Fine Needle Aspiration Biopsy

Three alternatives are present when considering FNAB. First, the choice not to use FNAB as a diagnostic technique rests with the premise that it will not alter management. Second, proponents of routine use want to have as much information as possible available preoperatively for counseling patients, often with reference to facial nerve management. Third, selective use of FNAB depending on the situation, which would appear to have the most merit. Any advantage conferred by having FNAB data depends entirely upon the accuracy of the information obtained. The latter unquestionably is experience driven, both in performing the procedure itself and in the interpretation thereof. It is acknowledged that FNAB is better at identifying and classifying benign lesions. Today, in 93% of cases, it is possible to differentiate benign from malignant. However, it is clearly more difficult to classify the malignant group with this technique.3 The difficult question as to the value of FNAB is whether it alters decision making. Further, with a small but acknowledged false-positive rate, should a more aggressive surgical procedure be performed based primarily on FNAB data? The answer is, selectively, yes. For example, squamous cell carcinoma should be readily identifiable on FNAB. Mucoepidermoid tumors can often be identified as well. Appropriate preoperative counseling could then be given, with intraoperative frozen-section confirmation leading to an appropriate surgical procedure. It is interesting, however, that a recent survey of 34 head and neck surgeons found that FNAB data did not alter decision making for a discrete parotid mass.3 In such a setting, patient and physician comfort with the clinical preoperative information gleaned from the history and physical examination will be the final arbiter as to the value of FNA for the isolated parotid mass.

I find FNAB efficacious when lymphadenopathy is suspected, (e.g., inflammation, benign lymphoepithelial disease, sarcoid, or lupus erythematosus). It has merit if lymphoma is a consideration and also for the elderly in whom confirmation of a benign neoplasm might affect surgical decision making. FNAB is beneficial in identifying recurrent neoplasia, benign or malignant.

In summary, as a technique, FNAB has stood the test of time, spanning several decades. It has some value in tumor identification without evidence of tumor seeding and has very limited morbidity. It is better in separating benign from malignant pathology than determining specific malignant histologic characteristics.

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