Head and neck FNB target organ errors. Did I Miss the Target or was it a physician mislabeling

Background:The diagnostic accuracy of fine needle aspiration cytology (FNAC) of head and neck lesionsis relatively high, but cytologic interpretation might be confusing if the sample is lackingtypical cytologic features according to labeled site by physicianMaterials and Methods:The cytology archive database of a referral center as well as archival files of one of theauthors (YD) covering the period 2001 to 2011) was searched using keywords: salivarygland, head, neck, FNA, and cytology. All the extracted reports were reviewed. The reportswhich showed discordance between the clinicians impression of the organ involved andsubsequent FNB request, and the eventual cytological diagnosis were selected. Thecytological diagnosis was confirmed by surgical biopsy and histology, or cell block, withassistance from imaging, clinical outcome, physical examination, molecular studies, ormicrobiological culture,.Result:The total number of 10200 head and neck superficial FNA were included in the study, , 70cotraversial cases was found, and 48 cases showed discordance between the cliniciansrequest and the actual site of pathology. The commonest discrepancies were for FNA ofsalivary gland total: 20 with actual final pathology in: bone (7), soft tissue (5), lymph node(3)odontogenic (3) and skin (2) ymph node total: 12 with final pathology in: soft tissue (3),skin (3), bone (1) and brain (1) soft tissuetotal: 11 with final pathology in: bone (5), skin (2),salivary gland (1) and ocular (1)] and skin [total: 5 with final pathology in: lymph node (2),bone (1), soft tissue (1) and salivary gland (1)]. Besides histopathology, imaging, clinicalhistory, physical examination, immunohistochemical study, culture and molecular studyhelped to finalize the target organ of pathology in 23, 6, 7, 8, 2 and 1 cases respectively.Conclusion:The primary physician requesting FNB of a head and neck lesion is incorrect in their clinicalimpression of the actual site in a significant percentage of cases, due to the overlappingclinical and imaging findings or possibly due to inadequate history taking or physicalexamination.

Keywords:

Head and Neck , Cytology , FNA , Discrepancy , target organ , label error