Abstract

Abstract The aim of our study was to report our own experience with utilizing fine needle aspiration (FNA) as a primary diagnostic procedure in adolescent patients with head and neck masses, examining the utility, feasibility, and appropriateness of this technique. This is a retrospective, single-institute study that was conducted at Dammam Medical Complex from January 2004 to December 2006. All adolescent patients aged between 10 and 18 years with neck masses who underwent FNA as the primary diagnostic modality were included in our study. We excluded patients with neck masses of thyroid origin and those who were lost to follow-up. A total of 26 patients between 10 and 18 years of age were studied. All patients presented with nonthyroidal neck masses and underwent FNA. The study population was divided into three groups depending on the tissue of origin of the mass: lymph node origin (18 patients), salivary gland origin (five patients), and miscellaneous origin (three patients). FNA from lymph-node-related masses revealed lymphadenitis in about two third of the cases, whereas of the patients with masses of salivary gland origin, 60% had a diagnosis of pleomorphic adenoma. In the third group, the masses were of variable origin. There were no reported complications. The overall sensitivity and specificity were calculated and found to be more than 90%. We believe that FNA as an office-based procedure is well tolerated and has a high diagnostic potential in head and neck masses. FNA in the adolescent age group has not been studied separately in the literature. FNA, apart from reassuring benignity, helps in confirming malignancy and thus in initiating early treatment.

Highlights

  • Palpable masses in the head and neck region include a wide range of differential diagnosis, ranging from simple inflammatory masses to more complicated neoplasms, with both benign and malignant entities

  • Despite these benefits with regard to pediatric head and neck masses, Fine needle aspiration (FNA) has gained limited acceptance in the recent years as a minimally invasive procedure in tertiary-care pediatric centers mainly because the procedure is operator dependent, a cytopathologist experienced in working with children and assessing pediatric specimens is required, and general anesthesia is needed in selected cases for FNA in children, especially in case the procedure is being performed by an unexperienced surgeon, mitigating one of the main advantages of this technique in adults

  • Of the 18 patients who had masses of lymph-node origin, three underwent excisional biopsies (16.6%); all of them showed the same findings as those from FNA. We included in this short analysis 32 adolescent patients presenting with nonthyroidal neck masses between January 2004 and December 2006

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Summary

Introduction

Palpable masses in the head and neck region include a wide range of differential diagnosis, ranging from simple inflammatory masses to more complicated neoplasms, with both benign and malignant entities. FNA has the following advantages over the open biopsy technique: first, FNA avoids the need for operating room facilities; second, it decreases morbidity; and third, it leads to more accurate open surgical planning if needed [2] Despite these benefits with regard to pediatric head and neck masses, FNA has gained limited acceptance in the recent years as a minimally invasive procedure in tertiary-care pediatric centers mainly because the procedure is operator dependent, a cytopathologist experienced in working with children and assessing pediatric specimens is required, and general anesthesia is needed in selected cases for FNA in children, especially in case the procedure is being performed by an unexperienced surgeon, mitigating one of the main advantages of this technique in adults. Even in the presence of a benign cytological result, parental concern and pressure with regard to persistence of a benign lymph node can still eventually prompt an open biopsy [2]

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