Current usefulness of aspiration cytology (FNAC) in the head and neck diagnosis.

Background: Fine Needle Aspiration Cytology (FNAC) is a well established and widely used method for both a preliminary and sometime final non-invasive pathologic diagnosis. FNAC is a simple and inexpensive diagnostic tool and should represent the standard of care in developing and resource-poor countries while maintaining its diagnostic usefulness in developed and advanced ones.

Methods: The concordance between preoperative FNAC and final histology was evaluated in 168 patients operated on at the Otorhinolaryngology Unit, "A. Murri" Hospital, Fermo (Italy), from January 2012 to October 2016, including thyroid cases, salivary glands and cervical masses.

Results: The percentages of correct diagnosis provided by FNAC were good in all groups of pathologies and in accordance with the mean data of the literature. In particular the kappa statistic for the degree of agreement between FNAC and definitive histology (good > 0.6 and excellent > 0.8) was 0.74 for the thyroid, 0.83 for the parotid and 0.71 for both the submandibular and the cervical masses.

Discussion: Thy 3 group is still the most challenging for a successful FNAC diagnostic prediction. Especially in the developed and advanced countries, both the immediate review of the smear with its repetition, if needed, and the aspiration performed under CT/MRI guidance, when necessary, seem to further empower FNAC diagnostic resolution and should be pursued. Being routinely used for more than 40 years, FNAC is still a valuable and cost-effective tool to distinguish between cases that don't need any treatment, cases to be treated medically and those that require surgical excision. In the Authors' opinion every institution should periodically review its data in order to monitor and assess the accuracy of its diagnostic activity.