A systematic review of ultrasound-guided FNA of lesions in the head and neck—focusing on operator, sample inadequacy and presence of on-spot cytology service

Abstract

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.

Comparison of Cytopathologist-Performed Ultrasound-Guided Fine-Needle Aspiration With Cytopathologist-Performed Palpation-Guided Fine-Needle Aspiration: A Single Institutional Experience

“…Among the small number of nondiagnostic cases with surgical follow-up (27 cases), the major discordance rate was slightly lower for UGFNA cases ( radiologists or clinicians, at least in the setting of thyroid nodules and head and neck lesions. 4,7,15 Moreover, the burgeoning interest in UGFNA has led to reports by some pathology training programs and individual pathologists on their experiences with the technique in pathologist-led clinics. [12][13][14]16 Although there are studies comparing UGFNA and PGFNA by nonpathologists showing a decrease in specimen inadequacy rates 2,[8][9][10][11] and increased accuracy rates 9,11 with UGFNA relative to PGFNA, there currently exist only a few such comparison studies for procedures done by cytopathologists.…”

Neck lump clinic: a new initiative at North Shore Hospital

“…The NICE guidelines do not specify the requirement for USSguided FNA; however, since the publication of the guidelines in 2004, the use of USS to target lesions has become more common and a preferred method of diagnosis. 11,12 We believe USS is an important tool for improving accuracy and has contributed to high rates of diagnostic sensitivity in the NLC group.…”

“…One benefit of having an onsite pathologist is that all FNA specimens are immediately assessed for adequacy, and whilst five (13%) non‐diagnostic initial specimens were observed in the control group, no patients required repeat FNA in the NLC, which compares favourably with published figures in comparative audits. The NICE guidelines do not specify the requirement for USS‐guided FNA; however, since the publication of the guidelines in 2004, the use of USS to target lesions has become more common and a preferred method of diagnosis . We believe USS is an important tool for improving accuracy and has contributed to high rates of diagnostic sensitivity in the NLC group.…”

Introduction of surgeon‐performed ultrasound to a head and neck clinic: indications, diagnostic adequacy and a new clinic model?

“…Diagnostic adequacy in our study was 92% using our technique, giving a favourable ‘inadequacy’ rate of 8%. In a systematic review of US‐FNA of lesions in the head and neck (examining performance by radiologists, clinicians and cytopathologists), overall inadequacy rate for clinicians without immediate on‐site assessment was 11.0%. The inadequacy rate for radiologists without immediate on‐site assessment was 9.6%.…”