Cystic masses of the lateral neck: Diagnostic value comparison between fine‐needle aspiration, core‐needle biopsy, and frozen section

Abstract

Background The usefulness of fine‐needle aspiration (FNA), core‐needle biopsy (CNB), and frozen section (FS) for assessing lateral cystic neck masses (LCNM) remains unclear. Methods A retrospective review of patients presenting with a LCNM was undertaken. Results In total, 135 patients were included. FNA had a lower sensitivity then CNB (59% vs 83%; P = .036) and FS (59% vs 93%; P = .01). FS had a better negative predictive value (NPV) when compared to FNA (92% vs 40%; P < .001) and CNB (92% vs 50%; P = .062). Positive predictive values (PPV) and sensitivities were similar among all groups. Conclusion Given its adequate PPV (92%), FNA should be used initially on LCNM. Because of its high sensitivity, CNB should be considered if FNA is not diagnostic of malignancy. FS should always follow a CNB indicative of malignancy, because of low NPV. A diagnosis of malignancy on FNA, CNB, or FS strongly indicates presence of malignancy.

Metastatic Squamous Cell Carcinoma to the Cervical Lymph Nodes From an Unknown Primary Cancer: Management in the HPV Era

“…Of these, 7.4% were papillary thyroid cancers, and 62% were squamous cell carcinomas. Among the squamous cell carcinomas, 17.8% had unknown primary tumors, a higher percentage than for solid metastases (32).…”

“…Tabet et al (32). found the sensitivity of core needle biopsy in cystic squamous cell carcinoma lymphatic metastases to be 87%.…”

“…Tabet et al (32) specifically reviewed the management of cystic metastases with an unknown primary. In 135 cystic metastases of the neck, they found a high PPV of 92%, but sensitivity of only 59%.…”

“…mucoepidermoid carcinoma) that can be misread as squamous cell carcinoma on cytology. More IHC and molecular tests generally are more accurate in histopathologic specimens (32). Excisional biopsy of a mass or node, without completion neck dissection, offers no therapeutic advantage over a less-invasive positive core biopsy, as the patient needs the same dose of radiation.…”

“…If a primary site is not identified on clinical examination, the next step will be FNA of the neck mass for cytological examination, preferably under ultrasound guidance (see Figure 1 for workup of the suspicious neck mass). For patients with solid masses that harbor squamous cell carcinoma, FNA will be positive in 80% or more ( 32 – 34 ) and repeated FNA can yield an additional increment. With cystic neck masses the percentage is lower, but still, if ultrasound assisted and directed toward the most solid parts of the lesion, in the majority of patients with a suspicious neck mass, the FNA will correctly diagnose malignancy if present.…”