Clinical significance of repeat fine-needle aspiration in managing patients with suppurative lesion

Abstract

Background: Fine-needle aspiration (FNA) has been challenged about its role in the management of patients with clinical suspicion of infective or neoplastic etiology but cytological picture showing features of acute suppuration. This study emphasizes the need to perform repeat FNA cytology (FNAC), especially if the mass lesion is indicating suppuration and has not responded to the initial course of antibiotics. Materials and Methods: All patients with a previously diagnosed suppurative lesion on cytology smears who have undergone repeat FNA were included in the study. Insufficient material on FNA and the nonavailability of slides were excluded from this study. Results: Repeat FNA assisted in the detection of malignant lesions (3), tubercular lesions (20), fungal lesions (9), and benign lesions (9) out of the 123 cases of previously diagnosed acute suppurative lesions. Comparison of FNAC findings with histopathological specimens was available for 52 cases, following which repeat FNA had a sensitivity of 66.67% (95% confidence interval 34.89%-90.08%) in detecting neoplastic, specificity was 100%, positive predictive value was 100%, negative predictive value was 90.91%, and the total diagnostic accuracy was 92.31%. Conclusion: Patients with acute suppurative lesions should be followed by repeat FNA, especially if the lesion is not responded to initial antibiotic therapy. Repeat FNA will enhance the diagnostic accuracy of malignant lesions and many other lesions, such as fungal or tubercular infections. It will reduce the need for surgical interventions and molecular detection of infectious diseases.