Role of FNA in the initial management of a wide range of pathological conditions: 3-years experience in a teaching hospital

Abstract

OBJECTIVE: The aim of this study is to determine the utility  and accuracy  of fine needle aspiration (FNA) cytology in the diagnosis of a wide range of pathological conditions, to increase  the awareness about this test to those who are unfamiliar with it and to compare  the results with that of others.

METHODS: All patients  with palpable lesions  and azospermia attending  to the hospital during the period 2009 through to 2011 were included  in this study. The patients were interrogated   and a complete  history  and physical  examination   was conducted.  The procedure is performed in an outpatient setting  without any image guidance.  The aspirated smears  were stained  and examined  and the specimens  were assigned  to one of four  different  diagnoses: unsatisfactory/inadequate, negative  for malignancy, atypical/suspicious, and positive  for malignancy.

The cases were followed up and if surgical excision done, the results were compared to that of FNA and the reliability and accuracy of FNA were evaluated for all cases.

RESULTS: A total of 566 FNAs were performed 162 male and 404 female were 11 inadequate smears  ( 1.94%) with an overall  adequacy  rate of 98.06%.  Most of the insufficiency   was seen-in-thyroid  cases. Two hundred seventy  three (273)  FNAs were thyroid aspirate, 127 breast, 98 lymph node,  and 24 had salivary  gland enlargement.  In addition  there were  five (5) patients  had soft tissue  lesions.  Thirty  nine (39) patients  underwent  testicular FNA for assessment of infertility.  Only 273 (51.8%)  had subsequent   surgical  biopsy. Comparison of FNA with subsequent  biopsy  results showed  an accuracy  rate of 95.23%. Overall false positive results were seen in only5  cases (1.8%)  most of which are thyroid cases, while false negative results  were reported in only 8 cases (2.93%)  and breast cases were the most common.  The total sensitivity of FNA procedure  was 89.47%% and specificity 97.46%,  with the predictive  value for positive diagnosis 93.15 % and for negative diagnosis 96%.

CONCLUSION: FNA is a reliable safe and efficient  tool that can yields a definitive  diagnosis in a wide range of inflammatory, benign and malignant lesions.  The results of this study are similar to those found in previous regional and international studies. Its use for routine diagnosis must be encouraged particularly in underdeveloped countries.