Fine needle aspiration at a Regional Head and Neck Clinic: A clinically beneficial and cost‐effective service

Regional Head and Neck Clinic, Belfast City Hospital, Belfast, UK.
Cytopathology (Impact Factor: 1.48). 02/2008; 20(2):81-6. DOI: 10.1111/j.1365-2303.2007.00549.x
Source: PubMed


Fine needle aspiration (FNA) is an important adjuvant to the diagnosis of a palpable lesion which often permits the complete assessment of patients. The main objective of this study was to determine the clinical benefit of a dedicated FNA service at a tertiary referral Head and Neck Clinic and to assess if such a service is cost effective.
All patients attending the Head and Neck Clinic during 2004 were prospectively assessed in this study. Patient records were analysed regarding investigative modalities including FNA, the subsequent cytology result and the requirement for further histopathological investigations. A cost analysis for all investigative procedures was performed.
A total of 135 patients (36 males) had FNAs performed during the study period. The median age was 51.5 years (range 17-92). Patients presented with lesions of lymph nodes (n = 46), thyroid (n = 41), salivary, parotid or submandibular glands (n = 22) and other cutaneous or cystic lesions (n = 26). Cytological grading results were; C1 = 26, C2 = 93, C3 = 8, C4 = 2 and C5 = 6. Patients with lesions C3 or above normally proceeded to further investigations. The overall cost of the FNA per episode in the out-patient clinic was pound114 per episode compared to day case open biopsy per patient of pound333 and an in-patient stay per patient was pound2371. FNA provided sufficient pathological diagnosis to avoid day case surgery in 57 patients (42.2%), and inpatient surgery in 65 patients (48.1%) resulting in a total saving of pound158 372 in 2004.
This study demonstrates the clinical benefit and cost-effectiveness of FNA services in a dedicated Head and Neck clinic.

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    • "FNAC became popular 30 years ago 1 as it is useful in the differential diagnosis of salivary gland swellings. It is a minimally invasive procedure that does not require anaesthesia 2. It is well-tolerated, simple, safe and cost-effective 3 4. Moreover, it can be easily repeated in the event of non-diagnostic results, thus improving diagnostic precision 5. "
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    ABSTRACT: Fine-needle aspiration cytology guided by ultrasound imaging is a widely used diagnostic tool to evaluate neoplastic or inflammatory lesions of salivary glands. From February 2002 to February 2008 all the parotid lesions removed surgically in our Unit of Otolaryngology were reviewed. Study focused on sensitivity, specificity, accuracy, predictive values, likelihood ratios, and Kappa statistics for fine-needle aspiration cytology vs histological diagnosis in 176 cases. Fine-needle aspiration cytology sensitivity and specificity were 81% and 99%, respectively. Accuracy for malignancy was 97%, accuracy for benignity was 83%; positive and negative predictive values were 93% and 98%, respectively; likelihood ratio of positive and negative test results were 100.3 and 0.19, respectively ("positive" was used to define "malignant"). The prevalence of malignancy was 0.114. Kappa statistics for the degree of agreement between fine-needle aspiration cytology and histological results were 0.85 (95% CI = 0.71-0.99). Pre-operative fine-needle aspiration cytology diagnosis improves surgical treatment of parotid masses.
    Full-text · Article · Feb 2011 · Acta otorhinolaryngologica Italica: organo ufficiale della Società italiana di otorinolaringologia e chirurgia cervico-facciale
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    ABSTRACT: OBJECTIVE: This review highlights the role of cytopathology in cancer management within UK Head and Neck Cancer Networks and informs on the issues raised by recent UK Department of Health documents and other UK professional guidance. UK guidance requires the formal involvement of cytopathologists within multidisciplinary cancer teams, with medical and non-medical cytopathology staff setting up and running rapid access lump clinics, and support for image-guided fine needle aspiration cytology (FNAC) services. UK guidance also makes recommendations for training, resources and quality control. This review also highlights the resource gap between best practice evidence-based guidance for head and neck (HN) cancer services and existing UK provision for cytopathology, as evidenced by lack of availability of experienced staff and adequacy of training and quality control (QC). Finally, it stresses the importance in the UK of the Royal College of Pathologists' guidance, which defines the need for training, the experience needed for new consultants, the requirements for audit and QC. The implications for the additional resources required for HN cancer cytopathology services are discussed. Recent professional guidance specifying the provision of HN cancer services in the UK includes a cytopathology service for cancer networks, such as rapid access FNAC clinics. Although these clinics already operate in some institutions, there are many institutions where they do not and where the provision of cytopathology services would have to be restructured. This would need the support of local cancer networks and their acceptance of the detailed requirements for cytopathology, including resources, training and QC. The standards are not defined locally, as Strategic Health Authorities and Primary Care Trusts have been instructed by the Department of Health to support, invest and implement them.
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    ABSTRACT: The British Society for Clinical Cytology Code of Practice on fine needle aspiration cytology complements that on exfoliative cytopathology, which was published in the last issue (Cytopathology 2009;20:211-23). Both have been prepared with wide consultation within and outside the BSCC and have been endorsed by the Royal College of Pathologists. A separate code of practice for gynaecological cytopathology is in preparation. Fine needle aspiration (FNA) cytology is an accepted first line investigation for mass lesions, which may be targeted by palpation or a variety of imaging methods. Although FNA cytology has been shown to be a cost-effective, reliable technique its accurate interpretation depends on obtaining adequately cellular samples prepared to a high standard. Its accuracy and cost-effectiveness can be seriously compromised by inadequate samples. Although cytopathologists, radiologists, nurses or clinicians may take FNAs, they must be adequately trained, experienced and subject to regular audit. The best results are obtained when a pathologist or an experienced and trained biomedical scientist (cytotechnologist) provides immediate on-site assessment of sample adequacy whether or not the FNA requires image-guidance. This COP provides evidence-based recommendations for setting up FNA services, managing the patients, taking the samples, preparing the slides, collecting material for ancillary tests, providing rapid on-site assessment, classifying the diagnosis and providing a final report. Costs, cost-effectiveness and rare complications are taken into account as well as the time and resources required for quality control, audit and correlation of cytology with histology and outcome. Laboratories are expected to have an effective quality management system conforming to the requirements of a recognised accreditation scheme such as Clinical Pathology Accreditation (UK) Ltd.
    Full-text · Article · Oct 2009 · Cytopathology
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