical Center, Department of Otolaryngology, 100 N. Academy Ave., Danville, PA 17822, USA. Electronic address: bddanza@geisinger.edu.
authors.forename: Brian
authors.initials: B
authors.lastname: D'Anza
authors.affiliation: Naperville Ear, Nose & Throat Associates, 10W. Martin Ave, No. 260, Naperville, IL 60540, USA.
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Kraseman
authors.affiliation: Geisinger Medical Center, Department of Otolaryngology, 100 N. Academy Ave., Danville, PA 17822, USA.
authors.forename: Cecilia
authors.initials: C
authors.lastname: Canto-Helwig
authors.affiliation: Geisinger Medical Center, Department of Otolaryngology, 100 N. Academy Ave., Danville, PA 17822, USA.
authors.forename: J Scott
authors.initials: JS
authors.lastname: Greene
authors.affiliation: Geisinger Medical Center, Department of Otolaryngology, 100 N. Academy Ave., Danville, PA 17822, USA.
authors.forename: W Edward
authors.initials: WE
authors.lastname: Wood
mesh_terms: D000293:Adolescent; D044963:Biopsy, Fine-Needle; D002648:Child; D002675:Child, Preschool; D005260:Female; D006258:Head and Neck Neoplasms / Q000473:pathology*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009333:Neck; D011237:Predictive Value of Tests; D012189:Retrospective Studies
keywords: Fine needle aspiration biopsy; Pediatric cervicofacial masses; Physical exam characteristics