Indian Pediatrics 1999;36: 921-923

FNAC as a Diagnostic Tool in Pediatric Head and Neck Lesions

From the Departments of Pathology and Otorhinolaryngology*, Lady Hardinge Medical College, New Delhi 110 001, India.
Reprint requests: Prof. M. Jain, DII/173, West Kidwai Nagar, New Delhi 110 023, India.
Manuscript received: November 17, 1998;
Initial review completed: December 10, 1998;
Revision accepted: March 18, 1999

Fine needle aspiration cytology (FNAC) is well accepted as a useful diagnostic technique in the management of adult patients with head and neck lumps(1-3). Until recently the application of FNAC to the pediatric population was largely ignored in the Indian and American pediatric literature. Previous reports have studied its utility in only small series of pediatric patients(4-6). The current study evaluates the role of FNAC as a diagnostic tool in investigation of head and neck lesions in children.

Subjects and Methods

During the period from July 1992 to June 1995, FNAC was carried out on 748 children (age 0-12 years) in the Departments of Pathology, Otorhinolaryngology and Pediatric Surgery at Lady Hardinge Medical College and associated Hospitals, New Delhi. Routine FNAC procedure was done using 21-24 G needle. Smears were stained by Giemsa and Paps stain and special stains were carried out as and when required(7).

Results

Out of 748 lesions, adequacy of material was achieved in 94% cases. Lymph node lesions predominated accounting for 605 cases (81%). Out of these, 60.6% were diagnosed as reactive and 30.5% as tuberculous lymphadenitis. The other lesions aspirated were from thryoid, salivary gland, miscellaneous surface lumps and orbital lesions comprising 3.2%, 2.1%, 7.6% and 0.2% respectively. The final diagnosis of the lesions aspirated according to the site is given in Table I. Of all the cases, 98.5% cases were reported as benign and 1.5% cases as malignant. All malignant cases were confirmed by surgical biopsy. The positive predictive value of a cytologically malignant FNAC was 100%.

Table I^__Final Diagnosis of the Lesions Aspirated According to the Site.

Depending upon the cytomorphological appearances, tuberculous lymphnodes were further subdivided into four categories: (i) Purulent with caseation_13% (ii) Only caseation_46.7%, (iii) Caseation with epithelioid cells_21.1%; and (iv) Non caseating with epithelioid cells_19.1%. Smears consisting of only caseous material predominated out of all cytomorphological appearances. AFB positivity was observed in 60.8% cases with maximum AFB positivity (80.3%) being observed in smears with only casea-tion. Thirty per cent patients with AFB negativity were followed up and they responded to antitubercular treatment.

All cases of FNAC were subsequently confirmed either by follow up for a minimum of 12 months or by surgical biopsy wherever needed. Overall the procedure was simple and rapid obviating the need of surgical intervention. No procedure related complications were encountered in this series. The cytologic diagnostic accuracy in various head and neck lesions in present series varied from 80.7%-100%.

Discussion

The use of FNAC is popular for super-ficial and deep masses in adults(1,2,8). However, in children there are few studies regarding FNAC and these too are mostly elaborating its use in areas other than head and neck(9,10).

Unsatisfactory aspirates have been reported in various studies in the range of 9.3-15%(8,11) which is much higher than that observed in our study (6%).Unsatisfactory aspirates in the previous studies were the result of poor handling of the aspirated material and the lack of trained cytopathologists whereas inadequacy in the present study was attributable to the small size of the lesions and poor handling of aspirated material. Lymph node lesions predominated followed by other sites which is comparable to the previous studies(5,12,13). In consonance to earlier reports(5,14) we also observed a predominance of benign lesions. However, in other series(2,15) malignancy predominated over benign conditions. These differences may be related to the age composition of the sample surveyed. Earlier work(5) has shown the predictive value of cytologically malignant FNAC to be only 89.4% whereas in the present series it was 100%.

Therefore with increasing cost of medical facilities any technique which speeds up the process of diagnosis, limits the physical and psychological trauma to the patient and saves the expenditure of hospitalization, will be of tremendous value. It may also help the surgeon to select, guide and modify surgical planning in patients requiring surgery.

To conclude FNAC is a very simple and expeditious procedure which can be carried out with ease in children without encountering much problems. It reduces the necessity to perform excision biopsy in many cases, saving children from surgical complications. Thus FNAC can be recommended as a first line of investigation in the diagnosis of head and neck swellings in pediatric age group.

References

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