Value of fine needle aspiration cytology in head and neck lymphoma: Experience in a head and neck cancer unit in the United Kingdom

Abstract

Conclusion. In our experience, fine needle aspiration cytology (FNAC) combined with immunocytochemistry/flow cytometry in the investigation of lymphoma presenting in the neck is highly valuable. In our unit it has a sensitivity of 95.5% and a positive predictive value (PPV) of 96.8% and is the first-line investigation in suspected lymphoma. It enables planning of radiological and haematological investigations and obviates panendoscopy as part of the staging protocol. Objective: Lymphoma commonly presents to otolaryngologists. The aim of our study was to evaluate the accuracy of FNAC in lymphoma presenting in the neck at our institute. Methods: Data were collected retrospectively between 2003 and 2007. Separate searches for cytological and histopathological diagnosis of lymphoma on cervical lymph node biopsies were cross-referenced. Immunocytochemistry stains used were recorded. Results: A total of 121 cases met the inclusion criteria. The FNAC diagnosis of lymphoma was correct on lymph node biopsy in 68.6% (83/121). In 18 (14.9%) cases a false-negative result and in 3 (2.5%) cases a false-positive result was seen. In all, 17 (14.0%) cases were non-diagnostic (11 inadequate and 6 suspicious). In 16/20 (80.0%) cases of wrong diagnosis, immunocytochemistry had not been performed. Flow cytometry and immunocytochemistry were used in 67 cases and the FNAC diagnosis had a sensitivity of 95.5% and a PPV of 96.8% in this group.