title: Discrepancy of target sites between clinician and cytopathological reports in head neck fine needle aspiration: Did I miss the target or did the clinician mistake the organ site?
abstract: The diagnostic accuracy of fine needle aspiration cytology (FNAC) of head and neck lesions is relatively high, but cytologic interpretation might be confusing if the sample is lacking typical cytologic features according to labeled site by physician. These errors may have an impact on pathology search engines, healthcare costs or even adverse outcomes. The cytology archive database of multiple institutions in southern Iran and Australia covering the period 2001-2011, were searched using keywords: salivary gland, head, neck, FNAC, and cytology. All the extracted reports were reviewed. The reports which showed discordance between the clinician's impression of the organ involved and subsequent fine needle biopsy request, and the eventual cytological diagnosis were selected. The cytological diagnosis was confirmed by histology or cell block, with assistance from imaging, clinical outcome, physical examination, molecular studies, or microbiological culture. The total number of 10,200 head and neck superficial FNAC were included in the study, from which 48 cases showed discordance between the clinicians request and the actual site of pathology. Apart from the histopathology, the imaging, clinical history, physical examination, immunohistochemical study, microbiologic culture and molecular testing helped to finalize the target organ of pathology in 23, 6, 7, 8, 2, and 1 cases respectively. The commonest discrepancies were for FNAC of "salivary gland" [total: 20 with actual final pathology in: bone (7), soft tissue (5), lymph node (3), odontogenic (3) and skin (2)], "lymph node" [total: 12 with final pathology in: soft tissue (3), skin (3), bone (1) and brain (1)], "soft tissue" [total: 11 with final pathology in: bone (5), skin (2), salivary gland (1), and ocular region (1)] and "skin" [total: 5 with final pathology in: lymph node (2), bone (1), soft tissue (1) and salivary gland (1)]. The primary physician requesting FNAC of head and neck lesions are incorrect in their clinical impression of the actual site in nearly 0.5 percent of cases, due to the overlapping clinical and imaging findings or possibly due to inadequate history taking or physical examination.
authors.affiliation: Department of Cytopathology, Dr. Daneshbod Pathology Laboratory, Shiraz, Iran.
authors.forename: Mahsa
authors.initials: M
authors.lastname: Khanlari
authors.affiliation: Department of Cytopathology, Dr. Daneshbod Pathology Laboratory, Shiraz, Iran.
authors.forename: Yahya
authors.initials: Y
authors.lastname: Daneshbod
authors.affiliation: Department of Pathology, School of Veterinary Medicine, Shiraz University, Shiraz, Iran.
authors.forename: Hanieh
authors.initials: H
authors.lastname: Shaterzadeh Yazdi
authors.affiliation: Department of Pathology, Shahrekord University, School of Veterinary Medicine, Shahrekord, Iran.|Shefa Neuroscience Research Center, Khatam-Al-Anbia Hospital, Tehran, Iran.|Brain and Spinal Cord Injury Research Center, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Sadegh
authors.initials: S
authors.lastname: Shirian
authors.affiliation: Department of Cytopathology, Dr. Daneshbod Pathology Laboratory, Shiraz, Iran.
authors.forename: Shahrzad
authors.initials: S
authors.lastname: Negahban
authors.affiliation: Department of Cytopathology, Dr. Daneshbod Pathology Laboratory, Shiraz, Iran.
authors.forename: Azita
authors.initials: A
authors.lastname: Aledavood
authors.affiliation: Department of Pathology, School of Veterinary Medicine, Shiraz University, Shiraz, Iran.
authors.forename: Ahmad
authors.initials: A
authors.lastname: Oryan
authors.affiliation: Department of Otolaryngology, Shiraz University of Medical Sciences, Shiraz, Iran.
authors.forename: Bijan
authors.initials: B
authors.lastname: Khademi
authors.affiliation: Department of Cytopathology, Dr. Daneshbod Pathology Laboratory, Shiraz, Iran.
authors.forename: Khosrow
authors.initials: K
authors.lastname: Daneshbod
authors.affiliation: Hospital and University of Notre Dame Medical School Sydney, Fremantle, Australia.
authors.forename: Andrew
authors.initials: A
authors.lastname: Field
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001315:Australia; D044963:Biopsy, Fine-Needle; D002648:Child; D002675:Child, Preschool; D002983:Clinical Competence; D003951:Diagnostic Errors; D003952:Diagnostic Imaging; D005260:Female; D006258:Head and Neck Neoplasms / Q000175:diagnosis* / Q000453:epidemiology; D006801:Humans; D007223:Infant; D007492:Iran; D008297:Male; D008875:Middle Aged; D055815:Young Adult
keywords: Cytology; FNAC; discrepancy; head and neck; label error; target organ