|Year : 2014 | Volume
| Issue : 2 | Page : 98-99
A comparative study of fine-needle aspiration and fine-needle non-aspiration techniques in head and neck swellings
S Srikanth, G Anandam, MM Kashif
Department of Pathology, Prathima Institute of Medical Science, Andhra Pradesh, India
|Date of Web Publication||7-Aug-2014|
Department of Pathology, Prathima Institute of Medical Science, Andhra Pradesh
Source of Support: None, Conflict of Interest: None
Aims and Objective: The present study was undertaken to compare the fine-needle aspiration cytology (FNAC) and the fine-needle non-aspiration cytology (FNNAC) techniques in head and neck swellings and to study the cytology features of various head and neck swellings. Materials and Methods: A total of 138 cases of head and neck swellings were sampled by a single operator, using both FNAC and FNNAC techniques. The two techniques were compared for the five objective parameters, amount of background blood or clots, amount of cellular material present, retention of appropriate architecture, degree of cellular degeneration and degree of cellular trauma, using Mair's point scoring system. Results: Blood contamination was similar in FNNAC as compared to FNAC in all cases. The difference was not statistically significant. Cellular yield was more in FNNAC in Thyroid and salivary gland lesions, with a significant statistical difference being noted in both. Better retention of architecture with a statistically significant difference was seen in FNNAC smears from lymph node lesions. There was no significant difference between the two techniques in degree of background blood. More number of FNNAC smears was diagnostically superior. Conclusion: The FNNAC technique provides an adequate cellular yield for a definite diagnosis in all head and neck swellings, except in cystic and fibrotic swellings where FNAC is a better technique.
Keywords: Comparison, fine needle aspiration, lymph node, salivary gland, thyroid
|How to cite this article:|
Srikanth S, Anandam G, Kashif M M. A comparative study of fine-needle aspiration and fine-needle non-aspiration techniques in head and neck swellings. Indian J Cancer 2014;51:98-9
|How to cite this URL:|
Srikanth S, Anandam G, Kashif M M. A comparative study of fine-needle aspiration and fine-needle non-aspiration techniques in head and neck swellings. Indian J Cancer [serial online] 2014 [cited 2019 Dec 15];51:98-9. Available from: http://www.indianjcancer.com/text.asp?2014/51/2/98/137935
| » Introduction|| |
Fine-needle aspiration cytology (FNAC) is being used as a first line of investigation in the diagnosis of head and neck swellings. The negative pressure applied during aspiration leads to bloody smears, especially in highly vascular organs like thyroid. In 1981, fine needle sampling without aspiration, called as fine needle non-aspiration cytology (FNNAC) was introduced. FNNAC, variously termed fine needle capillary sampling,  cytopuncture, non-aspiration fine-needle cytology and fine needle sampling without aspiration,  is a simple procedure. Cells make up the basic structural unit of the human body. Study of cells is therefore helpful not only in understanding the normal structure but also in analyzing various disease processes. Both exfoliative cytology and aspiration cytology were performed mostly by clinicians, as an aid to rapid diagnosis. 
The technique of FNAC has undergone various modifications over a period of time. It was thought to cause cell trauma, altering the cell morphology. It also leads to bloody aspirates in highly vascular organs like thyroid. This lead to the development of fine needle sampling without aspiration called as FNNAC. However, will the fine needle non aspiration technique yield adequate material for a cytologic diagnosis was the question in doubt. Thus, the present study was undertaken to compare the two techniques namely fine needle aspiration and fine needle non-aspiration cytology. Nowadays, FNAC is being used as a first line of investigation in palpable masses anywhere in the body, but especially in the head and neck area. 
| » Materials and Methods|| |
A total of 138 cases were studied. Patients were presented with swellings in the head and neck region to the various out-patient departments. Relevant clinical details including the site and size of the swelling, duration since onset, signs and symptoms associated with the swelling and other investigations done were noted in a proforma prepared for this study. All patients with head and neck swellings were included in this study. Tumors of vascular origin and central nervous system tumors were excluded from the study. For both techniques, we used 10 cc syringe.
| » Results|| |
The total number of cases in which both the techniques were available for comparison was 138. All the 138 cases included in our study showed a wide variety of lesions. These cases were grouped based on the origin of the swelling into the lymph node, thyroid and salivary glands. They were subgrouped depending upon the cytology diagnosis. Each of these groups and subgroups were analyzed and compared for the five objective parameters in the two techniques [Table 1].
Our study included patients in the age group of 1½ years to 80 years, with a mean age of 35.36 years. There were 129 females and 33 males, with a female to male ratio of 3.9:1.
| » Discussion|| |
FNAC is accepted as first line of investigation for palpable masses of the head and neck. The present study was undertaken to assess the efficacy of FNNAC in the diagnosis of head and neck masses and to debate the need for both the techniques in every case. In the present study of 138 aspirates from head and neck swellings, the largest group was of thyroid lesions comprising 66.66% of cases, followed by lymph node 20.28% and salivary glands 13.04% [Table 2].
Lymphadenopathy with highly cellular lesions like reactive hyperplasia and metastatic malignancy, both the techniques yielded comparable cellular material. In non-specific lymphadenitis, the non-aspiration technique was significantly better than aspiration technique with regard to background blood, amount of cellular material and retention of appropriate architecture. Amount of cellular degeneration and trauma was equal in both the techniques and hence, the non-aspiration technique was as good as, or better than the aspiration technique.
In the present study, FNNAC was better for lymph node lesions with respect to all the five parameters.
In the 40 cases of colloid goiter that were studied in the present series, FNNAC performed good as or better than FNAC. In thyroiditis and neoplasms, there was minimal difference in scores obtained in the two techniques. The FNNAC was as good as FNAC and was diagnostic in all cases. For thyroid lesions, the non-aspiration technique was better than the aspiration technique in all the parameters.
Out of the 18 salivary gland lesions cases the various lesions encountered were chronic sialadenitis, pleomorphic adenoma, mucoepidermoid carcinoma and adenoid cystic carcinoma.
FNNAC yielded better amount of cellular material than FNAC.
In the non-aspiration technique, the needle can be moved freely in any desired direction. It causes less blood contamination and it is less painful. In the aspiration technique, keeping the plunger pulled back to create a negative pressure, it becomes difficult to control the precise needle movements, causing more trauma and hence more blood contamination.
To conclude the ultimate purpose of fine needle cytology is the diagnosis and guidance for the clinician in selecting the appropriate treatment.
Fine needle cytology can differentiate between neoplastic and non-neoplastic lesions. When neoplastic, the diagnosis of benign or malignant tumor allows the surgeon to plan the operative approach if found to be inflammatory or reactive lesion, surgery can be avoided. The main aim of the present study is to compare the technique of fine needle aspiration and fine-needle non-aspiration cytology in the head and neck swellings and to study the cytology features of various head and neck swellings.
| » References|| |
|1.||Yue XH, Zheng SF. Cytologic diagnosis by transthoracic fine needle sampling without aspiration. Acta Cytol 1989;33:805-8. |
|2.||Zajdela A, Zillhardt P, Voillemot N. Cytological diagnosis by fine needle sampling without aspiration. Cancer 1987;59:1201-5. |
|3.||Orell SR, Sterret GF, Max NI, Whitaker DD, editors. Manual and Atlas of Fine Needle Aspiration Cytology. 4 th ed. London: Churchill Livingstone; 2005. p. 1-9. |
|4.||Amedee RG, Dhurandhar NR. Fine-needle aspiration biopsy. Laryngoscope 2001;111:1551-7. |
[Table 1], [Table 2]
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