Evaluation of ultrasound and fine-needle aspiration in the assessment of head and neck lesions.

PURPOSE

Neck masses of uncertain character need further investigation through imaging and tissue sampling. This is the most extensive study in the literature of clinician-operated ultrasound and fine-needle aspiration (US + FNA) of the head and neck with histological verification, itemized into organ system. The purpose of the present study was to comprehensively evaluate the combination of US + FNA in the assessment of various kinds of head and neck lesions in the hand of the clinician in one single study.

METHODS

A total of 408 histologically verified head and neck lesions in 376 consecutive patients undergoing all three diagnostic steps (US, FNA, US + FNA) were included. Excisional biopsy or core-needle biopsy served as a gold standard. US and FNA were evaluated alone and in combination to distinguish between malignant and benign lesions as well as to establish an approximate and specific diagnosis. Each calculation was itemized by organ system.

RESULTS

In detecting malignancy, US + FNA showed a significantly higher accuracy (97% vs 86% and 92%) than US and FNA alone. An approximate diagnosis was established in 93%, and a specific diagnosis in 88%, which was significantly better than that of US and FNA alone.

CONCLUSION

US + FNA is suited for an efficient evaluation of head and neck masses. This combined method should be the first line of investigation in such lesions before any other imaging and/or sampling methods. While discrepancies in diagnostic findings potentially occur, the key is the interpretation of the package (US and cytologic findings, clinical information) made in one consultation by one clinician to proceed in proper decision making regarding an adequate treatment plan. Consequently US + FNA belong to the standard armamentarium of the otolaryngologist.