217 / 232
In addition to being highly accurate, FNAB offers the
potential for a more rapid diagnosis when the cytopathologist
can make an on-site judgment. Our study found that in the 106
instances when an initial diagnosis was offered, it correlated
with final cytopathology 99.1% of the time—an improve-
ment from 92% in the predecessor study from our institu-
tion.
14
Rapid on-site diagnosis correlated with 93.3% of
histopathologic results. The ability to offer an accurate
on-site diagnosis is not only helpful in treatment planning
but also in alleviating patient and family anxiety.
The rate of nondiagnostic FNAB results is seemingly
high (n = 30, 8.9%) but was found to be lower than in a
large meta-analysis of adult HNM.
3
Current management of
such a result consists of clinical follow-up with possible
repeat FNAB or surgical excision. With these and all other
results, it is critical to remember that neither the sensitivity
nor the specificity of FNAB is 100%, and FNAB results
must be taken in the context of clinical factors.
General Anesthesia
General anesthesia or sedation was used in a significant por-
tion of the children in this study, thus nullifying one of
main benefits of FNAB. Most of these cases were thyroid
evaluations, where GA is employed routinely by policy at
our institution. While a younger average age was seen in
the nonthyroid patients undergoing FNAB with sedation or
Table 4.
Partial List of Patient Final Diagnoses.
Nonthyroid (169 Patients, 210 FNABs)
Thyroid (88 Patients, 128 FNABs)
Malignant Neoplasms
T-cell lymphoblastic lymphoma
Papillary thyroid carcinoma (13)
Diffuse large B-cell lymphoma
Medullary thyroid carcinoma
Ganglioneuroblastoma
Follicular thyroid carcinoma
Ewing’s sarcoma
Burkitt’s lymphoma
Low-grade mucoepidermoid carcinoma (parotid)
Benign Neoplasms
Pleomorphic adenoma (3)
Oncocytic adenoma (1)
Lipoma (2)
Follicular adenoma (4)
Lymphatic malformations (6)
Myofibroma
Pilomatrixoma
Desmoplastic fibroma
Benign Lesions
Benign reactive lymphadenopathy (99)
Benign colloid nodule (31)
Atypical tuberculosis (15)
Chronic lymphocytic thyroiditis (11)
Branchial cleft cyst
Hyperplastic nodule (8)
Cat scratch disease
Thyroid cyst (9)
Castleman’s disease
Multinodular goiter (2)
Cervicofacial actinomyces
Kuttner tumor
Langerhans histiocytosis
Thymic cyst (2)
Abbreviation: FNAB, fine-needle aspiration biopsy.
Table 5.
Risk of Thyroid Malignancy as cited by TBSRTC,
4
Lale et al,
19
and This Study.
a
This Study
Lale et al.
19
TBSRTC Category
TBSRTC Risk of Malignancy, % Rate of Malignancy, % FNAB, No.
Rate of Malignancy, % FNAB, No.
Nondiagnostic
1-4
0.0
9
0-25
59
Benign
0-3
2.6
77
0
136
FLUS
5-15
15.8
19
50
6
Follicular neoplasm
15-30
41.7
12
47.36
40
Suspicious for malignancy
60-75
80.0
5
100
6
Malignant
97-99
100.0
6
100
35
Abbreviations: FLUS, follicular lesion of undetermined significance; FNAB, fine-needle aspiration; TBSRTC, The Bethesda System for Reporting Thyroid
Cytopathology.
a
Rate of thyroid malignancy and number of FNABs are presented for each Bethesda System category. Rates according to TBSRTC and Lale et al
19
are pre-
sented for reference.
Huyett et al
195