Results of the FNAC procedure

The fine-needle aspiration (FNA) cytology procedure has become a well-liked modality in the diagnosis, staging and follow-up of head and neck masses. Although the golden standard for many tumors in this region is acquiring histopathology, performing a biopsy is more invasive and not cost-effective for most of the head and neck nodules.

The FNA cytology is less invasive and usually gives enough information necessary to differentiate between benign and malignant disease. When assessing the cytology, this gives us three scenarios:

1. Benign results;
2. Undetermined, with atypical cells. They don’t look malignant, but also do not look benign either.
3. Malignant cells

A benign result

In the case of our patient, the cytology shows benign results. A benign result is excellent news for the patient. We know for sure that the nodule is not malignant and prevents the patient from undergoing a biopsy, a more invasive procedure. The treatment of the nodule is usually a reassurance. However, if the nodule gives mechanical complaints, such as difficulty with swallowing or dyspnea that affects the quality of life of the patient, surgical removal of the benign tumor is possible.

An undetermined result

An undetermined result consists of cases that cannot be definitively diagnosed as benign, suspicious for / consistent with neoplasm, suspicious for malignancy or malignant. The recommended management for nodules with undetermined result is to repeat the FNA at an appropriate interval, usually between 6 and 12 months. In case of repeated undetermined result, a doctor can consider to perform a biopsy to rule out malignancy.

A malignant result

A malignant result gives a 80-99% positive predictive value that the result is actually malignant. Usually, no biopsy is needed to determine the actual diagnosis. The next step after this result is to determine the primary tumor of this disease if the FNA was performed on a lymph node. If the FNA was performed on an organ, or known mass from other tissue no further diagnostics should be performed. The treatment of most of these tumors consists of surgery.