Accuracy of fine-needle aspiration and frozen section for the detection of squamous metastasis in cystic masses of the lateral neck

Tofanelli, Margherita; Rigo, Stefania; Polesel, Jerry; Zanconati, Fabrizio; Bonazza, Deborah; Marcuzzo, Alberto Vito; Gardenal, Nicoletta; Boscolo‐Rizzo, Paolo; Tirelli, Gian Carlo

doi:10.1016/j.bjoms.2022.07.009

Cited by 3 publications

(4 citation statements)

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“…A possible explanation for these results is that the posterolateral regions harbor a much broader histologic spectrum of lesions than the anterior neck region. In addition, posterolateral SCNM has a higher malignancy rate than anterior SCNM (38.78% and 3.33%, respectively) 1,13 . Comparisons of other measures of FNAC performance (sensitivity, specificity, predictive values, likelihood ratios, and diagnostic odds ratios) between anterior and posterolateral SCNM were limited because of the small sample size of the study subgroups.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, posterolateral SCNM has a higher malignancy rate than anterior SCNM (38.78% and 3.33%, respectively). 1,13 Comparisons of other measures of FNAC performance (sensitivity, specificity, predictive values, likelihood ratios, and diagnostic odds ratios) between anterior and posterolateral SCNM were limited because of the small sample size of the study subgroups. For instance, there was only 1 malignant lesion in the anterior SCNM group.…”

Section: Discussionmentioning

confidence: 99%

“…However, the diagnostic accuracy of FNAC for the detection of malignant SCNM varies considerably between different studies. 13,14 Failure to predict malignancy leads to unnecessary breaching of the deep neck spaces to perform a biopsy. Hammarstedt Nordenvall et al 15 reported a malignancy rate of 3.3% in adult patients who underwent surgical treatment for BCA.…”

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confidence: 99%

“…According to current literature, evaluating patients with SCNM is mainly based on ultrasound (U/S)-guided fine-needle aspiration cytology (FNAC). However, the diagnostic accuracy of FNAC for the detection of malignant SCNM varies considerably between different studies 13,14 . Failure to predict malignancy leads to unnecessary breaching of the deep neck spaces to perform a biopsy.…”

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confidence: 99%

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Malignancy and “Violated Neck” Rates in Consecutive Cohort of 79 Adult Patients With Solitary Cystic Neck Mass—Lessons Learned and Recommendations for Clinical Practice Guidelines

Pupić-Bakrač,

Jayasekara,

Peiris

et al. 2024

Journal of Craniofacial Surgery

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Objective: The neck region is a common site for solitary cystic neck mass (SCNM) of various etiologies, including congenital, inflammatory, and neoplastic. In adults, the primary focus is excluding malignancy. The objective of this study was to retrospectively analyze the accuracy of available diagnostic technologies for the differentiation of benign and malignant SCNM in adult patients. The study aimed to develop new clinical practice guidelines for evaluating and managing SCNM. Methods: The primary predictive variables were the diagnostic utilities of fine-needle aspiration cytology (FNAC), ultrasound (U/S), multislice computed tomography, and magnetic resonance imaging. The study’s endpoint was the overall diagnostic accuracy in differentiating between benign and malignant SCNM. The final diagnosis was based on histopathology. Results: The study included 79 adult patients: 55 (69.62%) male and 24 (30.38%) female (P<0.05). The mean age at presentation was 42.1 years (range: 18–84 years). Solitary cystic neck mass was distributed in the anterior neck region in 30 (37.97%) patients and the posterolateral neck regions in 49 (62.03%) patients (P<0.05). The posterolateral neck regions had a significantly higher rate of malignant SCNM than the anterior neck region [19/49 (38.78%) versus 1/30 (3.33%)] (P<0.05). There was no statistically significant difference between the U/S+FNAC and U/S+FNAC+multislice computed tomography and/or magnetic resonance imaging groups in differentiating benign and malignant SCNM (40/42 versus 36/37, P>0.05). “Violated neck” was recorded in 2 cases. Conclusion: A systematic investigation protocol should be applied to evaluate adult patients with SCNM.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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confidence: 99%

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Malignancy and “Violated Neck” Rates in Consecutive Cohort of 79 Adult Patients With Solitary Cystic Neck Mass—Lessons Learned and Recommendations for Clinical Practice Guidelines

Pupić-Bakrač,

Jayasekara,

Peiris

et al. 2024

Journal of Craniofacial Surgery

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Diagnostic Accuracy of Circulating Tumor HPV DNA Testing in Patients With a Lateral Neck Mass

Ferrandino,

Barlow,

Gold

et al. 2024

JAMA Otolaryngol Head Neck Surg

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ImportanceThe most frequent presenting symptom for patients with human papillomavirus (HPV)–associated oropharyngeal squamous cell carcinoma (OPSCC) is a lateral neck mass. Circulating tumor tissue–modified viral (TTMV)–HPV DNA is a unique biomarker produced by the fragmentation of HPV DNA during the degradation of HPV-associated tumors, and its detection and quantitation are currently being used as an adjunct to imaging in monitoring for disease recurrence and may have utility for diagnosis.ObjectiveTo measure the diagnostic characteristics of TTMV-HPV DNA compared with gold standard tissue biopsy for diagnosing HPV-OPSCC in patients presenting with an indeterminate lateral neck mass.Design, Setting, and ParticipantsThis prospective diagnostic test study enrolled patients 18 years or older who presented with a lateral neck mass to a large urban tertiary health care system from December 2021 to June 2023. Participants underwent standard-of-care testing to obtain a tissue diagnosis and a single TTMV-HPV DNA measurement.Main Outcomes and MeasuresThe primary outcome of interest was sensitivity, while specificity, positive predictive value, and negative predictive value were secondary end points. A subset analysis was performed comparing test performance metrics between TTMV-HPV DNA testing and fine-needle aspiration.ResultsA total of 138 patients were included, of whom 80 (58.0%) were men, with median age of 57.5 years (IQR, 43.3-67.0 years). Of 138 patients, 87 (63.0%) had neck masses in level 2 and 47 (34.1%) had HPV-OPSCC. TTMV-HPV DNA testing exhibited a sensitivity of 95.7% (95% CI, 85.5%-99.5% [45 of 47 patients]), specificity of 97.8% (95% CI, 92.3%-99.7% [89 of 91 patients]), positive predictive value of 95.7% (95% CI, 85.5%-99.5% [45 of 47 patients]), and negative predictive value of 97.8% (95% CI, 92.3%-99.7% [89 of 91 patients]).Conclusions and RelevanceIn this diagnostic study of patients presenting with a lateral neck mass, circulating TTMV-HPV DNA demonstrated excellent diagnostic test characteristics for the detection of HPV-OPSCC. Such testing may have particular utility for patients in whom obtaining adequate tissue is problematic, as is often the case with cystic neck masses and unknown primary tumors.

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Value of cytopathology in the diagnosis of adenoid cystic carcinoma and an analysis of misdiagnoses

Chang-hai

Liu

et al. 2023

BMC Surg

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Background The diagnosis of adenoid cystic carcinoma (ACC) by cytopathology can be challenging. This study was aimed at testing the effectiveness of this technique and at assessing possible differences in the coincidence rate of fine-needle aspiration cytology(FNAC) and brush exfoliation. Methods The pathology database of Southwest Medical University( Luzhou, China) was searched for patients who had undergone surgery or biopsy for ACC between January 2017 and January 2022 and had preoperative cytopathologic results. Their cytologic and histologic data were then analyzed retrospectively and the coincidence rates of cytopathology in the diagnosis of ACC were calculated. Results Compared with histopathology, the total coincidence rate of the cytologic diagnosis of ACC was 76.8%, that of FNAC was 78.9%, and that of brush exfoliation was 55.6%. Conclusion In the diagnosis of ACC, cytopathology is an effective tool; this is especially true of FNAC, which plays an important role in the diagnosis of ACC. The authors further suggest that it is advisable for diagnosticians to master the cytopathological features of ACC to reduce the possibility of preoperative misdiagnoses.

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Accuracy of fine-needle aspiration and frozen section for the detection of squamous metastasis in cystic masses of the lateral neck

Cited by 3 publications

References 24 publications

Malignancy and “Violated Neck” Rates in Consecutive Cohort of 79 Adult Patients With Solitary Cystic Neck Mass—Lessons Learned and Recommendations for Clinical Practice Guidelines

Malignancy and “Violated Neck” Rates in Consecutive Cohort of 79 Adult Patients With Solitary Cystic Neck Mass—Lessons Learned and Recommendations for Clinical Practice Guidelines

Diagnostic Accuracy of Circulating Tumor HPV DNA Testing in Patients With a Lateral Neck Mass

Value of cytopathology in the diagnosis of adenoid cystic carcinoma and an analysis of misdiagnoses

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