2017 Sec 1 Green Book

Original Research—Pediatric Otolaryngology

Utility of Fine-Needle Aspiration Biopsy

in the Evaluation of Pediatric Head and

Neck Masses

Otolaryngology–

Head and Neck Surgery

2016, Vol. 154(5) 928–935

American Academy of

Otolaryngology—Head and Neck

Surgery Foundation 2016

Reprints and permission:

sagepub.com/journalsPermissions.nav

DOI: 10.1177/0194599816631728

http://otojournal.org

Phillip Huyett, MD

, Sara E. Monaco, MD

, Sukgi S. Choi, MD

, and

Jeffrey P. Simons, MD

Sponsorships or competing interests that may be relevant to content are dis-

closed at the end of this article.

Abstract

Objectives

. Fine-needle aspiration biopsy (FNAB) has a well-

established role in the evaluation of an adult head and neck

mass (HNM) but remains underused in children. The objec-

tives of this study were to assess the diagnostic accuracy,

safety profile, use of anesthesia, and influence on surgical deci-

sion making of FNAB of HNM in the pediatric population.

Study Design

. Case series with chart review.

Setting

. Tertiary care children’s hospital.

Subjects and Methods

. In total, 257 consecutive patients with

HNM who underwent 338 FNABs from July 2007 to July

2014 were reviewed. Patients ranged in age from 0 to 21

years (mean, 9.3 years); lesions ranged in size from 0.3 to

12.5 cm (mean, 2.4cm). Fine-needle aspiration biopsies were

performed in the interventional radiology suite, operating

room, clinic, or ward.

Results

. The most common patient final diagnoses included

reactive lymphadenopathy (n = 99, 38.5%), benign thyroid

colloid nodule (n = 31, 12.1%), malignancies (n = 21, 8.2%),

and atypical mycobacterial infection (n = 15, 5.8%). On sur-

gical histopathologic and clinical follow-up, overall sensitivity

of FNAB was 94.6% and specificity was 97.7%. The compli-

cation rate was 2.1%, and general anesthesia or sedation

was used for 73% of FNAB. Surgery occurred only 9 times

following the 191 patients with negative FNAB results, indi-

cating that 95.3% of unnecessary surgeries were avoided

with the assistance of the FNAB result.

Conclusions

. Fine-needle aspiration biopsy is an accurate and

safe diagnostic tool for guiding management of persistent

lymphadenopathy, thyroid nodules, and other HNM in pedia-

tric patients. Negative FNABs can often obviate the need

for surgical intervention.

Keywords

fine-needle aspiration biopsy, head and neck mass, thyroid

nodule, pediatrics, sensitivity and specificity

Received October 29, 2015; revised January 14, 2016; accepted

January 20, 2016.

ine-needle aspiration biopsy (FNAB) dates back as

far as 1857 and has been established in the diagnosis

of head and neck masses (HNMs) since the late

1920s.

In the adult population, FNAB is widely used and

accurate for diagnosis of both benign and malignant lesions

throughout the head and neck region.

2,3

For example, FNAB

has been used with great success as the primary screening

test for thyroid nodules in adults,

but such a structured

approach has lagged in the evaluation of pediatric thyroid

nodules.

5,6

This diagnostic modality has gradually become more

accepted in the pediatric population but remains underused.

The first studies examining pediatric FNAB were published

in the 1980s,

7-9

and the first report dedicated to pediatric

HNM FNAB was published in 1991 by Mobley et al.

Since that time, several publications have related the safety,

accuracy, and feasibility of FNAB in pediatric HNM

11-16

but have been limited by case numbers or restricted ana-

tomic subsites.

The potential avoidance of surgery with associated scar-

ring, complications, general anesthetic risk, recovery time,

and expense have all been heralded as benefits of FNAB,

especially given the high prevalence of nonneoplastic pediatric

HNM. The objectives of this study were to assess the diagnos-

tic accuracy and safety profile of FNAB in a large number of

thyroid and nonthyroid pediatric HNMs. In addition, we exam-

ined the clinical application of FNAB, including the use of

Department of Otolaryngology–Head and Neck Surgery, University of

Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA

Department of Pathology, University of Pittsburgh Medical Center,

Pittsburgh, Pennsylvania, USA

Department of Otolaryngology, Children’s Hospital of Pittsburgh of

University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA

Corresponding Author:

Phillip Huyett, MD, Department of Otolaryngology–Head & Neck Surgery,

University of Pittsburgh Medical Center, 203 Lothrop St, Suite 500,

Pittsburgh, PA 15213, USA.

Email:

huyettpa@upmc.edu

Reprinted by permission of Otolaryngol Head Neck Surg. 2016; 154(5):928-935.

190