This audit demonstrated widespread diagnostic difficulties associated with head and neck FNAC in a large patient sample. It is likely that these problems will be mirrored in other cancer networks. In order for one-stop head and neck clinics to succeed, the non-diagnostic rate of FNAC in particular must be minimised. There are strategies to enable this, depending on local resources, including increased access to cytologists or cytology technicians, diagnostic ultrasound, image guidance for FNAC and the use of ultrasound-guided core biopsy.

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In the majority of cases USCB is adequate for confident histopathological diagnosis avoiding the need for surgical excision biopsy in cases of suspected head and neck lymphoma.

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Although the association between intestinal metaplasia and gastric carcinoma has long been recognised,' the prevalence of intestinal metaplasia in benign gastric conditions has precluded its use as an aid to the diagnosis of gastric carcinoma. Recent work has focused on the subtyping of intestinal metaplasia using mucin histochemistry. One