Gross Appearance of Fine Needle Aspiration Smears: Can Adequacy of the Sample be Assessed and Correlated with their Microscopic Cytological Yield

Background

Fine needle aspiration cytology (FNAC) is a simple procedure that is widely accepted as a first-line investigation. It should ideally be performed near the patient with microscopic assessment for evaluation of adequacy of aspirate. Since this is not always possible, a worthwhile substitute is to assess the gross appearance of the material obtained. This study was aimed to determine the value of this alternative rapid, bed-side approach.

Method

This study was carried out in a tertiary care hospital for a duration of 1 year, where 50 cases undergoing FNAC in the out-patient department (OPD) were included. Unstained smears of commonly encountered lesions were photographed and assessed by three independent observers, who graded them into four grades, viz. Grade 1: unlikely to contain diagnostic material. Grade 2: possibly contains diagnostic material. Grade 3: probably contains diagnostic material. Grade 4: material suggesting a specific diagnosis. Results were subsequently compared with the microscopic findings of stained smears.

Results

Distribution of the 50 cases between grades 1, 2, 3, and 4 were 5, 6, 17, and 22, respectively.

Conclusion

Gross appearances of FNA smears are helpful in predicting the adequacy of the sample and sometimes the final microscopic diagnosis. The cellularity of a sample can be gauged by inspection and sometimes a likely diagnosis can be made. Some lesions show typical gross appearance easily detected by the experienced eye so a likely diagnosis can be predicted prior to microscopic examination. However, near-patient microscopic assessment of FNA specimens for rapid onsite evaluation, if available, should be the preferred mode.

The Changing Face of Head and Neck Cancer; How the Head and Neck One-Stop Clinic Has Evolved Since Conception

Purpose

The purpose of this study was to compare the patient journey through the head and neck clinic across 13 years of service improvement. We aimed to compare pick-up rates of cancer; number of patients receiving tissue diagnoses at first visit; and number of patients who were discharged on their first visit.

Methods

In the one-stop head and neck cancer clinic, the demographic data, investigations and outcomes for 277 patients who attended in 2004 were compared to those of 205 patients who attended in 2017. The number of patients receiving ultrasonography and fine needle aspiration cytology was compared. Patient outcomes were analysed: specifically, the number discharged on first visit and the number of malignancies diagnosed.

Results

The pick-up rate for malignancy from 2004 to 2017 has remained stable (17.3% vs 17.1%). The number of patients receiving ultrasound has remained stable from 264 (95%) in 2004 to 191 (93%) in 2017. The number undergoing FNA has decreased from 139 (50%) to 68 (33%) (p < 0.01). The number of patient's discharged on the first visit has significantly increased from 82 (30%) in 2004 to 89 (43%) in 2017 (p < 0.01).

Conclusion

The one-stop clinic provides an effective and efficient means of head and neck lump assessment. Since inception of this service, the accuracy of diagnostic investigation has improved over time.

Effects of COVID-19 Pandemic on Cytology: Specimen Adequacy in Fine Needle Aspiration of Palpable Head and Neck Masses

Introduction

At our institution, palpation-guided fine-needle aspiration (FNA) is performed by the cytopathology service on an outpatient basis at the request of otolaryngologist surgeons. The aim of this study is to assess the effect of COVID lockdown measures on our FNA service with specific focus on adequacy rates.

Materials and methods

All palpation-guided FNA performed in 2019 to 2020 were identified in our pathology database. Adequacy rates were compared for 3 time periods in 2020: pre-COVID, lockdown, and post-lockdown.

Results

In 2019, 121 FNAs were performed with 98% (119 of 121) obtained by pathology and only 2% (2 of 121) obtained by surgeons. In 2020, 89 FNAs were performed with 45% (40 of 89) collected by pathologists and 55% (49 of 89) by surgeons. During the pre-COVID period of 2020, 27 FNAs were collected, 85% (23 of 27) by pathologists, 8.7% of these (2 of 23) were nondiagnostic. Of the 4 FNAs performed by surgeons, all were positive for malignancy. During COVID lockdown all 24 FNAs were performed by surgeons with a 50% (12 of 24) nondiagnostic rate. Post-lockdown, with FNA referrals still below pre-COVID levels, surgeons performed 55.3% (21 of 38) of FNAs with 28.6% (6 of 21) non-diagnostic, while pathology performed 44.7% (17 of 38) with an 11.8% (2 of 17) nondiagnostic rate.

Conclusions

Our FNA service noted significant changes in 2020 as a result of the COVID pandemic. Nondiagnostic rates were significantly increased in 2020 compared with 2019, primarily due to a shift to majority surgeon-performed palpation-guided FNA in the absence of cytopathology service during the lockdown period.

Assessment of Neck Lumps in Relation to Dentistry

Neck lumps have a varied aetiology, from a benign inflammatory cause to the first presenting sign of a malignancy. Patients may present to primary care complaining of a neck lump or they may be identified as an incidental finding during routine examination. This article highlights a structured approach to the initial assessment including history taking, risk factor assessment and clinical examination. Further investigations undertaken in a secondary care setting, such as ultrasound and guided fine needle aspirations, are then discussed. The common congenital, inflammatory, infective, vascular and neoplastic causes of neck lumps and their management and specialist referral pathway are discussed.

Do Immediate Cytology and Specialist Radiologists Improve the Adequacy of Ultrasound-Guided Fine-Needle Aspiration Cytology?

Objective

To assess whether a dedicated “1-stop” neck lump clinic has improved the percentage of adequate fine-needle aspiration cytology (FNAC) samples and reduced the need for repeat FNAC.

Study Design

Retrospective review.

Setting

District General Hospital in the United Kingdom.

Subjects and Methods

Patients attending for ultrasound-guided FNAC over a 6-month period from August 2012 to February 2013. Patients were placed in 4 groups: group 1, FNAC performed by any of the subspecialist radiologists with cytology support (n = 100); group 2, FNAC performed by general radiologists without cytology support (n = 112); group 3, FNAC performed by a particular subspecialist radiologist with cytology support (n = 61); and group 4, FNAC performed by the same subspecialist radiologist without cytology support (n = 125).

Results

There was a significantly higher rate of adequacy of FNAC in the presence of a subspecialist radiologist with immediate cytology (group 1) versus a general radiologist without cytology support (group 2; 87/100 vs 63/112, P = .0001), a significantly higher rate of adequacy of FNAC in the presence of cytology support with the same radiologist (group 3 vs group 4, 55/61 vs 97/125, P = .04), and a significantly higher rate of adequacy of FNAC in the presence of a subspecialist radiologist versus a general radiologist without cytology support (group 4 vs group 2, 97/125 vs 63/112, P = .0005).

Conclusion

Immediate cytology and the presence of a subspecialist radiologist increase the adequacy of FNAC. The adequacy rate of non–cytology-supported FNAC or nonsubspecialist FNAC is below the adequate rate expected from the literature or as recommended in national guidelines.