Superficial cervical swelling in children; role of fnac in diagnosis - experience at Bahawalpur

ABSTRACT

Fine needle aspiration cytology [FNAC] is commonly used first line diagnostic test for palpable cervical swelling by ENT and Head and Neck surgeon. To analyze the diagnostic importance of FNAC by knowing its sensitivity and specificity in children having palpable cervical swelling. Prospective study. Department of ENT and Head Neck Surgery QAMC, Bahawalpur. July 2006 to June 2007. 82 cases of superficial cervical swelling with ages between 5 and 12 years were selected. Most of them were of poor socioeconomic class. All underwent FNAC for diagnosis and results were analyzed after comparing with histopathology examinations. Out of 432 total patients [of all ages] who attended the ENT department during the study period, only 82 were selected for the research which fulfilled the inclusion criteria. These were 5-12 years old, both sexes, 47 boys [57.3%] and 35 girls [42.75%]. Sixty eight [83%] patients had benign diseases while 14 patients [17%] had malignant lesions. Out of the 68 benign lesion [44.11%] were reaction hyperplasia [non specific inflammation], followed by tuberculous lymphadenitis [38.23%], cystic masses [5.88%], benign tumours [4.4%] and nodular goiter [7.35%]. Out of 14 malignant lesions, 6 [42.85%] had Hodgkin's Lymphoma, 2 [14.28%] had Non Hodgkin's Lymphoma, 3 [21.42%] patients had squamous cell carcinoma and 1 [7.14%] patient each of rhabdomyosarcoma, undifferentiated carcinoma and pleomorphic adenoma. In our study sensitivity and specificity of FNAC to diagnose the malignant lesion was 85.7% and 89.7% respectively. Accuracy of FNAC in our study was 89.0%. FNAC is highly helpful to diagnose the pathology of cervical swelling in children. It has high rate of sensitivity, specificity and accuracy to diagnose the malignancy in these lesions. Proper and specific sampling needs complete cooperation of the child and sedation may be necessary for this. Expertise is required for FNAC reporting