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

      Abstract

      PURPOSE

      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.

      METHODS

      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.

      RESULTS

      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.

      CONCLUSION

      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.

      Keywords

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