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.
Highlights
The head and neck region includes skin, bone, salivary glands, thyroid, soft tissue, and lymph nodes
Head and neck FNA target organ errors did the clinician recognize the organ involved incorrectly? Despite in clinical and pathology textbooks and some single reports have been mentioned that some organs such as: lymph node or salivary gland may be difficult to tell apart by clinical evaluation alone, there are no study focused on the discordance between the requesting physician’s target organ and the final fine needle aspiration cytology (FNAC) diagnosis [1,2,3,4,5,6,7,8,9]
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
Summary
The head and neck region includes skin, bone, salivary glands, thyroid, soft tissue, and lymph nodes. Despite in clinical and pathology textbooks and some single reports have been mentioned that some organs such as: lymph node or salivary gland may be difficult to tell apart by clinical evaluation alone, there are no study focused on the discordance between the requesting physician’s target organ and the final fine needle aspiration cytology (FNAC) diagnosis [1,2,3,4,5,6,7,8,9] The rate of this discordance will vary with the expertize of the clinician’s patient examination, the utilized imaging and the skill of the practitioner carrying out the FNAC. The discordance rate will have a diagnostic and subsequently management impact on assessment of FNAC series, for example, FNAC of “salivary gland lesions” may yield parotid primaries, metastatic periparotid lymph nodes, skin or bone primaries which may have different management and surgical approaches
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