Accuracy of fine-needle aspiration and frozen section for the detection of squamous metastasis in cystic masses of the lateral neck



      Cystic masses of the lateral neck are mostly benign; however, the incidence of metastatic squamous cell carcinoma (SCC) in cervical cystic masses initially diagnosed as benign is quite high in patients older than 40 years. The aim of this study was to compare the diagnostic accuracy of preoperative cytology and intraoperative frozen section (FS) evaluation in detecting malignancy in cystic masses of the neck.


      We reviewed 61 patients who underwent preoperative ultrasound-guided FNAC and neck biopsy of a cystic neck mass. We analysed the concordance between FNAC and intraoperative FS respect of definitive histology. HPV status was also tested.


      Out of 49 eligible cases, the accuracy of preoperative FNAC was 70.5% and the weighted Kappa resulted 0.53 meaning a moderate agreement between cytology and final diagnosis. Intraoperative FS consultations detected 16 cases of SCC metastasis while the remaining 33 cases were negative for SCC showing a perfect agreement with histology.


      Since FS analysis resulted useful in evaluating cystic neck masses, despite of moderate accuracy of cytology, we suggest intraoperative FS analysis for all cystic neck masses. This technique allows to switch towards a therapeutical neck dissection, multiple upper aerodigestive tract biopsies, tongue base mucosectomy and bilateral tonsillectomy in the same surgical setting.


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        • Sira J.
        • Makura Z.G.G.
        Differential Diagnosis of Cystic Neck Lesions.
        Ann Otol Rhinol Laryngol. 2011; 120 (PMID: 8651637): 409-413
        • Pynnonen M.A.
        • Gillespie M.B.
        • Roman B.
        • et al.
        Clinical Practice Guideline: Evaluation of the Neck Mass in Adults.
        Otolaryngol Neck Surg. 2017;157(2_suppl):S1–S30.; (PMID: 28891424)
        • Begbie F.
        • Visvanathan V.
        • Clark L.J.
        Fine needle aspiration cytology versus frozen section in branchial cleft cysts.
        J Laryngol Otol. 2015; 129 (Epub 2015 Feb 16 PMID: 25684337): 174-178
        • Goldenberg D.
        • Begum S.
        • Westra W.H.
        • et al.
        Cystic lymph node metastasis in patients with head and neck cancer: an HPV-associated phenomenon.
        Head Neck. 2008; 30: 898-903
        • Cianchetti M.
        • Mancuso A.
        • a., Amdur RJ,
        • et al.
        Diagnostic evaluation of squamous cell carcinoma metastatic to cervical lymph nodes from an unknown head and neck primary site.
        Laryngoscope. 2009; 119 (PMID: 19718744): 2348-2354
      1. National Comprehensive Cancer Network. Clinical practice guidelines in oncology for head and neck cancers. Version 2.2019. [accessed August 19th, 2019].

        • Tandon S.
        • Shahab R.
        • Benton J.I.I.
        • et al.
        Fine-needle aspiration cytology in a regional head and neck cancer center: comparison with a systematic review and meta meta-analysis.
        Head Neck. 2008; 30: 1246-1252
        • Ahn D.
        • Sohn J.H.
        • Yeo C.K.
        • Jeon J.H.
        Feasibility of surgeon-performed ultrasound-guided core needle biopsy in the thyroid and lymph nodes.
        Head Neck. 2016; 38 (Epub 2015 Nov 11 PMID: 26559644): E1413-E1418
        • Stanley M.W.
        Selected problems in fine needle aspiration of head and neck masses.
        Mod Pathol. 2002; 15 (PMID: 11904347): 342-350
        • Mahe E.
        • Ara S.
        • Bishara M.
        • et al.
        Intraoperative pathology consultation: Error, cause and impact.
        Can J Surg. 2013; 56: 13-18 PMID: 23706852; PMCID: PMC3672438
        • Franzen A.
        • Günzel T.
        • Buchali A.
        • Coordes A.
        Cystic Lateral Neck Lesions: Etiologic and Differential Diagnostic Significance in a Series of 133 Patients.
        Anticancer Res. 2019; 39 (PMID: 31519613): 5047-5052 doi: 10.21873/anticanres.13696
        • Koch E.M.
        • Fazel A.
        • Hoffmann M.
        Cystic masses of the lateral neck - proposition of an algorithm for increased treatment efficiency.
        J Craniomaxillofac Surg. 2018;46:1664–8. PMID:; : 29983308
        • Kubik M.W.
        • Channir H.I.
        • Rubek N.
        • et al.
        TORS Base-of-Tongue Mucosectomy in Human Papilloma Virus-Negative Carcinoma of Unknown Primary.
        Laryngoscope. 2021; 131 (Epub 2020 Apr 2 PMID: 32239774): 78-81
        • Amedee R.G.
        • Dhurandhar N.R.
        Fine-Needle Aspiration Biopsy.
        Laryngoscope. 2001; 111: 1551-1557
        • Tirelli G.
        • Cova M.A.
        • Zanconati F.
        • et al.
        Charcoal suspension tattoo: new tool for the localization of malignant laterocervical lymph nodes.
        Eur Arch Oto-Rhino-Laryngology. 2016; 273 (Epub 2016 May 3 PMID: 27142619): 3973-3978
        • Borsetto D.
        • Fussey J.M.
        • Cazzador D.
        • et al.
        The diagnostic value of cytology in parotid Warthin's tumors: International multicenter series.
        Head Neck. 2020; 42 (Epub 2020 Feb 28 PMID: 32108408): 2215-2216
        • Tirelli G.
        • Piovesana M.
        • Gatto A.
        • et al.
        Is NBI-Guided Resection a Breakthrough for Achieving Adequate Resection Margins in Oral and Oropharyngeal Squamous Cell Carcinoma?.
        Ann Otol Rhinol Laryngol. 2016; 125 (Epub 2016 Apr 7 PMID: 27056557): 596-601
        • Tirelli G.
        • Zacchigna S.
        • Boscolo Nata F.
        • et al.
        Will the mininvasive approach challenge the old paradigms in oral cancer surgery?.
        Eur Arch Oto-Rhino-Laryngology. 2017; 274 (Epub 2016 Aug 4 PMID: 27491319): 1279-1289
      2. Fakhry C, Agrawal N, Califano J et al. The use of ultrasound in the search for the primary site of unknown primary head and neck squamous cell cancers. Oral Oncol 2014;50:640-5. doi: 10.1016/j.oraloncology.2014.03.015. Epub 2014 May 10. PMID: 24819862; PMCID: PMC4696034.

        • Raffaelli M.
        • De Crea C.
        • Sessa L.
        • et al.
        Can intraoperative frozen section influence the extension of central neck dissection in cN0 papillary thyroid carcinoma?.
        Langenbeck’s Arch Surg. 2013; 398 (Epub 2012 Dec 4 PMID: 23207498): 383-388
      3. Lee DH, Yoon TM, Kim HK, et al. Intraoperative frozen biopsy of central lymph node in the management of papillary thyroid microcarcinoma. Indian J Otolaryngol Head Neck Surg 2016;68:56-9. doi: 10.1007/s12070-015-0900-1. Epub 2015 Sep 15. PMID: 27066412; PMCID: PMC4809834.

        • Tabet P.
        • Saydy N.
        Letourneau-Guillon L et al Cystic masses of the lateral neck: Diagnostic value comparison between fine-needle aspiration, core-needle biopsy, and frozen section.
        Head Neck. 2019; 41 (Epub 2019 Apr 4 PMID: 30945785): 2696-2703
        • Shah K.S.
        • Ethunandan M.
        Tumour seeding after fine-needle aspiration and core biopsy of the head and neck–a systematic review.
        Br J Oral Maxillofac Surg. 2016; 54 (Epub 2016 Feb 1 PMID: 26837638): 260-265
        • Huang Y.H.
        • Yeh C.H.
        • Cheng N.M.
        • et al.
        Cystic nodal metastasis in patients with oropharyngeal squamous cell carcinoma receiving chemoradiotherapy: Relationship with human papillomavirus status and failure patterns.
        PLoS One. 2017; 7: 7-12