Fine needle aspiration cytology of head and neck masses: a cytohistopathological correlation study with emphasis on false positives and false negatives.

OBJECTIVES: This study aims to evaluate the accuracy ratio of fine needle aspiration (FNA) cytology in the diagnosis of non-thyroidal head and neck masses. PATIENTS AND METHODS: Between 2000 January and 2003 December, the pathology reports of 571 patients (297 males, 274 females; mean age 45 years; range 4 to 83 years) with non-thyroidal head and neck masses who underwent FNA cytology during a four year period were retrospectively analyzed. Cytopathological and histopathological results of the samples were recorded. The smear results indicating an inconsistency were reviewed. The possible causes of the false positivity and false negativity were investigated. RESULTS: Of a total of 571 patients, 181 had a confirmed histopathological diagnosis. The overall accuracy ratio, specificity, sensitivity, negative predictive value and positive predictive value of FNA in the diagnosis of the head and neck masses were 83%, 85%, 81%, 84%, 83%, respectively. CONCLUSION: The FNA has a high accuracy, sensitivity, specificity, negative and positive predictive values in the diagnosis of head and neck masses. If the major causes of misdiagnosis including inadequate sampling and misinterpretation are avoided, the diagnostic accuracy ratio of FNA in the head and neck and will be improved.

The value of touch imprint cytology of core needle biopsy in the diagnosis of spinal lesions.

AIM: We aimed to investigate the contribution of the touch imprint cytology (TIC) of core needle biopsies (CNBs) to the diagnosis in spinal lesions. MATERIAL AND METHODS: Sixty cases with spinal CNB and TIC were included in the study. Hematoxylin and Eosin (H&E) and May-Grunwald- Giemsa (MGG) stained TIC slides and CNB of each case were blindly reevaluated by two pathologists. TIC and CNB findings were categorized as follows: 1-Nondiagnostic 2- Benign nonneoplastic 3- Benign neoplastic 4- Malignant 5-Malignant lesions that can be typed. RESULTS: TIC and CNBs were nondiagnostic in 62% and 45% of all cases, respectively. Malignancy could be identified and typed in 23% of imprint preparations and 35% of CNBs. When TIC and CNB diagnosis were compared, it was seen that diagnostic categories were just the same in 70% of the cases. In 37% of the cases benign and malignant groups could be distinguished. In 20% of the cases diagnostic categories were totally different. CONCLUSION: The percentage of the nondiagnostic material in CNBs can reach up to 45%. The findings in TIC and CNBs were compatible with each other. We observed that TIC was diagnostic on its own especially in carcinoma metastasis and contributed to the assessment of cytologic detail in hematologic malignancies.

Inter-observer agreement in laryngeal pre-neoplastic lesions.

In this series, laryngeal preneoplastic lesions were evaluated by the classifications of the World Health Organization (WHOC), Ljubljana (LC) and squamous intraepithelial neoplasia (SINC) by multiple observers. The inter-observer agreement (IA) by WHOC for laryngeal lesions had been previously evaluated, but to the best of our knowledge, there are no data for LC and SINC. H&E stained slides from 42 laryngeal biopsies were evaluated by fourteen participants according to WHOC and LC, and SINC was additionally applied by 6. The results were analyzed statistically. The diagnoses which were favored by most participants for each case, according to WHOC, were as follows: squamous cell hyperplasia (n = 5; 12%), mild dysplasia (n = 11; 26.2%), moderate dysplasia (n = 12; 28.6%), severe dysplasia (n = 7; 16.7%), carcinoma in situ (n = 5; 12%), and invasive squamous cell carcinoma (n = 2; 4.8%). There was a significant difference between the participants for all three classifications; some participants gave lower or higher scores than the others. The mean correlation coefficients (MCC) of the participants were higher for WHOC compared to LC (0.55 ± 0.15 and 0.48 ± 0.14, respectively). The mean linear-weighted kappa (wKappa) values of participants were not significantly different (0.42 ± 0.10, 0.41 ± 0.12 and 0.37 ± 0.07 for WHOC, LC and SINC, respectively). The kappa values in this series are in agreement with those in previous literature for WHOC, and the similar results obtained for LC and SINC are novel findings. Although the MCC of WHOC was higher, as the wkappa was not significantly different, the findings in this series are not in favor of any of the classifications for better IA for pre-neoplastic laryngeal lesions.