Ultrasound-guided FNAC has a significantly lower yield of inadequate aspirates than palpable FNAC. The ability of FNAC to predict neoplasia in 89% patients and to exclude neoplasia in 95.9% patients makes an important contribution to the multidisciplinary assessment of patients.

The objective of this review is to perform a systematic review of ultrasound-guided fine-needle aspiration (FNA) services for head and neck lesions with assessment of inadequacy rates and related variables such as the presence of immediate cytological assessment. A computer-based systematic search of articles in English language was performed using MEDLINE (1950 to date) from National Health Service evidence healthcare database and PubMed. Full texts of all relevant articles were obtained and scrutinized independently by two authors according to the stated inclusion and exclusion criteria. The primary search identified 932 articles, but only 78 met all the study criteria. The overall inadequacy rate was 9.3%, 16 studies had on-site evaluation by a cytopathologist/specialist clinician with a rate of 6.0%. In seven studies, a cytotechnician was available to either assess the sample or prepare the slides with an average inadequacy rate of 11.4%. In 1 study, the assessment was unclear, but the inadequacy rate for the remaining 54 studies, without immediate assessment, was 10.3%. The rate for the cytopathologist/specialist clinicians was significantly different to no on-site assessment but this was not found for assessment by cytotechnicians. The review suggests that the best results are obtained with a cytopathologist-led FNA service, where the pathologist reviews the specimen immediately, in relation to the clinical context, thereby deciding on adequacy and need for further biopsies. A systematic review looking at ultrasound-guided FNA of head and neck lesions has not been published previously.

This audit has illustrated the benefits of a one-stop clinic with on-site cytology in providing a rapid diagnostic head and neck cancer service.

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A study of film reject and repeat rates was undertaken in the Department of Dental Radiology of King's College School of Medicine and Dentistry over a 6 month period. The aim of the study was to assess the effects of changes implemented after a previous audit, and to carry out a more detailed analysis of the factors influencing the reject and repeat rates using a larger volume of data. The information recorded included the equipment and projection used, and the age of the patient if under 16 years. The overall reject rate was 3.06%, 1.84% less than recorded in the earlier study, and the repeat rate was 0.93%. Positioning errors were the most frequent cause for rejection. Significant differences in reject rates were noted between different projections, and also between qualified staff and those in training. The rejection rate for patients under 16 years was not significantly higher than for patients over 16 years, the most frequent cause of rejection was still positioning faults, but patient movement accounted for a larger proportion of the rejects than was the case in adult patients. The results demonstrate the role of audit in isolating factors leading to additional exposures. The effectiveness of changes implemented following a reject film analysis is also shown.