title: Utility of Fine-Needle Aspiration Biopsy in the Evaluation of Pediatric Head and Neck Masses.
abstract: Fine-needle aspiration biopsy (FNAB) has a well-established role in the evaluation of an adult head and neck mass (HNM) but remains underused in children. The objectives of this study were to assess the diagnostic accuracy, safety profile, use of anesthesia, and influence on surgical decision making of FNAB of HNM in the pediatric population.
  
  
  
  Case series with chart review.
  
  
  
  Tertiary care children's hospital.
  
  
  
  In total, 257 consecutive patients with HNM who underwent 338 FNABs from July 2007 to July 2014 were reviewed. Patients ranged in age from 0 to 21 years (mean, 9.3 years); lesions ranged in size from 0.3 to 12.5 cm (mean, 2.4cm). Fine-needle aspiration biopsies were performed in the interventional radiology suite, operating room, clinic, or ward.
  
  
  
  The most common patient final diagnoses included reactive lymphadenopathy (n = 99, 38.5%), benign thyroid colloid nodule (n = 31, 12.1%), malignancies (n = 21, 8.2%), and atypical mycobacterial infection (n = 15, 5.8%). On surgical histopathologic and clinical follow-up, overall sensitivity of FNAB was 94.6% and specificity was 97.7%. The complication rate was 2.1%, and general anesthesia or sedation was used for 73% of FNAB. Surgery occurred only 9 times following the 191 patients with negative FNAB results, indicating that 95.3% of unnecessary surgeries were avoided with the assistance of the FNAB result.
  
  
  
  Fine-needle aspiration biopsy is an accurate and safe diagnostic tool for guiding management of persistent lymphadenopathy, thyroid nodules, and other HNM in pediatric patients. Negative FNABs can often obviate the need for surgical intervention.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA huyettpa@upmc.edu.
authors.forename: Phillip
authors.initials: P
authors.lastname: Huyett
authors.affiliation: Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
authors.forename: Sara E
authors.initials: SE
authors.lastname: Monaco
authors.affiliation: Department of Otolaryngology, Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
authors.forename: Sukgi S
authors.initials: SS
authors.lastname: Choi
authors.affiliation: Department of Otolaryngology, Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
authors.forename: Jeffrey P
authors.initials: JP
authors.lastname: Simons
mesh_terms: D000293:Adolescent; D044963:Biopsy, Fine-Needle / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D003657:Decision Making; D005260:Female; D006257:Head; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009333:Neck; D061214:Patient Safety; D015642:Radiology, Interventional; D012680:Sensitivity and Specificity; D055815:Young Adult
keywords: fine-needle aspiration biopsy; head and neck mass; pediatrics; sensitivity and specificity; thyroid nodule